Background <p>Home-delivered meal programs (HDMP), such as Meals on Wheels, offer nutritious meals for homebound older adults experiencing nutritional risk. Despite receiving meals, participants may still have difficulty achieving nutritional goals, overcoming social isolation, and addressing other health issues. We aim to evaluate the impact of adding enhancements to traditional HDMP on improving diet quality, food and nutrition security, loneliness, and health-related quality of life among older adults in a randomized controlled trial.</p> Methods <p>Homebound older adults at nutritional risk and participating in the Meals on Wheels of Rhode Island, Inc. (MOWRI) HDMP are randomized to receive either a usual care control group of the traditional HDMP (5 meals delivered per week) or the enhanced program (Meals+), which includes four Community Health Worker (CHW) coaching calls using motivational interviewing, and delivery of three healthful grocery bags during 12 weeks, in addition to the traditional HDMP. The primary outcome is diet quality measured by the validated Dietary Screening Tool (DST). Food and nutrition security, loneliness, and health-related quality of life are secondary outcomes assessed by validated measures. In the 12-week follow-up call, CHWs also ask participants about utilization and satisfaction with the intervention. The usual care group receives coaching from CHWs to connect them to community resources in this follow-up call. Study procedures were tested in a pilot randomized controlled trial (<i>n</i> = 12), resulting in modifications to the study protocol.</p> Discussion <p>Enhancements such as CHW calls and grocery bags can help HDMP target food access, social and health interventions for older adults. These enhanced HDMP have the potential to be sustained and replicated nationwide.</p> Trial registration <p>Number NCT06401694; Start date: 2024-06-20.</p>