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Month: January 2025

NYHealth Testimony on Universal School Meals

Posted on by teamnyshealth

NYHealth President and CEO David Sandman testified at the New York State Joint Legislative Public Hearing 2025 Executive Budget Proposal: Elementary & Secondary Education on January 29, 2025. In his testimony, he addressed the opportunity for New York to provide universally free meals for all students in New York State in schools that participate in the National School Lunch and School Breakfast Programs.

(The recording of Dr. Sandman’s oral testimony at the hearing is available here.)

Thank you to Chair Kreuger, Chair Pretlow, and members of the Senate Finance and Assembly Ways and Means Committees for the opportunity to testify today. I am pleased to provide testimony on behalf of the New York Health Foundation (NYHealth). NYHealth is a private foundation that works to improve the health of all New Yorkers, especially people of color and others who have been historically marginalized. Our Healthy Food, Healthy Lives program works to advance policies and programs that link New Yorkers with the food they need to thrive. Supporting nutritious, culturally responsive food in New York’s public institutions, including schools, is a core approach of our program. NYHealth has also supported initiatives to increase State funding for farm-to-school programs that expand local products in school cafeterias.

We enthusiastically support universally free meals for all students in New York State in schools that participate in the National School Lunch and School Breakfast Programs.

For nearly a decade, NYHealth and our partners have worked to make this vision a reality. In 2017, NYHealth grantee Community Food Advocates (CFA) helped secure free school meals for New York City’s 1.1 million public school children. That move was a game changer for the largest public school system in the nation. Subsequently, CFA and grantee Hunger Solutions New York led a coalition to extend that policy statewide. In 2023, both houses of the legislature supported full funding for universal free school meals. Following negotiations, the final enacted budget vastly expanded the free school meals program. Last year’s expansion of the Community Eligibility Provision (CEP)—a federal option that allows high-poverty schools to offer free breakfast and lunch to all students—led to 90% of all students receiving free school meals.

The proposed investment contained in the Executive Budget is the final step to making healthy school meals truly universal. It will provide free school meals for an additional 280,000 students (approximately 10% of New York students) across the 600 school districts that do not participate in CEP. Closing the gap for these students will help save their families up to $165 per child per month.[1] It will make New York more affordable. It will also reduce the administrative burden on schools, so they can focus on educating children and improving meal quality instead of harassing families for money they may not have.

Extensive evidence proves the roles that food and nutrition play in enhancing children’s health and wellbeing. School meals are often the healthiest parts of students’ diets, regardless of income level. When students eat school meals, they consume more fruits and vegetables and have higher quality diets than students who don’t eat school meals.[2],,[3], Nutritious school meals support students’ academic performance.[4] School meals also reduce food insecurity among children in families with low income. Food-insecure students struggle to focus, have lower school attendance, and face greater risks of mental health issues compared to peers. Because it affects children’s ability to develop, socialize, and learn, food insecurity can lead to poor health and economic disadvantages later. Food insecurity disproportionately affects Black and Latino children, so healthy school meals for all is also a win for equity.[5]

Universal means everyone, and too many children are left behind by the current policy, including:

  • Children whose families struggle to afford basic needs but do not qualify for free school meals. Currently, if a family of four earns more than $58,000 a year, the children are not eligible for free meals unless they are already in a school that participates in[6]
  • Children in small rural or suburban schools that cannot provide free meals for all students through existing federal options. The State’s CEP subsidy has led to 90% of New York students receiving free school meals. Smaller rural and suburban schools, specifically in the regions of the Hudson Valley, Long Island, and Western New York—which may have lower, but still notable, rates of poverty—are often ineligible for CEP.[7]
  • Children who qualify for free school meals but fall through the cracks because of stigma or administrative barriers. Students, especially older students, may choose not to participate in school meals despite their hunger, because they perceive school meals as only for low-income students. Stigma may also discourage eligible families from submitting applications for free school meals, as can administrative burdens and literacy or language barriers.

Voters overwhelmingly want universal free school meals. An NYHealth survey found that almost 90% of New Yorkers support healthy school meals for all.[8] Since the onset of the COVID-19 pandemic, eight states have enacted permanent policies supporting healthy school meals for all students. While most states saw decreases in school lunch participation in the 2022–2023 school year, participation in school lunch programs increased in states that enacted healthy school meals for all.[9] When school meals are universal, the stigma decreases, and participation increases.

Until now, food has been the one part of public education that discriminates by income. This change will make meals an intrinsic part of New York students’ education, just like textbooks and transportation. Let’s close the gap for school meals and make school meals truly universal.

NYHealth appreciates the State’s recognition of school meals’ role in fighting hunger, improving health, and helping children thrive. We look forward to working with you in partnership to support New York students and families.

 

[1] Healthy School Meals for All. 2025. “Healthy School Meals for All.” https://schoolmealsforallny.org/wp-content/uploads/2023/01/HSMFA-policy-proposal-1_14_25.pdf, accessed January 2025.

[2] Fox, M.K.; Gearan, E.; Cabili. C.; et al. 2019. “School Nutrition and Meal Cost Study, Final Report Volume 4: Student Participation, Satisfaction, Plate Waste, and Dietary Intakes.” U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support. https://fns-prod.azureedge.us/sites/default/files/resource-files/SNMCS-Volume4.pdf, accessed January 2025.

[3] Kinderknecht, K.; Harris, C.; Jones-Smith, J. 2020. Association of the Healthy, Hunger-Free Kids Act with Dietary Quality Among Children in the US National School Lunch Program. Journal of the American Medical Association. 324(4), 359-368.

[4] Pucher, K.K.; Boot, N.M.W.M.; De Vries, N.K. 2013. School health promotion interventions targeting physical activity and nutrition can improve academic performance in primary- and middle school children. Health Education. 55(5), 372-391.

[5] The Education Trust. 2021. School meals are a key party of educational equity. https://edtrust.org/the-equity-line/school-meals-are-a-key-part-of-educational-equity/, accessed January 2025.

[6] Healthy School Meals for All. 2025. “Healthy School Meals for All.” https://schoolmealsforallny.org/wp-content/uploads/2023/01/HSMFA-policy-proposal-1_14_25.pdf, accessed January 2025.

[7] Healthy School Meals for All. 2025. “Healthy School Meals for All.” https://schoolmealsforallny.org/wp-content/uploads/2023/01/HSMFA-policy-proposal-1_14_25.pdf, accessed January 2025.

[8] New York Health Foundation. 2022. “NYHealth Survey of Food and Health.” https://nyhealthfoundation.org/wp-content/uploads/2022/11/NYHealth-survey-of-food-and-health.pdf.pdf, accessed January 2025.

[9] Food Research & Action Center. 2024. “The Reach of School Breakfast and Lunch During the 2022–2023 School Year.” https://frac.org/wp-content/uploads/Reach-Report-2024.pdf, accessed January 2025.

Healthy and Free School Meals for All

Posted on by teamnyshealth

In her recent State of the State address, Governor Kathy Hochul outlined several proposals that would make New York a healthier place, including ones to shore up services for new parents and babies, prevent veteran suicide, and improve youth mental health.

The policy I’m most excited about will make healthy school meals available to every public school student in New York State. That means 2.7 million kids will have the food they need to learn well and be healthy, regardless of their family’s income and without shame and stigma. It’s a cliché to call it a game-changer, but it really is.

One of my proudest professional moments was when New York City made school lunches free for all of its 1.1 million school children. Since then, we’ve seen steady progress to expand free school meals statewide. Last year’s State budget included $145 million for free school meals, reaching more than 80% of students statewide. But as I wrote just last month, close is not complete. Governor Hochul’s proposal would, for the first time, make free school meals truly universal — and universal means everyone.

Why does it matter? Free school meals improve physical health, mental wellbeing, and academic performance. Yet food has been the one arena in public schools that segregates children by family income. When kids need textbooks, they aren’t asked to stand in a poor line. When meals are free to all, the stigma and shame associated with school lunch decreases and participation increases.

Free meals also reduce administrative burdens on schools and their staff. I remember the testimony of a school lunch director from central New York at a State budget hearing. She said, “I spent 8 hours yesterday chasing money, instead of spending the day sourcing local foods, working side by side with my staff, and collaborating with other directors and business owners to bring new and exciting menu items to our program.” Schools should focus on educating, not acting like bill collectors.

School meals that are truly universal will be a win for students’ health, a win for affordability, a win for equity, and a win for learning. The public supports it; a New York Health Foundation survey found that nearly 90% of New Yorkers support free school meals. Let’s make it happen.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on December 21, 2024

NYHealth Comments on Telehealth Program for Veterans

Posted on by teamnyshealth

NYHealth submitted the following comments in support of a proposed U.S. Department of Veterans Affairs rule to establish a telehealth grant program and exempt all telehealth services from copayment requirements:

January 10, 2025

The Honorable Denis R. McDonough
Secretary
U.S. Department of Veterans Affairs
810 Vermont Ave., NW
Washington, DC 20420

RE: File Code VA-2024-VHA-0027-0001; 8 CFR Parts 17 and 84; Telehealth Grant Program

Dear Secretary McDonough:

We appreciate the opportunity to provide comments on the U.S. Department of Veterans Affairs (VA) proposed rule to establish a telehealth grant program and exempt all telehealth services from copayment requirements. This proposed rule represents a significant step toward ensuring equitable access to vital telehealth services for veterans, particularly those in rural or medically underserved areas.

The New York Health Foundation (NYHealth) is a private, independent, statewide foundation committed to improving the health of all New Yorkers, especially people of color and others who have been historically marginalized. Through our Primary Care program, we advance policies and programs that expand and enhance primary care services and promote health equity across New York State. Our Veterans’ Health program advocates for policies and initiatives that improve the health of veterans and their families. Across programs, we have supported partners in expanding equitable access to telehealth through policy analysis, pilots of virtual access stations, and patient navigation programs. With our extensive knowledge of telehealth’s potential to enhance access to care, address mental health needs, and support underserved communities, we are well-positioned to offer insights and recommendations on this critical proposal.

Support for Eliminating Telehealth Copays
The VA’s decision to waive copays for telehealth services is commendable. Cost has long been a barrier to care, particularly for veterans in low-income and rural communities. By eliminating this financial burden, the VA is taking an essential step to make telehealth a truly viable option for all veterans. This change aligns with findings from a RAND needs assessment commissioned by NYHealth, which revealed that 15% of veterans in New York who recently separated from the military struggle to access and afford the care they need.[1] Exempting telehealth services—in all forms and settings—from copays will help ensure that veterans can receive timely and affordable care, improving both health outcomes and patient satisfaction.

By prohibiting copays in community settings, in addition to home and clinical settings, the VA would enable patients to receive virtual care in the locations that are most convenient and accessible to them—enhancing the likelihood of the telehealth grant program’s success. By codifying the practice of not imposing copays for phone visits, the VA would also take an important step in promoting equity in telehealth access in all modalities. Patients who are older, people of color, and/or low-income are more likely than younger, white, and/or more affluent patients to use phone rather than video visits for telehealth services.[2] The same barriers to telehealth video appointments likely exist for veterans from these same patient groups.

Support for Establishing Telehealth Access Stations
The proposal to expand telehealth capabilities through the creation of telehealth access stations in community-based locations is an innovative approach to making telehealth available to all veterans who want and need it. Many veterans, particularly those in rural or medically underserved areas, live far from VA facilities and face barriers to telehealth, such as inadequate broadband access, lack of appropriate devices, or limited private spaces for telehealth appointments. Community telehealth access stations can mitigate these barriers and increase access to care.

Importance of Connections to VA Care
We support the VA’s approach to launching this program by connecting veterans in community settings to remote VA health care professionals through telehealth access stations. The VA often leads the way in health innovation and spreading new models; using VA health care professionals will allow for rigorous real-time quality improvement and evaluation, leveraging data from the VA’s common systems. Given the VA’s history of delivering quality care and high patient satisfaction,[3] this approach will provide veterans with high-quality care in comfortable and accessible settings and ensure that veterans have more options. Over time, VA should consider how outcomes from the program can be used to inform expansion to additional providers and sites.

Endorsement of Training as a Permissible Grant Expense
Many veterans need support to effectively access and use telehealth. The VA’s “Bridging the Digital Divide” program serves as an example of how targeted initiatives can address barriers like connectivity. Through Digital Divide Consults, veterans are connected to social workers who assess their eligibility for programs that provide internet-connected devices or subsidized internet service. Additionally, the VA’s partnerships with major mobile carriers to eliminate data charges for telehealth appointments, as well as its ATLAS program, which provides private telehealth stations in communities, make telehealth more accessible to veterans facing connectivity challenges.

Veterans also need supports beyond a digital connection and devices to attend virtual care appointments. Our partners leading patient navigation programs have reported that patients—particularly those with low digital literacy, no devices, or no prior telehealth experience—benefited greatly from navigators’ technical assistance, visit reminders, and answers to their questions before and after telehealth appointments. Therefore, we appreciate that the VA proposes to allow grant funds to cover training programs and resources to help veterans understand how to access virtual care, including education on scheduling appointments, navigating telehealth platforms, and troubleshooting technical issues. Partnerships with community-based organizations can further strengthen these efforts, ensuring veterans receive hands-on technical support and guidance tailored to their needs.

Need for Deep Veteran and Community Engagement
We also appreciate the VA’s expansive and inclusive definition of community access points. Our partners have piloted telehealth delivery in various community settings, including banks, behavioral health clinics, family service agencies, libraries, local health departments, older adult service agencies, settlement houses, social service agencies, shelters, and supportive housing communities.

These partners’ experiences, while promising, have affirmed the need for deep patient and community engagement for community access stations to succeed. For instance, a pilot of kiosks in rural bank branches had limited uptake of telehealth visits in the first six months, despite strong organizational partnerships, operational plans, and clinical considerations. Although our partner conducted early marketing and outreach, it did not uncover patient resistance until surveys of non-users revealed that community members preferred other types of locations (e.g., pharmacies, grocery stores, gyms); had multiple concerns (e.g., location, privacy, cleanliness); and would have been persuaded if a health care provider recommended the kiosk.

For the VA’s access stations to succeed, veterans must be actively involved in planning and implementation processes. Veterans are uniquely qualified to identify the locations and settings where they feel most comfortable accessing care. Therefore, we encourage the VA to strengthen its scoring approach to assessing outreach plans (§ 84.25(b)(2)); applicants should not only detail how they would inform veterans about telehealth services, but also engage veterans in program design. We also stress the importance of scoring criteria related to organizational partnerships for outreach ((§ 84.25(e)). Community-based organizations, such as veteran service organizations and local, community-based health providers, should play a role in site selection and outreach to ensure that the stations are accessible and that veterans actually use them.

Need for Strategic Investment in Infrastructure and Staffing
Establishing access stations and waiving copays alone will not ensure the success of telehealth programs. Sustainable and stable reimbursement policies are essential to the effectiveness of any telehealth initiative. Successful telehealth services require significant investments in technology, infrastructure, and staffing to meet the growing demand. Without certainty about ongoing payment for telehealth services, providers and community-based partners alike will be reluctant to continue investing in virtual care, leaving the system at risk of falling short of its potential.

Conclusion
The VA’s proposed rule to establish a telehealth grant program and eliminate telehealth copays demonstrates a strong commitment to improving health care access for veterans. These measures have the potential to significantly reduce disparities in care, particularly for veterans in underserved communities. To maximize the impact of this initiative, the VA should:

  • Actively engage veterans in the planning and implementation of telehealth access stations.
  • Provide robust technology training and support for veterans.
  • Enshrine sustainable reimbursement policies and investment in infrastructure to ensure the long-term viability of telehealth services.

NYHealth stands ready to support these initiatives. Together, we can build a telehealth system that ensures every veteran has access to high-quality, affordable care.

Thank you for your leadership and for considering our comments. If you have any questions, please contact Ali Foti, program officer, at foti@nyhealthfoundation.org.

Sincerely,

David Sandman, Ph.D.
President & CEO
New York Health Foundation

 

 

[1] Ringel, J.S.; Lejeune, J.; Phillips, J.; Robbins, M.W.; Bradley, M.A.; Wolf, J.; and Timmer, M.J. (2024). Understanding Veterans in New York: A Needs Assessment of Veterans Recently Separated from the Military. https://nyhealthfoundation.org/resource/new-york-rand-assessment-veterans-2024/, accessed January 2025.

[2] Chen, K.; Zhang, C.; Gurley, A.; Akkem, S.; and Jackson, H. (2023). Patient Characteristics Associated with Telehealth Scheduling and Completion in Primary Care at a Large, Urban Public Healthcare System. Journal of Urban Health. 100(3), 468-477. doi: 10.1007/s11524-023-00744-9.

[3] Shekelle, P.; Maggard-Gibbons, M.; Blegen, M.; et al. (2024). “VA versus Non-VA Quality of Care: A Living Systematic Review,” Evidence Synthesis Program, Health Systems Research Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226. https://www.hsrd.research.va.gov/publications/esp/quality-of-care-review.cfm, accessed January 2025.

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