Giving Compass' Take:

• Association for Community Affiliated Plans and Center for Health Care Strategies provide policy recommendations to improve social determinants of health for Medicaid recipients. 

• How can funders work to get these policies implemented? What work can be done outside of the government to improve social determinants of health?

• Learn about funding the fight to expand Medicaid. 

The conditions in which we are born, live, learn, work, and play affect health in myriad ways—in some cases more than the medical care we receive. State Medicaid agencies have increasingly looked at ways to address these social determinants of health (SDOH) in an effort to provide more efficient care and improve health outcomes. They have begun to use a variety of approaches to support such work, thinking strategically about how best to align SDOH-related activities with other reforms, such as value-based purchasing, care transformation, and the development of larger partnerships focused on population health.

In this report, supported by the Association for Community Affiliated Plans (ACAP), the Center for Health Care Strategies (CHCS) examines Medicaid managed care contracts or requests for proposals (RFPs) in 40 states, in addition to 25 approved § 1115 demonstrations. CHCS compiled incentives and requirements relating to SDOH, identified common themes in the states’ approaches, and developed recommendations for federal policymakers, including the Centers for Medicare & Medicaid Services (CMS).

States have begun working on ways to address SDOH. However, additional guidance from CMS would support creativity and innovation at the state level and advance this work even further. Building on findings in its scan, CHCS developed several recommendations for federal policymakers to support continued development of SDOH-focused interventions:

  1. Make it easier for vulnerable populations to access needed health services and care coordination. Effective SDOH strategies require health care organizations to engage beneficiaries over a sustained period of time.
  2. Enhance agency collaboration at the federal level.
  3. Provide additional guidance on addressing SDOH. When CMS issues guidance to Medicaid agencies, states listen.
  4. Approve § 1115 demonstrations that test strategies to address SDOH. CMS can approve state § 1115 demonstrations that test the impact of targeted SDOH interventions in managed care.
  5. Support outcomes-based payment for SDOH interventions. Pay-for-success models allow states and MCOs to pay only for “what works.”