Rockefeller Foundation analysis projects $12.3 million more a year for Hawaiʻi farmers
More than 100,000 Hawaiʻi residents who qualify for Medicaid may soon find their doctors prescribing fresh food as medicine — fresh fruit and vegetables, even ahi, beef, chicken and eggs. The federally funded initiative, called Food Is Medicine, is set to begin as soon as January as part of a special state Medicaid program aimed at chronic diet-related health issues in low-income communities.
Hawaiʻi joins at least a dozen states implementing the nutrition scheme, which is enabled by the Social Security Act’s 11-15 waiver program allowing experimental and innovative health programs under Medicaid. The program has been years in the making. It will roll out in three phases, starting in January with nutrition education programs and prescription food boxes for eligible patients.
The program targets a state where food insecurity and diet-related disease are widespread. One-third of Hawaiʻi households report insufficient access to adequate, nutritious, affordable food, according to Hawaiʻi Food Bank’s 2025 State of Food Security Report, and about half of Native Hawaiians and Pacific Islanders are food insecure, suffering the diet-related health ramifications. On Hawaiʻi island, 43% of residents report food insecurity. Nutrition’s role in health has gained greater attention worldwide as obesity and diet-related illness climb, after years in which conventional medicine gave it little weight, and advocates hope the program will help ensure lower-income communities have sufficient food, that the food is nutritious, and that patients are well-versed in healthy eating.
The initiative carries an economic dimension as well. State advocacy and health groups have tailored the program to promote local produce, which could inject millions of dollars into the economy and create almost 1,000 new jobs. A national Rockefeller Foundation analysis projects the program could unlock $12.3 million in additional annual revenue for Hawaiʻi farmers — the lion’s share benefiting small and mid-sized farms — and boost the state’s GDP by $125.5 million. Hawaiʻi has long held goals to build up its local food supply and reverse its shrinking farmer population, but few programs have meaningfully increased the islands’ food security as the islands continue to be hit by natural disasters.
Sourcing is a defining choice. Healthcare providers and advocates recommend that at least 15% of all produce and protein come from local sources — a nonbinding aspiration that sets Hawaiʻi apart from other states, said Jordan Smith of the Hawaiʻi Good Food Alliance, one of the program’s lead agencies, where Smith serves as Food Is Medicine program manager. That sourcing goal is still a work in progress. “It’s a lot of work to bring together a broken healthcare system and a broken food system, and asking them to work together,” Smith said. Sourcing food from the continent would be easier, but providers are resolved to stay as local as possible; otherwise the food is mostly “coming across the ocean on a boat, it’s not fresh, it’s not necessarily culturally relevant,” Smith said. “That’s why we’re exceptionally excited about the 11-15 waiver.”
“It’s really a no-brainer,” said Alicia Higa, chief health equity officer at Waiʻanae Coast Comprehensive Health Center. “If there’s an opportunity to give food as medicine to our people, we should absolutely be using that money to support the local farmers. We’ll have an increased food supply and we’ll be much better off… Not to mention it’s the pono thing to do.”
Big Island residents Moses and Suzette Paio illustrate the problem the program targets. The couple has struggled for years with health issues associated with diet and made little progress, and what they could afford to eat played a major role in what they ate. They live in Puna, a district classified as a food desert — a location with limited or no access to affordable, fresh, healthy and nutritious food. “It’s not that I don’t want to buy it,” Suzette Paio said, “it’s just that I can’t.”
Earlier this year, the couple took part in a pilot that rolled out under the Medicaid waiver: five months of weekly produce and protein boxes delivered by The Food Basket, Hawaiʻi island’s food bank, filled with locally caught and harvested proteins, greens and fruits. Suzette Paio’s average blood sugar has halved — a level she had struggled to control for more than a decade — and Moses Paio lost more than 70 pounds. “They’re my candy,” Suzette Paio said of local bananas and papayas, which have replaced the cheaper sugary treats she used to enjoy. The couple has also started gardening, preserving food and getting more active, taking lessons from other education programs.
“We just thank God for the opportunity that we had,” Suzette Paio said, “because you know our health issues have been going on for a while.” Advocates are encouraged by the data they have collected during pilot studies that have run for at least the past year, though much more research remains. The University of Hawaiʻi is conducting a five-year study on the program’s influence on hypertension at various healthcare centers in the islands. Monica Esquivel, the UH assistant professor of nutrition leading the study, said much more data will come as the program develops, but its premise reflects a growing recognition of diet’s influence on health.
In West Oʻahu, itself considered a food desert, nutritionally focused healthcare programs have been operating since 2017, separate from the Medicaid initiative. The positive results kept them going, said Higa, who is also ʻElepaio Social Service’s CEO. “We built it because we didn’t have it,” she said. “I think that’s traditionally what Waiʻanae does because we’re so far from everything.” During the Covid-19 pandemic, Waiʻanae Comprehensive Health Center tracked almost 500 Medicaid patients over 18 months as they received a $60 monthly produce prescription, Higa said. Her team tracked how much of the money was used, how recipients’ health changed and how much it cost insurance — resulting in about $118 in healthcare savings per patient per month, she said. With the Med-QUEST program now behind the initiative, Higa said, it has far greater security.
Advocates believe the produce prescription will function like Hawaiʻi’s Da Bux program, which doubles the spending power of Supplemental Nutrition Assistance Program beneficiaries — formerly known as food stamps — when purchasing locally produced food. Da Bux recorded almost 250,000 transactions last year, accounting for more than $5.5 million in local produce — a result advocates describe as a triple win for the economy, the hungry and local farmers.
Farmers are already seeing demand. Waiʻanae Farmers Market vendors on Oʻahu have scaled up production in response to food-based health programs run by Waiʻanae Comprehensive, and egg producers on the Big Island have scaled up to meet demand as well, said Kristen Frost Albrecht, The Food Basket’s CEO. Micah Richards of local meat provider Mauka Meats said his business and the ranchers he works with have benefited immensely, and he believes the program holds great promise for the entire agriculture sector. Hurdles remain, though, including helping farmers and ranchers obtain food safety certifications so they can take part. The greatest payoff, Richards said, has been “having auntie come up to you at the market, tell you they feel better, they’re making progress with their doctor, but all they feel they changed was going to the farmers market and having access to the funds for local meat and produce.”
The program is being coordinated by Med-QUEST, part of the state Department of Human Services, and the Hawaiʻi Good Food Alliance. The official rollout in January will start with prescriptions and nutrition education but will rely mostly on organizations’ ability to deliver the service to eligible residents. The full rollout will depend on individual health centers and food distributors, Med-QUEST Administrator Meredith Nichols said in an email, adding that the state is providing grants to help increase organizations’ capacity to deliver the programs statewide. A second phase will help eligible Medicaid users stock their pantries and acquire cooking supplies, and will phase in medically tailored meals — which, on a national level, could help reduce the need for 2.6 million hospitalizations annually, a net cost savings of $23.7 billion, according to Tufts University.
Advocates anticipate the program will be popular among the approximately 121,000 residents who could be eligible. Prescriptions will give recipients $50 a week to buy fresh protein and produce on Oʻahu; residents of the other islands will receive $55 weekly. The food could come as boxes, like the Paios receive, or as vouchers to spend at farmers markets, as Waiʻanae Coast Comprehensive Health Center’s patients do.
On the Big Island, Moses Paio has been recommending the program openly to friends, family and members of his church, saying that losing the weight and being able to stay active have changed his life. “My yard pushes me. I see the grass growing,” he said. “There are times out there, I’m cutting grass, and I’m just crying. You know, I’m just thanking God that I can even just stand there.”