Produce prescription benefits redemption and activity in an observational study of 2,680 Massachusetts Medicaid members.

Abstract

Background: Food is Medicine interventions are increasingly employed to address food and nutrition insecurity and diet sensitive conditions, and advance health equity. Produce prescription (PRx) programs hold particular promise, providing funds to purchase fruits and vegetables as part of a treatment plan. Despite early evidence, key knowledge gaps remain regarding redemption and activity rates, identified as critical but understudied factors with research, clinical, and policy implications.

Objective: This prospective observational study investigates benefits utilization in a population of 2,680 Massachusetts Medicaid members enrolled in the Fresh Connect PRx intervention between July 2020 - December 2022.

Design: We examined trends overall, by duration of participation, alongside program changes, and by individual-level characteristics, providing a more complete picture of key correlates to benefits utilization.

Results: Participants enrolling during program periods with access to larger number of stores had up to 14.5% absolute higher redemption rates (95% CI 10.4, 18.7) and, separately, five-fold greater likelihood of shopping each month (OR 5.0, 95% CI 3.7, 6.7) than those enrolled with fewest locations. Within individuals in the program 24 months, participation increased with time, with active shoppers rising from 65% in month 1 to 75% in month 12 to 85% in month 24; and redemption rising from 31% to 68% to 88% over the same period. Redemption was also higher for females compared to males (5.9% higher, 95% CI 3.0, 8.7), Asian compared to White participants (18.3% higher, 95% CI 10.6, 26.1) and for participants reporting Spanish as their preferred language compared to English (13.9% higher, 95% CI 10.9, 16.9).

Conclusions: Activity and redemption can each be high in PRx, and may be positively associated with more shopping locations, longer participation and program implementation experience, and specific participant demographic factors. These findings inform interpretation of prior and design of future research on PRx, health outcomes, and health care utilization.