Medicaid Policy in 2019: Social Determinants of Health

Shwartz R
Publication Year: 2019
Patient Need Addressed: Behavioral health, Food insecurity, Homelessness/housing, Substance Use, Transportation
Population Focus: Medicaid beneficiaries
Type of Literature: Grey

In this blog series, America’s Essential Hospitals forecasts the direction the administration might take on several aspects of Medicaid policy of importance to essential hospitals, including those related to expansion, social determinants of health, and program eligibility.

Insights Results

Overview of article

  • Essential hospitals have made significant advances in recognizing and treating social determinants of health (SDOH), which are critical to improving individual and community health. However, public policies to finance and support SDOH initiatives often lag
  • HHS (Department oh Health and Human Services) and CMS (Centers for Medicare and Medicaid Services) leaders have publicly voiced support for developing new models that fund work to treat SDOH. Administration officials also have alluded to a new program — called Model One— that would use CMMI authority to advance SDOH work. CMS has not announced an official Model One description or timeline
  • The administration also leveraged CMMI to test new approaches to treat behavioral health and substance use disorders through the Maternal Opioid Misuse model and the Integrated Care for Kids model, both launched in 2018. As HHS and states continue to use Medicaid financing mechanisms to pay for SDOH work, some stakeholders caution against medicalizing existing community services and supports. The use of Medicaid funding comes with the risk of added complexity and disruptions to existing programs. CMS must work in tandem with states and community partners to provide needed funding while ensuring services are delivered appropriately
  • For example, North Carolina has deployed a Section 1115 waiver that presents an opportunity to test new approaches to treating SDOH in a state-specific, community-focused model. As part of its transition, the waiver includes an innovative set of Healthy Opportunities Pilots to test evidence-based interventions to address key social determinants of health, including: 1) Housing instability; 2) Transportation insecurity; 3) Food insecurity; 4) Interpersonal violence; and 5) Toxic stress. CMS’ approval of North Carolina’s waiver is significant, but much work remains as the state begins the long implementation and evaluation process. North Carolina anticipates that the pilots will begin delivering services in late 2020

Key takeaways/implications

  • The administration’s emphasis on state flexibility means more states likely will request new authorities to address SDOH, whether through managed care or broader Section 1115 waivers. Moving forward, as essential hospitals target SDOH in their communities, it is crucial that the Medicaid program continues to evolve to ensure this vital work can continue