Medical foods, which fall in the gray area between food and drugs, are a necessity for persons with inborn errors of metabolism. Being more expensive than regular foods, some U.S. states have mandated insurance companies to provide coverage for the afflicted community. To investigate the legislative adoption process, this paper develops a political economy model of medical food reimbursement and coverage policy. Analytical cross-state logit regression models confirm the positive influences of metabolic clinics and the political clout of the afflicted community on the probability of adoption. The countervailing interest of the insurance industry and the afflicted community were also confirmed. Results suggest that efforts by medical food companies to influence the political process could yield food market and distribution channel opportunities in states contemplating legislative adoption.