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.
On January 15, 2025, the Centers for Medicare & Medicaid Services released updated State Health Official letter and Frequently Asked Questions guidance, replacing a previously issued SHO letter and FAQs on the requirement in the Consolidated Appropriations Act, 2023 that states provide 12 months of continuous eligibility for children and youth under the age of 19 in Medicaid and the Children’s Health Insurance Program, effective as of January 1, 2024.
Following the November release of guidance to support states’ efforts to verify eligibility and conduct renewals in compliance with federal Medicaid and CHIP requirements, the Centers for Medicare & Medicaid Services issued on December 20 two additional Center for Medicaid and CHIP Services Informational Bulletins (CIBs). This expert perspective summarizes the requirements outlined in the CIBs.
