For an Option to Address Social Determinants of Health, Look to Medicaid

DeSalvo K, Leavitt M
Publication Year: 2019
Patient Need Addressed: Food insecurity, Homelessness/housing, Transportation
Population Focus: Medicaid beneficiaries
Intervention Type: Partnership
Type of Literature: Grey

Research affirms what we intuitively know: The ability of individuals and families to lead healthy and productive lives is influenced by a multitude of factors. Beyond the more commonly recognized factors such as insurance coverage and access to medical care are the non-medical social determinants of health (SDOH). These non-medical drivers include access to healthier foods, safer neighborhoods, reliable transportation, and educational attainment. They also include how we behave in our environment such as exercise, eating habits, and tobacco use. SDOH account for more health outcomes, including cost, than medical care alone. Importantly, emerging evidence suggests that addressing negative SDOH can lead to improvements in health outcome

Insights Results

Overview of article

  • Increasingly, many state Medicaid programs are using their levers to address non-medical drivers of health. Approximately 40 states incorporate SDOH-related activities through managed care contracts or Section 1115 demonstration waivers. These activities range from employment, education, food, housing, transportation, and violence/abuse support services, or other related concepts such as wellness, disparities, community health workers, and justice-involved populations
  • For example, Oregon’s 1115 waiver allows for a model of managed care focusing on SDOH, value-based payment, and evaluation of community needs. North Carolina is receiving attention most recently for its innovative approach of blending best practices from other states to strategically identify evidence-based interventions that will address SDOH such as housing instability, transportation insecurity, food security, and interpersonal violence and toxic stress. Under this approach, high-need Medicaid beneficiaries are identified and receive a specific package of services tailored to their individual needs, including social service needs such as emergency housing or access to a food bank. North Carolina’s approach is important because it is leveraging public-private partnerships to create a sustainable infrastructure, such as a digital service access platform that will serve not only Medicaid beneficiaries but all people in the state regardless of the payer source

Key takeaways/implications

  • Opportunities to accelerate state innovation: 1) CMS can highlight steps states can take by consolidating approved guidance (such as the state Medicaid director letter and postings on the CMS website) and simplifying access for states seeking to develop state plan amendments or waivers; 2) CMS can lend its support for enhanced flexibility to build best practices on addressing SDOH, such as allowing states to establish managed care capitation rates that support SDOH interventions as quality improvement activities, which could accelerate the work of states; 3) CMS can develop and provide access to template contract language for states’ contracts with Medicaid MCOs, so states and CMS have a common and consistent understanding of standards for quality measurement and data collection; 4) CMS should establish a CMS-led learning collaborative and technical support program through the Innovation Center’s Innovation Accelerator Program, so states can share leading practices and learn from each other’s successes
  • Overall, partnerships between state Medicaid programs and key stakeholders, such as MCOs, healthcare providers, and consumers, to pilot and evaluate strategies to address SDOH pose a unique opportunity to develop promising models