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domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md

@@ -57,6 +57,16 @@ IMPaCT's $2.47 Medicaid ROI within the same fiscal year demonstrates that at lea
 
 VBID termination was driven by $2.3B excess costs in CY2021-2022, measured within a short window that could not capture long-term savings from food-as-medicine interventions. CMS cited 'unprecedented' excess costs as justification, demonstrating how short-term cost accounting drives policy decisions even for preventive interventions with strong theoretical long-term ROI.
 
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+### Auto-enrichment (near-duplicate conversion, similarity=1.00)
+*Source: PR #1436 — "federal budget scoring methodology systematically undervalues preventive interventions because 10 year window excludes long term savings"*
+*Auto-converted by substantive fixer. Review: revert if this evidence doesn't belong here.*
+
+### Additional Evidence (confirm)
+*Source: [[2024-10-31-cms-vbid-model-termination-food-medicine]] | Added: 2026-03-19*
+
+VBID termination cited $2.3-2.2 billion annual excess costs as justification, but this accounting captures only immediate expenditures for food/nutrition benefits, not the long-term savings from preventing chronic disease in food-insecure populations. The 10-year scoring window excludes the 15-30 year horizon where food-as-medicine ROI materializes through reduced diabetes, cardiovascular disease, and other chronic conditions. A program with positive lifetime ROI was terminated for 'excess costs' that ignore downstream savings.
+
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 Relevant Notes: