The guidance will help states offer alternative benefits that address a range of health-related social needs, such as housing instability and food insecurity, to help enrollees maintain their coverage and improve their health outcomes.
The Department of Health and Human Services (HHS) through the Centers for Medicaid * Medicaid Services (CMS), on Wednesday released guidance on an opportunity for states to address health-related social needs for people with Medicaid coverage through the use of “in lieu of services and settings” in Medicaid managed care.
The action aims to drive innovation in the Medicaid program by strengthening access to care, improving population health, and reducing health disparities. “Today’s step ensures people with Medicaid receive the broader care they need to live safe and healthy lives.” said HHS Secretary Xavier Becerra in the announcement. “We call on all states to leverage these innovative options and stand ready to partner with them in providing essential health care services.”
HHS said the guidance also supports the administration’s goal to end hunger and reduce diet-related diseases by 2030–all while reducing disparities and its corresponding National Strategy on Hunger, Nutrition, and Health. For example, under the new guidance, states may adopt in lieu of services and settings to offer medically appropriate, cost-effective tailored meals for people with severe, chronic health conditions made worse by poor diet, living in “food deserts,” or not having access to nutritious food choices.
In addition to outlining this opportunity for states, the letter addresses the requirements and guardrails states must meet to ensure these innovations are cost effective, medically appropriate, preserve enrollee rights and protections, and fulfill the objectives of the Medicaid program. These requirements empower CMS to ensure appropriate oversight and provide additional guidance to states on how to evaluate and monitor the impact of these in lieu of services and settings.
To learn more, join RISE for the 8th Annual Medicaid Managed Care Leadership Summit, a virtual event, April 19-20. Attendees will leave with tools to better manage the end of the public health emergency (PHE), improve clinical outcomes, succeed with value-based contracting, stay on top of regulatory changes, and address social determinants of health.