"WHO PICKS UP THE GLUTEN-FREE TAB?"

Should GF Diet Cost Be a Medical Expense?

Last year the study Economic burden of a gluten-free diet by Anne Roland Lee (right) and others at the Celiac Disease Center at Columbia University (CDCCU) found that "gluten-free foods have poor availability and are more expensive than their gluten-containing counterparts." According to the study, gluten-free bread and pasta cost twice as much.

So should the added cost of gluten-free food be covered by New York State health insurance policies? Empire Plan (UnitedHealth) has actually covered Mike Stickelmyer and perhaps a dozen other people for the additional cost of gf food...until this year, according to "Who picks up the gluten-free tab?"—an article by Cathleen Crowley in Albany's Times Union (January 28, 2008).

Crowley writes that New York's Insurance Department is investigating the change and quotes Barbara Jordan of The Celiac Disease Resource explaining that "Our food is our medication, basically." Jordan offers comparisons with policies in other countries, saying that Australia reimburses for food and Italy gives individuals with celiac disease extra days off work plus $2,000 annually for food costs.

But things are different in New York State, especially as of 2008. Crowley offers the following remarks:

"There's a very narrow category of diseases that require a special diet," said David Ernst of the state Department of Civil Services, which oversees the Empire Plan. "But celiac does not fall into that category."


"Celiac disease is viewed as more of an allergy, where if the individual avoids the gluten products, but they can still thrive on other types of food," said MVP [Health Care] spokesman Gary Hughes.

Many foods are naturally gluten-free, like plain fish, meat, chicken, rice, fruits and vegetables, said Kristin Marshall, spokeswoman for [the HMO] CDPHP.

"Because these members can also eat these foods, as can the celiac-free population, this condition does not qualify," Marshall said.

But I think part of the point is that those foods wouldn't necessarily be covered—only the difference in costs would be covered. This could be particularly helpful for families, where the costs of medically safe foods can be especially high.

Crowley also points out that people on gluten-free diets might have some recourse in other areas:

Celiac sufferers have some other financial options, including a tax deduction or paying food costs with pre-tax dollars. If their out-of-pocket medical expenses exceed 7.5 percent of their adjusted gross income ($3,750 for a $50,000 income), the gluten-free food costs can be deducted. Or, they can pay for gluten-free food through a flexible spending account.

My opinion? Health insurers should certainly help people on medical diets that are more expensive than average diets. Also, the government should calculate standard food deductions for those diets so that people who are thinking of asking for a deduction don't have to spend year after year collecting receipts and cooking up their own calculations. There's a kind of cruelty involved in requiring individuals to go through such a bookkeeping exercise when they might be spending their time doing something much more worthwhile—and healthy. Giving people the option of standard food deductions would, I think, be a very helpful practice.

There are other possible approaches to softening the blow of gluten-free food costs, such as government subsidies of food providers. I believe that practice exists abroad, too.