What’s New in State Approaches to Addressing Health-Related Social Needs in Medicaid Managed Care

Bailit Health

States are increasingly leveraging their Medicaid programs to transform healthcare delivery and improve individual and population health with a focus on addressing health-related social needs (HRSN). States use a variety of approaches to encourage, require, and incentivize Medicaid managed care (MMC) entities to identify and address unmet social needs that can contribute to poor health outcomes, lower quality care, and higher medical expenditures.

State Health and Value Strategies continues to support states’ efforts by updating the Addressing Health-Related Social Needs Through Medicaid Managed Care toolkit. This update describes 8 different HRSN approaches across 20 state MMC programs–including approaches that address HRSN through managed care requirements for community engagement, partnerships and/or investments–and adds four new states to the toolkit: Florida, Georgia, Michigan, and New Hampshire. It also incorporates references to new guidance from the Centers for Medicare & Medicaid Services (CMS) regarding the use of Medicaid and Children’s Health Insurance Program authorities to address enrollees’ HRSN, including services and supports to address HRSN that CMS considers allowable under specific authorities.     

Below are HRSN highlights from the new states included in the toolkit. In addition to summarizing these states’ MMC requirements, Appendix A of the toolkit includes MMC procurement questions from these and other states focused on HRSN.

As part of their recent MMC procurements, both Georgia and Michigan include requirements for managed care plans (MCPs) to invest in their local communities and to submit community reinvestment plans to the state Medicaid agency.

• In Georgia, each MCP’s community reinvestment plan must identify population health strategies, including investments to address members’ nonmedical risk factors, and the sources of funds to be used for community reinvestment. Strategies may include engaging community-based organizations (CBOs) to increase the impact of activities associated with reinvestment spending.
• Except in the case of a required reinvestment as a result of MCP deficiencies in meeting performance targets, Georgia indicates that MCP community reinvestment contributions are voluntary. In contrast, the statement of work from the recent Michigan MMC procurement requires each MCP to contribute a minimum of five percent of its annual pre-tax profits to community reinvestment to address HRSN, including but not limited to increasing regional community capacity to provide social services.

New Hampshire’s MMC procurement requires MCPs to implement and provide administrative support for a “Provider-Delivered Care Coordination Program” that includes reimbursement and other incentives to enable participating providers to coordinate members’ health-related and community support services, including but not limited to housing. The state also requires MCPs to educate and train providers on how to access information about community support services and housing for members and how to facilitate member closed-loop referrals; incentivize providers for the use of closed-loop referrals for effective care coordination; and assist providers with actively linking members with other state, local, and community programs that address HRSN.

Both Florida and New Hampshire place emphasis on the use of in lieu of services (ILOS) to support members experiencing housing instability. New Hampshire’s MMC procurement authorizes MCPs to provide “assistance in finding and keeping housing” as an ILOS, subject to CMS approval. Similarly, Michigan encourages MCPs to use ILOS to address food insecurity.

Florida’s MMC procurement emphasizes MCP use of value-added services related to housing assistance, food assistance, non-emergency transportation, life skills development, and K-12 tutoring to advance its “Pathway to Prosperity” initiative which uses navigators to guide members, focusing on community collaboration to maximize resources.

Michigan’s MMC procurement requires MCPs to contract with CBOs to support population health improvement strategies in the MCPs’ regions, including efforts to address HRSN. Michigan will require MCPs to support the design and implementation of community health worker interventions delivered by CBOs to address HRSN. In addition, Michigan MCPs must collaborate with high-volume primary care practices to develop, promote, and implement targeted interventions for subpopulations experiencing HRSN.

Some states, including Florida, have included scenario or “vignette” questions in their MMC procurements to gain insight into how respondents would support and coordinate care for hypothetical Medicaid members, including individuals with HRSN.

State policymakers and Medicaid officials can use this updated edition of the toolkit to develop or update aspects of managed care procurements and contract provisions to address HRSN. SHVS will continue to monitor MMC programs to support dissemination and cross-state learning of activities and initiatives that address Medicaid members’ HRSN.