Issue Briefs | Oct 16, 2020

Social Risk Factor Screening in Medicaid Managed Care

Rachel Isaacson and Michael Bailit, Bailit Health

The past two years have seen a sharp increase in state Medicaid program interest in how social determinants of health (SDOH) influence Medicaid enrollee health status and spending. This brief provides an introduction to the first step most states are taking in response through their Medicaid managed care programs—screening members for social risk factors (SRFs). It explains why Medicaid managed care members should be screened for SRFs, identifies screening design decisions, identifies common SRFs, and reviews options for screening tool selection.

As a companion to this issue brief, State Health and Value Strategies hosted a webinar series that profiled the findings from this issue brief, and a second issue brief Developing a Social Risk Factor Screening Measure.


Expert Perspectives

December 1, 2023

The Proposed 2025 Notice of Benefit and Payment Parameters: Implications for States

On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.

CMS Releases Information Bulletin on Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid

This expert perspective summarizes CMS’ new Informational Bulletin and accompanying framework which together detail Medicaid coverage options for services that address the health-related social needs (HRSN) of Medicaid enrollees. The new guidance reiterates the importance of addressing HRSNs to improve access to care and health outcomes, and summarizes (and in some cases updates) multiple previous sources of CMS guidance on how HRSN services may be covered in Medicaid, including guidance on in lieu of services authority and on HRSN coverage in section 1115 waivers.