How States Address Social Determinants of Health in Their Medicaid Contracts and Contract Guidance Documents

Kartika T
Publication Year: 2018
Patient Need Addressed: Homelessness/housing, Transportation
Population Focus: Medicaid beneficiaries
Type of Literature: Grey
link: https://nashp.org/wp-content/uploads/2018/08/Social-Determinants-of-Health-in-Medicaid-Contracts-plus-CT-12_6_2018.pdf
Abstract

In recognition of the impact that social circumstances, such as stable employment and housing, have on health and well-being, states are increasingly interested in addressing social determinants of health (SDoH) to improve population health. One of the purchasing and regulatory levers that many states use to encourage investments in population health is the managed care and value-based contracting process. The National Academy for State Health Policy (NASHP) convenes a state accountable health workgroup that evolved from a NASHP analysis of accountable health initiatives in 12 states (CA, CO, CT, DE, MA, MI, MN, NY, OR, RI, VT, and WA) that emphasize population health in their models. Because contract provisions vary from state to state, workgroup members wanted to learn how other states leverage Medicaid
contracts to address SDoH.

Specifically, they wanted to know the following:

  • Which determinants states prioritized in their contracts;
  • How they incorporated SDoH priorities into contractor requirements; and
  • How states monitor and pay for these activities.
    • Insights Results

    Overview of article

    • The National Academy for State Health Policy (NASHP) convened a state accountable health workgroup that evolved from a NASHP analysis of accountable health initiatives in 12 states (CA, CO, CT, DE, MA, MI, MN, NY, OR, RI, VT, and WA) that emphasize population health in their models
    • NASHP analyzed publicly available Medicaid contracts and guidance documents that inform contract requirements in accountable health states using a keyword search. NASHP attempted to identify which contracting process in each state provided the most leverage for the Medicaid agency
    • Social determinants of health are explicitly mentioned in managed care organization contracts in CA, DE, MI, MN, and WA and mentioned in new care delivery contracts in CO, MA, OR, and VT
    • Specifically, CO, MA, and OR use new care delivery contracts such as accountable care organizations to address criminal justice. Additionally, CO and MA are using these contracts to address housing services. Lastly, MA, OR, and VT are all using these contracts to address issues related to transportation
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