“I call it poison,” he said. “But you can’t really choose what you eat.”

Franco said he gets $189 a month in food stamps, but he lacks a regular place to keep perishable food, and “the sugar-free stuff is very expensive.” Anderson said that his lack of a refrigerator also limits the options for treating his diabetes; insulin has to be kept cold, so she only prescribes him medication that comes in pill form.

The American Journal of Medicine analysis reported that chronically ill adults who reported “food insecurity” were much more likely to skip medication due to worries about cost than were those who denied problems affording food. But the article’s findings suggest that two programs, Medicaid and the federally-funded Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, might help. Medicaid usually covers basic medications with a small or no co-pay. WIC pays for specific foods for low-income pregnant women, mothers of small infants or those who breastfeed, and children younger than five. Compared with others of similar income, adults who were enrolled in one of these two programs were less likely to say they had problems obtaining healthy foods or prescribed medicine due to cost.

The researchers didn’t find a similar link among adults who said they got food stamps through the federal Supplemental Nutrition Assistance Program (SNAP), though other studies have found that children whose families got food stamps are much less likely to be “food insecure” than kids in families of similar income. Berkowitz said that this could be because the adults who actually enroll in the food stamp program tend to live in deeper poverty and have more health problems than other adults who qualify but don’t enroll, while the use of WIC is more widespread among families who qualify.

“WIC has traditionally been very good at enrolling everyone who qualifies,” he said. “It was meant as a health program, to avoid complications of malnutrition in children. SNAP was not meant as a health benefit, and the whole ethos is different. It still has lots of stigma, and the people in it tend to be much worse off.”

Learning about food insecurity isn’t part of the usual training for doctors who focus on adults, and I have never worked in a clinic that routinely asked patients if they had problems affording food and helped them apply for food assistance. In contrast, my colleagues in pediatrics and obstetrics routinely refer their patients to WIC, and are very familiar with the program. The American Academy of Pediatrics has even issued a position statement urging its members to collaborate with local WIC programs and provide information about WIC to patients who might be eligible. Some of this familiarity stems from the program’s rules: In order to qualify, women have to meet with a health professional such as a doctor, nurse practitioner, or dietician who determines whether they or their baby are at risk of having a nutritional deficiency. WIC is often administered by health departments, and frequently has offices in hospitals and clinics. In addition to providing food vouchers, WIC offers nutrition education, helps mothers who are trying to breast feed, and refers mothers and children to social service programs.