Addressing Social Factors That Affect Health: Emerging Trends and Leading Edge Practices in Medicaid

Manatt, Phelps & Phillips, LLP

Medicaid programs are increasingly considering how best to address the social factors, such as housing, healthy food, and economic security, that can affect health and medical expenditures. Often referred to as social determinants of health (SDOH), these factors drive as much as 80 percent of population health outcomes. With Medicaid programs looking to contain costs and to pay for health outcomes—not simply the volume of health care services delivered—there is a growing focus on addressing these social factors in both Medicaid fee-forservice and managed care programs. While states historically have had some experience tackling such issues for specialized, high-need populations (e.g., disabled enrollees with mental illness or HIV/AIDs), they are now confronting whether, and how, Medicaid should address SDOH for a broader population of Medicaid enrollees in order to achieve better health outcomes.

In this issue brief, we explore the “next generation” practices that states are deploying to address social factors using Medicaid 1115 waivers and managed care contracts, as well as the specific steps states can take to implement these practices. The issue brief is based on an in-depth review of the Medicaid managed care contracts in 17 states and Medicaid 1115 provisions in six states. (For a detailed discussion of the methodology used to identify the states and review their policies, see Appendix A.) The next generation practices discussed in this analysis include...

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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