The Centers for Medicare & Medicaid Services (CMS) on Thursday issued new guidance for states to address social determinants of health (SDoH) in Medicaid and the Children’s Health Insurance Program (CHIP).
The guidance to state health officials aims to drive the adoption of value-based care strategies that address SDoH among beneficiaries in Medicaid and CHIP to further improve health outcomes, reduce health disparities, and lower costs.
CMS’ guidance outlines a set of services and supports that states can cover under federal law to tackle SDoH that have an impact on adverse health outcomes. Those social determinants include housing-related services and supports, non-medical transportation, home-delivered meals, educational services, and employment supports. CMS will also support states with designing programs, benefits, and services that can more effectively improve population health and reduce the cost of caring for the most vulnerable and high-risk populations.
The longstanding health disparities and SDoH among Medicaid and CHIP populations have only been exacerbated by the COVID-19 pandemic, with many beneficiaries struggling more than ever with access to nutritious food, housing, employment, and education. School closures across the country due to COVID-19 have further restricted low-income children’s access to non-academic supports such as food assistance, counseling services, homelessness and maltreatment interventions, and other in-school services.
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Through the SDoH guidance, CMS plans to accelerate the industry’s shift from fee-for-service payment models to value-based models to provide efficient, high-quality care while lowering cost and improving health outcomes, a shift CMS believes will better address SDoH and disparities across the health care system.
“The evidence is clear: social determinants of health, such as access to stable housing or gainful employment, may not be strictly medical, but they nevertheless have a profound impact on people’s wellbeing,” said CMS Administrator Seema Verma in an announcement. “Unfortunately, our fee-for-service system inherently limits the doctor-patient relationship to what can be accomplished inside the four walls of a clinician’s office. Today’s letter to state health officials highlights strategies by which states can promote a value-based system that fosters treatment of the whole person and lowers healthcare costs. Patients are more than a bundle of medical diagnoses, and it’s time our healthcare system treated them as such.”