The Impact of Food Insecurity on Healthcare

Coding at the intersection of the social determinants of health (SDoH).

Today I will be providing some updates regarding z-codes, specifically Z59.4, Food insecurity, also defined as lack of adequate food. A January report from Health Affairs reviewed nationally representative data to look at the financial implications of food insecurity and the correlation with family healthcare expenditures. The results found that food-insecure families had 20-percent greater total healthcare costs than groups that were found to be food-secure. This was an annual difference of $2,456 in additional healthcare expenditures (Palakshappa, D. et al, 2023).  

Food insecurity is not an individual issue; if one member of a family unit is identified as food-insecure, it is likely that the entire household that is under the same risk. People who typically deal with food insecurity are at a significantly greater risk for chronic diseases such as diabetes and high blood pressure. In children, food insecurity has been linked to asthma, anemia, and behavioral issues such as anxiety and hyperactivity (

According to the new Centers for Medicare & Medicaid Services (CMS) guidelines to screen for social drivers of health, food insecurity is one of the required domains of information that should be collected for all adult inpatients in the hospital. A sample question that could be included upon admission or carried over from the outpatient primary care visits would be to ask, “how often in the past year have you run out or worried about running out of food before you had money to buy more?” A positive response may warrant a nutrition consult to assess for further risk factors, such as malnutrition.

Case management or social work may want to incorporate this response in their interventions to ensure that patients have access to food upon hospital discharge, either through community programs or programs for meal deliveries that may be available via the patient’s insurance plan.

The last thing a patient wants to do when discharging from the hospital is go to the grocery store, and if the hospital stay was of a significant length, most of their food may be spoiled when they return home.

Programming note:

Listen to Tiffany Ferguson report on the social determinants of health Tuesdays on Talk Ten Tuesdays at 10 Eastern.

References & Resources:


Feeding America (2023) retrieved from,aggression%20in%20school%2Dage%20children.

Heath, S. (January, 2023) Food insecurity, SDOH Costs, $2.5K in family healthcare expenditures. Patient Engagement HIT. Retrieved from Food Insecurity, SDOH Costs $2.5K in Family Healthcare Expenditures (

Palakshappa, D., Garg, A., Peltz, A., (January 2023). Food Insecurity was associated with greater family healthcare expenditures in the US, 2016-2017. Health Affairs, Vol. 42. No. 1 Retrieved from


Tiffany Ferguson, LMSW, CMAC, ACM

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the ACPA Observation Subcommittee. Tiffany is a contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group. Tiffany received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

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