Non Technical Summary
Our proposed project will serve as a proof of concept that Medicaid reimbursement funds can be spent locally to ensure that as nutrition supports become available in Illinois, local food businesses are positioned to provide these services.While working with our food partners to design this project, we identified several critical needs within the local food economy:Medicaid Reimbursement Infrastructure: Local food producers and distributors often lack the infrastructure needed for Medicaid reimbursement for nutrition support services.Revenue Stability: Local food organizations consistently express the need for multiple payment and funding streams.Through this project, Ann & Robert H. Lurie Children's Hospital (Lurie Children's) will formalize community leadership and capacity building in our existing West Side Food Collaborative (the Collaborative) to support the Collaborative's goal of securing insurance reimbursement for nutrition supports. We will achieve this by providing technical assistance in the following areas:Training and Capacity BuildingProgram Pilot, Development and EvaluationData Collection and AnalysisTechnical Support for Referral SystemsHealth CommunicationResearch and Best Practices DisseminationThe project will build infrastructure for the local food economy to partner directly with the healthcare sector to receive Medicaid reimbursement for locally produced foods. By demonstrating these partnerships, this project increases the capacity for growing the partnerships as the Medicaid waiver continues to gain traction.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
704	6299	3030	100%

Knowledge Area
704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6299 - Marketing, general/other;

Field Of Science
3030 - Information and communication;

Goals / Objectives
In the short-term, Ann & Robert H. Lurie Children's (Lurie Children's) project aims to meet the food needs children and families through local food box distribution and develop a referral and assistance process to encourage families' participation in Federal nutrition assistance programs. To achieve this goal, our objectives are to:Directly invest $194,000 of our matching funds in local food providers to pilot nutrition support projects over a two-year period to provide:40 patients awaiting a kidney transplant with bi-weekly local food boxes for up to 12 months110 post kidney-transplant patients with bi-weekly local food boxes for 6 months400 patients from our Advanced General Pediatric and Specialty Care populations with weekly food boxes for 1 monthTrain 800 healthcare providers on a referral process to WIC, SNAP, and Link-Up ILOur long-term goals include formalizing community leadership in our existing West Side Food Collaborative (the Collaborative), which brings together residents, local food growers, producers, distributors, retailers, and healthcare providers, and establishing Medicaid reimbursement pathways for Collaborative members to capitalize on once the waiver is implemented by the end of the grant period. By the end of this grant, both these goals will be sustained through Medicaid reimbursement which increases the self-reliance of communities in providing for the food needs of the community and promotes comprehensive responses to local food, food access, and nutrition issues through new funding streams. To achieve these goals, our objectives are to:Provide technical assistance to at least 12 local purveyors to become Medicaid compliantEstablish agreements with up to 3 local food purveyors to fulfill nutrition supports for Lurie Children's patients as outlined in the IL 1115 Medicaid WaiverAssist at least 5 local food purveyors in securing Medicaid reimbursement

Project Methods
Efforts:During routine appointments, patients are screened by their healthcare provider, and those identified as food insecure are referred to a social worker. The social worker then refers the patient to our food delivery program, which is fulfilled by local food vendors. Families provide consent to share their contact information with the food vendor, who coordinates delivery logistics.The boxes include~ $50 of produce and clean protein (e.g. low in contaminants, synthetic ingredients, pesticides, growth hormones). We will use our matching funds to purchase these boxes which include locally grown items supplemented with pantry and preserved items to accommodate seasonality. The contents of the boxes will vary with each delivery depending on seasonality and market pricing. Two units will refer patients: Advanced General Pediatrics (AGP), which handles many patients with multiple chronic conditions, and Nephrology, which focuses on patients aged 2-21 with kidney disease. 400 AGP patients will receive one month of weekly food deliveries, while nephrology patients receive low potassium/sodium/phosphorus boxes every other week for up to a year while awaiting transplant (40 patients), or six months post-transplant, as diet restrictions ease (110 patients). Nephrology dietitians will pre-approve the contents of these boxes. Additionally, the program will include a two-way educational text campaign, virtual cooking demos, and printed educational materials helping to ease the burden of feeding children with chronic healthcare conditions.While the food boxes provide essential temporary relief, families need longer-term solutions to achieve food self-reliance. To address this, we will implement a referral and enrollment support process for federal nutrition assistance programs such as WIC, SNAP, and Link-Up. This referral program will be supported by provider training for ~800 health providers who in turn reach over 20,000 patients in the target population. This training will be jointly offered across Lurie Children's, ACCESS Community Health, and Rush University System for Health. For families already enrolled but still facing food shortages, social workers will refer them to Lurie Children's existing partner network of food pantries, which are trained to handle hospital referrals.To support Collaborative members in obtaining Medicaid reimbursement, Lurie Children's will provide technical assistance in the following areas:Training and Capacity Building: We will offer workshops designed to enhance the health literacy skills of all 40+ Collaborative members, enabling them to better engage with healthcare partners. These sessions will include training on addressing specific diagnoses common in medically complex patients and understanding common processes and requirements when working with healthcare systems. Additionally, we will provide guidance on budget management, identifying funding opportunities, and optimizing resource allocation to ensure programs have the resources needed for success.Program Development and Evaluation: We will assist at least 12 Collaborative members in the design, implementation, and evaluation of nutrition support programs to ensure they are effective. Our focus will be on practical approaches to program development, including setting measurable goals, tracking performance, and fostering continuous improvement.Data Collection and Analysis: We will advise at least 12 Collaborative members in establishing data sharing agreements, collecting and analyzing data related to health outcomes, patient demographics, and program performance. This will include conducting surveys and gathering statistics, particularly for those serving Lurie Children's patients, to guide informed decision-making and enhance service delivery.Technical Support for Referral Systems: We will provide access to and train at least 12 Collaborative members on using Unite Us, Lurie Children's referral platform, to improve integration between community organizations and healthcare providers.Health Communication: We will develop communication strategies and materials to help all Collaborative members promote nutrition supports effectively with audiences, ensuring messages are clear.Research and Best Practices Dissemination: We will conduct and share research on nutrition supports, along with evidence-based best practices, to inform future program design and implementation across the Collaborative.Evaluation:The evaluation will be led by the Lurie Children's Magoon Institute team. The data will be collected and tracked by the Program Specialist on the Magoon Institute team. The process evaluation will:Assess patient satisfaction with the local food boxes and referral program, we expect this to be at least 90% satisfaction given our existing pilot of the programAssess attendance at the Collaborative meetings, we expect at least 40 members at each meeting given the current attendance rates100% of participating Collaborative members will report an increase in understanding of IL 1115 Medicaid Waiver requirementsIf lower than 90% satisfaction is detected, we will contact enrolled families directly through text, phone, and email to assess the challenges or frustrations that are happening with the program. This information will be used directly to address solutions through workflow improvements or discussions with the vendor. If attendance is lower than 40 individuals for two or more consecutive Collaborative meetings or less than 100% of Collaborative member report an increase in understanding at the 6 and 12-month marks, we will consult the co-chairs and steering committee members and reach out directly to members to gain insights into how we might adjust the logistics or content of the Collaborative to meet the needs of the members.Two main types of data will be collected: (1) firm-level data, to be collected quarterly from Collaborative members and Lurie Children's via a Project Activity Tracker maintained by the Program Specialist and monthly reports from providers directly supporting Lurie Children's patient programming; and (2) participant-level data (patients), to be collected annually via survey (paper and pencil, online, by phone, or mailed). All data will be de-identified and coded to ensure anonymity of firms and individuals. By collecting this data, the project will track improvements in both immediate food access and long-term improvement, providing evidence of success and helping to guide future replication efforts. The main variables and additional details for firm level and individual level are listed in the full Data Management Plan (DMP).Individual-level data, collected through Qualtrics and Electronic Health Record (EHR), will be exported to an Excel file and stored on the PD's and/or project manager's locked Lurie Children's computer and/or secure server. Excel is a community-recognized standard. A data dictionary will include information to allow understanding, validation, and analysis of data. Backups will be completed monthly. The PD's computer data is stored on an encrypted, secure server of Lurie Children's Hospital, through their data repository system. Data will be cleaned, coded, and corrected with a data dictionary on Excel before storage.