Editors Note: In a new report, Manatt explores how states are using two key toolsMedicaid managed care contracts and 1115 waiversto address the unmet social needs of people with Medicaid coverage. The findings have important implications for Medicaid managed care organizations (MCOs), providers, patients, community-based organizations (CBOs) and other healthcare stakeholders. Key highlights are summarized below. Click here to download our free infographicdrawn from the reports findingsto learn about common, emerging and leading-edge practices to advance whole person health across the country.

The ability to live a healthy life is influenced by a multitude of factors that extend beyond medical care. Access to stable housing, healthy foods, safe neighborhoods, reliable transportation, educational resources and other nonmedical drivers of healthoften called social determinants of health (SDOH)has a profound impact on health and longevity, driving as much as 80 percent of health outcomes.1 The current COVID-19 crisis has shone a bright light on the extent to which addressing SDOH is integral to ensuring the health of vulnerable individuals and communities. Those hardest hit by the pandemic are low-income communities as well as communities of colorwho not only have experienced higher rates of infection, hospitalization and death, but also have been disproportionately impacted by downstream job loss and socioeconomic instability.2,3 The crisis has underscored just how critical the linkages between economic and social services and healthcare are to the well-being of both individuals and their communities.

Medicaid, which currently provides health coverage for 1 in 7 adults and 2 in 5 children across the country,4 is the largest payer for healthcare for low-income populations. Because Medicaid by definition serves those most affected by social and economic challenges, states have a particularly strong imperative to address SDOH. As states seek to improve overall health for Medicaid beneficiaries and derive more value for their healthcare dollars, they are increasingly seeking to integrate strategies to address health-related social needs into their care delivery models.

States ability to pay for nonmedical servicessuch as food or housingwith Medicaid dollars is limited by federal statute. However, states have a variety of tools to support the health-related social needs of their Medicaid beneficiaries, including Medicaid managed care contracts and 1115 waivers.

Manatt reviewed the contracts of each state and territory with Medicaid managed care, as well as their 1115 waivers, to identify SDOH-related provisions in six areas of focus: Care Management: Workforce; Data Development, Collection and Evaluation; Quality Metrics and Strategy; Financing; and Community Initiatives.

These trends have important implications for people enrolled in Medicaid, CBOs, MCOs, state Medicaid programs and other stakeholders. The full report discusses these implications and provides insights into anticipated developments in the pursuit of whole person care for people with Medicaid, over the next months and years.

NOTE: The full report, which includes detailed state profiles, is available for purchase as a stand-alone PDF or through a subscription to Insights@ManattHealth, which also gives you access to an interactive SDOH map and database, filterable by area of focus, intervention, domain and target population, as well as ongoing access to Manatt Healths premium content information service. Insights@ManattHealth leverages Manatt Healths knowledge in the Medicaid, Medicare, Marketplace, life sciences, litigation, digital health and privacy arenas to bring you a roundup of each weeks federal and state policy changes; detailed regulatory and subregulatory guidance summaries; and 50-state surveys across a range of topics, including 1115 waivers, 340B policies and telehealth.

1 Moodys Analytics. Understanding Health Conditions Across the U.S. BlueCross BlueShield Association. December 2017. Available: https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/BCBS.HealthOfAmericaReport.Moodys_02.pdf.

2 US: Address Impact on COVID-19 on Poor: Virus Outbreak Highlights Structural Inequities. Human Rights Watch. March 19, 2020. Available: https://www.hrw.org/news/2020/03/19/us-address-impact-covid-19-poor#.

3 COVID-19 Hospitalization and Death by Race/Ethnicity. Centers for Disease Control and Prevention. Cases, Data & Surveillance. Available: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

4 Medicaid in the United States. Kaiser Family Foundation. October 2019. Available: http://files.kff.org/attachment/fact-sheet-medicaid-state-US

5 North Dakotas contract did not have any provisions that fit within the scope of this survey, whether required, encouraged or optional.

6 The requirements to refer to social services and coordinate social services would imply that MCOs have to screen for SDOH. In select states, Manatt found requirements for coordination and/or referral without screening.

Originally posted here:
In Pursuit of Whole Person Health: Leveraging Medicaid Managed Care & 1115 Waivers to Address SDOH - JD Supra