Tackling the “last mile” of safety-net food access during the COVID-19 pandemic

Strengthening ecosystems of care Food insecurity

Many people with complex health and social needs face food insecurity, the disruption of food intake or eating patterns because of lack of money and other resources. For individuals served by the Camden Coalition’s care management programs, securing reliable access to food often ranks high on participants’ list of personal goals. And now, the COVID-19 pandemic has greatly exacerbated food insecurity across the U.S.: In May 2020, a national poll found that 44% of American households worried that they may not be able to afford food. Images and headlines of hundreds of people in cars and masked lines waiting at food distribution sites illustrate the dire situation.

In communities like Camden, with existing health and socio-economic disparities, the pandemic creates new challenges to food distribution because of public safety and social distancing guidelines. Community members in quarantine and those who have been advised to self-isolate due to a COVID diagnosis or exposure have few options for obtaining safety-net food services. While some are eligible for meal delivery services such as Meals on Wheels, or online grocery purchasing using SNAP, many others do not qualify for or cannot access these programs. Individuals without supportive social networks face the impossible choice of either risking their health and safety to leave home and obtain food, or to simply go without. In urban areas in particular, reliance on crowded public transit puts people and communities at increased risk of transmitting COVID-19.

The “last mile,” a term derived from transportation planning and supply chain management, describes the movement of people or goods from a transportation hub to their final destination. This stretch is often rife with complications. In terms of food insecurity, the “last mile” represents the last hurdles in getting food to people in need.

The heightened demand for food coupled with increased difficulty in acquiring it means that many people in our communities are going hungry, and not enough resources are being invested to solve this problem. However, recent collaborations right here in Camden show that adapting a non-emergency medical transportation (NEMT) provider’s infrastructure may be an efficient, cross-sector way to distribute food to people’s homes.

Food delivery pilot in Camden leverages LogistiCare’s infrastructure

Through the Camden Coalition’s Accountable Health Communities Advisory Board and a subsequent community partners meeting, three organizations were able to connect to meet a shared goal of increasing food access in our community.

LogistiCare is the nation’s largest NEMT company and the contracted transportation vendor for New Jersey Medicaid participants. After the start of the pandemic, as patients complied with the stay-at-home order and delayed non-emergency medical appointments, LogistiCare’s ridership in New Jersey dropped from 15,000 patient trips a day to 8,000. Recognizing that many New Jerseyans were facing challenges accessing food, LogistiCare amended its contract with the New Jersey Department of Human Services to include the delivery of food to patients beginning in mid-March.

Under this pilot, food distribution sites provide LogistiCare drivers with pre-boxed food along with a list of recipients’ names and addresses. LogistiCare then contacts recipients by phone to confirm deliveries and leaves food packages at their doorsteps. To date, LogistiCare has used this process to deliver food to more than 15,000 families across New Jersey, and has also begun delivering food in Philadelphia, PA and in Miami, FL. LogistiCare’s national reach and existing transportation infrastructure make it feasible to replicate this pilot in many more states and municipalities.

One of LogistiCare’s early partnerships in South Jersey was with The Salvation Army Kroc Center in Camden. Opened in 2014, the Kroc Center is a state-of-the-art community center that provides a variety of services to Camden and the surrounding community, including a community food pantry. Due to the pandemic, many of the Kroc Center’s most vulnerable clients were no longer able to travel to the building to receive needed food, but the partnership with Logisticare allowed the The Salvation Army to continue to meet this need, while keeping individuals as safe as possible.

In addition to traditional food distribution sites like the Kroc Center’s food pantry, other community institutions such as the KIPP schools wanted to address food insecurity among the people they serve. KIPP operates four public renaissance schools in Camden. KIPP’s school community in Camden has high rates of food insecurity under normal circumstances, and many families rely heavily on schools to provide meals for their children. As soon as schools closed in New Jersey, KIPP leveraged pre-existing partnerships to begin distributing groceries to families.

The majority of KIPP’s families do not live within safe walking distance of the school’s food distribution site, and even families with transportation faced many obstacles to attending the distributions – including ongoing work as essential workers, providing full-time child care for several children, and health conditions that made it unsafe to go out in public. While KIPP was temporarily able to manage deliveries through their own staff, KIPP eventually partnered with LogistiCare, making an enormous difference in its ability to serve families and meet community needs. To date, KIPP has arranged free weekly grocery deliveries and served more than 300 families in Camden, which represents about 30-40% of all of the families across their four Camden schools. Many families who would not ordinarily visit a food bank but who would be considered food insecure have received groceries through this partnership.

Implications for permanently expanding access to safety-net food delivery

While the need for safety-net food delivery has been heightened by the pandemic, for people with complex health and social needs, food insecurity is a longstanding struggle that will outlast social distancing guidelines and emergency declarations. Individuals living with disabilities, those without reliable transportation, hourly and shift workers, and families with young children all face challenges in accessing safety-net food in a system where access relies on one’s ability to travel to a food distribution site with limited and often fluctuating hours of operation.

Furthermore, this pilot can only continue as long as New Jersey remains under the Governor’s State of Emergency Declaration. The partnerships with the Kroc Center and KIPP show that leveraging existing transportation infrastructure such as LogistiCare can improve access to food, but also many unanswered questions: how can an NEMT provider sustain food delivery after the demand for traditional NEMT services returns to normal? Is it realistic for vehicles with refrigeration capacity to be made available through Medicaid NEMT services? While states have some flexibility with how they use Medicaid dollars to pay for programs like food access initiatives, many of these policies are limited in scope making the use of NEMT to address social determinants of health largely untapped.

Alongside addressing the questions of how NEMT could sustain food delivery, we must also consider how to bolster community based organizations’ ability to provide food delivery. While community food pantries typically have discretion to provide delivery, these organizations often lack the financial and logistical resources to do so. Many community food pantries and food distribution sites receive assistance through the USDA’s Emergency Food Assistance Program (TEFAP). While there are no federal regulations that prohibit TEFAP programs to deliver food, each state is responsible for creating guidelines for the use of “proxy pick-ups” as part of their State Plan submitted to USDA. How these proxy guidelines are written, understood, and enforced have a significant impact on the ability of third parties – whether for non-profit organizations, NEMT providers, or volunteer groups – to provide delivery services.

Looking ahead with an eye toward innovation

In so many ways, the COVID-19 pandemic has laid bare gaps and inequities in many of our health and social service systems. It has also given rise to innovations that are worth sustaining and building upon. Whether planning for future emergencies, or for the return to our new (and hopefully improved) “normal,” the moment is ripe for long term solutions to conquer the last mile of safety-net food distribution.

About the authors: Evelyne Kane is Program Manager for Community Engagement at the Camden Coalition. Jamie Moses is National Sales Director at LogistiCare. Joe Hejlek is Director of Wraparound Services at KIPP New Jersey. Benjamin Ovadia is Resource Development Manager at The Salvation Army Kroc Center.

Looking for food resources in South Jersey? Visit My Resource Pal, a free, up-to-date database of direct services available to residents in Camden, Burlington, and Gloucester counties for free or reduced cost with step-by-step instructions for how to access them. My Resource Pal was developed by the Camden Coalition in response to the community’s need for an online directory of services in South Jersey.