Medicaid’s Role in Addressing Social Determinants of Health
Policymakers are increasingly recognizing the important role that social and economic factors, such as housing, healthy food, and income play in a “whole person” approach to healthcare, especially among Medicaid’s low-income enrollees. Often referred to as “social determinants of health” (SDOH), these factors can drive as much as 80 % of health outcomes. States have a significant opportunity to cover some nonmedical services that directly impact health, as well as to connect people to housing and other social services not covered by Medicaid.
Overview of article
- Social determinants of health (SDOH) can drive as much as 80% of health outcomes. States have a significant opportunity to cover some nonmedical services that directly impact health, as well as to connect people to housing and other social services not covered by Medicaid
- With state Medicaid programs increasingly looking to pay for health outcomes, there is an increased focus on strategies to address social needs that contribute to outcomes. To date, the evidence base for the cost-effectiveness of addressing social need is strongest for high-need populations. For example, providing supportive housing to a seriously mentally ill person who otherwise would be homeless can significantly reduce medical expenditures on emergency department visits and inpatient care
- Considerations for state policymakers to address SDOH: 1) States have the option to classify some community-based services as covered benefits in Medicaid, allowing them to receive federal Medicaid matching funds for these services; 2) If they operate a Medicaid managed care program, states can require Medicaid managed care organizations (MCOs) to connect beneficiaries to social supports as part of their care management obligations; 3) States cannot use Medicaid to directly finance the cost of providing housing, and a number of other social services, but they can offer and encourage their providers to make such expenditures by using value-based payments to support social interventions; and 4) It is important to assess whether SDOH interventions work outside of high-need and high-cost populations. If a state uses a Medicaid waiver as the basis for their SDOH strategy, CMS will require such evaluations as part of the waiver. States that rely on managed care-based strategies can also conduct evaluations of those programs