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 Center for Medicaid and CHIP Services (CMCS) explained the transition to “Account Transfer 2.0” (AT 2.0) in a CMCS Informational Bulletin (CIB) released on October 10, 2024. The CIB indicates significant federal investment in improving the process of transferring consumer application information between state Medicaid and CHIP agencies and the Marketplace in the states using the federal platform. This expert perspective reviews the CIB and highlights opportunities for states to improve account transfer data under the CIB.
On September 9, the Centers for Medicare & Medicaid Services (CMS) released a new collection of federal Medicaid and CHIP reporting templates designed to assist states in monitoring Mental Health Parity and Addiction Equity Act (MHPAEA) compliance in Medicaid and CHIP. Informal public comment is requested by December 2, 2024. This expert perspective reviews the reporting templates to highlight considerations for states and support the formulation of comment submissions.
On April 2, 2024, the Centers for Medicare & Medicaid Services offered a new option for states to update their essential health benefits (EHB) benchmark plan to require coverage of routine adult dental benefits. While there are multiple drivers of inequities in oral health, a primary barrier to accessing dental services is the cost of care, a barrier that can be reduced with dental insurance. This expert perspective provides an overview of the newly available flexibility and discusses considerations for states weighing whether to add a requirement that plans subject to EHB cover routine adult dental care.
