CMS has released a new roadmap outlining how states can improve social determinants of health and reinforce their value-based care approach using Medicaid flexibilities. CMS emphasized that the roadmap’s goal is to flip the common healthcare trends by supporting lower spending with more positive outcomes. Value-based care arrangements and social determinants of health strategies are key to reversing trends of high spending with poor outcomes.
- The roadmap is designed to make state health officials aware of the federal support and flexibilities available to advance Medicaid social determinants of health programs. However, private payers may also benefit from the lessons that Medicaid provides on social determinants of health.
- The roadmap divides Medicaid programs’ social determinants of health flexibilities into several categories: housing-related services and supports, non-medical transportation, home-delivered meals, educational services, employment, community integration and social supports, and case management.
- Access to healthy food is a major social determinant of health issues, not only due to shortages of food options in certain regions but also because beneficiaries may find it difficult to prepare food on their own. For HCBS beneficiaries with medical limitations or other barriers to making food, Medicaid programs can help with home-delivered meals.
- Other options to advance value-based care and social determinant of health awareness under Medicaid include implementing integrated care models, CHIP Health Services Initiatives, obtaining federal funding for administrative procedures, Medicare Savings Programs, and the Money Follows the Person demonstration.
- There are a few avenues that states can pursue to tap into these federal flexibilities. They can use a Section 1905(a) state plan authority, HCBS option, section 1115 demonstration, Section 1945 health homes, managed care programs, or the Program of All-inclusive Care for the Elderly (PACE). The roadmap provides more specific guidance on engaging in these alternatives.
