The Impact of Medicaid on Summer Meals in Maryland

Medicaid is more than healthcare—it also helps facilitate access to nutritious meals at school, supporting growth and development for children in America.

In 2021, the United States Department of Agriculture launched the Direct Certification with Medicaid program, allowing states to use Medicaid participation to automatically qualify children for free school meals, also referred to as “direct certification.” Before this, only families enrolled in the Supplemental Nutrition Assistance Program were automatically eligible. This expansion helped more children receive free meals at school without requiring an application.

Professors Susan Gross, associate practice professor, and Erin Hager, associate professor, both in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, partnered with Maryland Hunger Solutions to assess the program’s impact on school meal participation in Maryland from 2022 to 2024.

Their findings revealed that total summer meal participation increased during this period. Free meal participation rose by 39% in Maryland community public schools and by 173% in non-community school summer meal sites. However, starting in 2022, the number of summer meal sites statewide declined due to policy changes requiring a return to in-person meal service after two years of flexibility during the COVID-19 pandemic.

The Direct Certification with Medicaid program also sought to increase access to other nutrition programs that rely on school meal data. These include the Summer Food Service Program, which provides free meals to children in low-income areas during the summer months, and the Community Eligibility Provision, which allows schools in high-poverty areas to offer free meals to all students without requiring individual applications.

Gross and Hager’s analysis found that school lunch participation increased in schools that had never previously participated in the Community Eligibility Provision. Additionally, the number of schools participating in this program doubled, covering nearly half of Maryland’s schools.

To explore the program’s impact further, Gross and Hager conducted a qualitative study with school officials across 12 Maryland counties. The interviews highlighted three key themes:

1. The role of county demographics in student enrollment.
2. The influence of federal and state policies on school meal funding and reimbursement.
3. Operational challenges affecting school meal administration and participation rates.

Gross concludes that “overall, these findings reinforce that the Direct Certification with Medicaid program is a powerful tool in addressing childhood hunger and ensuring students have access to nutritious meals both in and out of school.”