State Medicaid Coverage for Nutrition Therapy Varies Widely

November 6, 2025

Washington, D.C. and Chicago – A new study shows that Medicaid coverage and reimbursement policies for medical nutrition therapy (MNT) varies widely within and across states. The project, led by researchers at The George Washington University and the Academy of Nutrition and Dietetics, concludes that access to this important health care service remains a concern for both consumers and providers.

"Medical nutrition therapy provided by a registered dietitian nutritionist is a proven, cost-effective solution to the prevention and management of chronic conditions, including heart disease, diabetes and obesity," said registered dietitian nutritionist Deanne Brandstetter, the Academy's 2025-2026 President. "Ensuring Americans have access to MNT, no matter which state they live in, is imperative to addressing rising health care costs and helping people live healthier lives."

"Our research reveals a striking patchwork of Medicaid policies for medical nutrition therapy across the United States," said Anne Markus, professor and chair of the Department of Health Policy and Management at the George Washington University Milken Institute School of Public Health. "While some states have made meaningful progress, too many still leave patients and providers navigating unclear or insufficient coverage. This inconsistency not only creates barriers to care, but also undermines the potential for nutrition therapy to prevent or manage costly chronic conditions."

The goal of the study was to establish a baseline of state Medicaid coverage and reimbursement policies for MNT, a personalized nutrition-based treatment plan that is provided by a registered dietitian nutritionist (RDN) to manage health conditions and enhance overall well-being through nutrition.

The researchers conducted a systematic mapping study in all 50 states and Washington, D.C. to assess the status of Medicaid coverage and reimbursement for MNT provided by RDNs.

Key Findings

• About half the states explicitly permit RDNs to enroll in Medicaid fee for service and a fifth in Medicaid managed care plans.
• Most states recognized the billing code for MNT however few chronic conditions were covered.
• Fewer than half of the states explicitly allowed RDNs to directly submit claims as an independent provider.
• The majority of states with Medicaid managed care contracts did not list MNT as a benefit.

Why It Matters

Insurance, including Medicaid, often does not cover or spell out the benefits for medical nutrition therapy. This analysis focuses on Medicaid coverage and finds that coverage and reimbursement policy varies from state to state. It also found variation within states between the state's Medicaid managed care program, where most children and adults are enrolled to get their care, and the rest of the program, which states typically manage directly. The end result is that people at risk for a chronic disease such as diabetes may have trouble accessing this preventive therapy, while people with a pre-existing health condition, such as heart disease, may also have trouble accessing MNT. Such patients need MNT to manage their condition and prevent it from getting worse.

The study, Integrating Registered Dietitian Nutritionists' Medical Nutrition Therapy Benefit into Existing State Medicaid Coverage and Reimbursement Policy: Results From a Nationwide Medicaid Medical Nutrition Therapy Mapping Project, was published in the Journal of the Academy of Nutrition and Dietetics.

Detailed state profiles for all 50 states and the District of Columbia are available.

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About the Academy of Nutrition and Dietetics

Representing more than 112,000 credentialed nutrition and dietetics practitioners, the Academy of Nutrition and Dietetics is the world's largest organization of food and nutrition professionals. The Academy is committed to improving the nation's health and advancing the profession of dietetics through research, education and advocacy. Visit the Academy at www.eatright.org.