Justine Zayhowski, Kate Reinhalter Bazinsky, and Michael Bailit, Bailit Health
State Medicaid agency interest in the impact of social determinants of health on the health status of Medicaid enrollees has surged in recent years. States have begun to stipulate performance requirements of their contracted managed care organizations and accountable care organizations to identify and mitigate social risk factors affecting individual members. To aid the identification process, some states have begun to recommend—and sometimes require—their contractors perform social risk factor screens.
This issue brief is designed as a resource for states looking to adopt a measure to assess social risk factor screening rates. It is the result of a series of convenings that the authors facilitated with three states—Massachusetts, Oregon, and Rhode Island—which helped them consider, discuss, and share perspectives related to the development of their own social risk factor screening process measures. The issue brief looks at the progress these states and North Carolina have made in developing their own social risk factor screening measures and highlights considerations for other states either planning to adopt an existing or develop a new screening measure.
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.