Qualifying Health Conditions in California

This page lists clinical conditions eligible for medically tailored nutrition services through Project FoodBox under California Medi-Cal. For questions, call our member service team at 949-673-0783, Mon-Fri 8A-8P or Sat-Sun 9A-5P.

Nutrition-sensitive conditions are chronic health conditions that respond positively to targeted dietary interventions and medically tailored nutrition support. These conditions have been identified through clinical research as benefiting from specific nutritional approaches that can improve health outcomes, reduce complications, and enhance quality of life.

Understanding which conditions qualify for coverage helps both patients and healthcare providers access appropriate nutrition-based treatments.

Food Is Medicine Venn

 

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Chronic Diseases

Qualifying conditions include diabetes (Type I, II, and gestational with Hgb A1c ≥ 7), cardiovascular disorders, hypertension, chronic kidney disease (Stage 3-4), COPD, and congestive heart failure. These conditions often respond well to medically tailored nutrition interventions.

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Mental and Behavioral Health Conditions

Coverage includes chronic or disabling mental health disorders that meet access criteria for Severe Mental Health Services (SMHS) or Drug Medi-Cal Organized Delivery System (DMC/DMC-ODS) with clinical documentation. Nutrition support can complement ongoing treatment plans.

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Contact Member Services

Have questions about qualifying conditions or clinical thresholds? Our member service team is here to help. Call us at 949-673-0783, Monday through Friday 8AM - 8PM, or Saturday and Sunday 9AM - 5PM for personalized assistance.

Qualifying Nutrition Sensitive Conditions

Project FoodBox provides medically tailored nutrition support for California Medi-Cal members with qualifying conditions. Review the conditions and clinical thresholds below to determine eligibility for our food-as-medicine program designed to improve health outcomes through targeted nutrition intervention.

Atherosclerosis (including Coronary artery disease, Peripheral artery disease, Carotid artery disease, Stroke or other cerebrovascular disease) - No specific threshold

Cardiovascular Disorders - No specific threshold

Congestive Heart Failure - No specific threshold

Diabetes: Type I, Type II, Gestational - Hgb A1c ≥ 7

Pre-Diabetes, Diabetes, Gestational Diabetes - No specific threshold

Dyslipidemia - No specific threshold

High Cholesterol - No specific threshold

Hyperlipidemia - Lipid panel with low-density lipoprotein (LDL) ≥ 190 mg/dL and/or Triglycerides (TG) ≥ 500 mg/dL

Hypertension - No specific threshold

Metabolic Syndrome - No specific threshold

Obesity - BMI >30.0 kg/m² AND two (2) qualifying comorbidities

Polycystic Ovary Syndrome (PCOS) - No specific threshold

Stroke - No specific threshold

Stroke resulting in problems swallowing - No specific threshold

Stroke with residual paralysis - No specific threshold

Have Questions About Your Eligibility or Coverage?

Our dedicated member services team is ready to help you understand qualifying conditions and enrollment.