Issue Briefs | Apr 12, 2019

Addressing Social Factors That Affect Health: Emerging Trends and Leading Edge Practices in Medicaid

Jocelyn Guyer, Patricia Boozang, and Bardia Nabet, Manatt Health

Medicaid programs are increasingly considering how best to address social factors, such as housing, healthy food, and economic security, that can affect health and medical expenditures. Often referred to as social determinants of health (SDOH), these factors are significant drivers of population health outcomes. While states historically have had some experience tackling such issues for specialized, high-need populations, they are now confronting whether, and how, Medicaid should address SDOH for a broader population of Medicaid enrollees in order to achieve better health outcomes. This issue brief explores the “next generation” practices that states are deploying to address social factors using Medicaid 1115 waivers and managed care contracts, as well as the specific steps states can take to implement these practices.

The State Health Policy Highlight, Leading Edge Practices in Medicaid for Addressing Social Factors that Affect Health, summarizes the next generation practices analyzed in more detail in the issue brief for those readers looking for a quick overview.


Expert Perspectives

October 13, 2021

ACA Marketplaces Well-Positioned for Strong 2022 Open Enrollment Season

With the Patient Protection and Affordable Care Act’s (ACA’s) ninth open enrollment period (OEP) set to launch in less than a month, the ACA Marketplaces are seeing record enrollment numbers with more generous subsidies, new carrier competition, and a relatively stable rating environment. At the same time, there is uncertainty with the trajectory of the COVID-19 pandemic and medical costs trending upward as the economy recovers, albeit at an uneven pace. These trends have made for a challenging rate review process in the 47 states plus the District of Columbia (D.C.) that conduct their own ACA rate reviews of carrier-proposed rates using federal review standards. State announcements of 2022 rates have trickled out at a slower pace than in prior years, and it is likely that many states will not publish their approved rates until the beginning of open enrollment. As always, state rate results vary widely and, even within states, there often are substantial variations among carriers and across different regions in geographically diverse states. With these caveats, this expert perspective highlights some observations about the factors that are impacting rate changes this year and the kind of variations that exist among states.

October 1, 2021

How State-Based Marketplaces Can Maximize Consumer Outreach during Open Enrollment

As state-based marketplaces (SBMs) get ready for the next annual open enrollment period for health insurance, for many it represents a renewed opportunity to build on the hard work and lessons learned that took place over the year to enroll individuals in quality and affordable health coverage. The challenge for SBMs is getting all consumers to check out their options for the coming year and find the health coverage that best meets their needs now. In addition, for those new to the marketplace, SBMs will need to help these individuals navigate a process that may be unfamiliar. Many SBMs are making concerted efforts to connect residents with public and private health coverage options and are continuing to communicate the new financial help available through the American Rescue Plan. The ongoing COVID-19 pandemic continues to bring uncertainty for consumers and a need for marketplaces to continue to respond to that reality. This expert perspective highlights key messaging and outreach strategies state-based marketplaces are employing to conduct outreach, provide enrollment assistance, and clearly communicate with consumers what health coverage options are available for them in 2022.