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Medicaid Coverage of Social Interventions: A Road Map for States

Medicaid Coverage of Social Interventions: A Road Map for States
  • By: Manatt Health
  • Date: July 2016
  • Priority Area: Advancing Primary Care
  • Type: Resources
  • Category: Report
  • Document: Download

Overview

This issue brief by Manatt Health, supported by NYSHealth and Milbank Memorial Fund, outlines opportunities for state Medicaid programs to integrate social interventions into their coverage, payment, and delivery models.

Social factors, such as income, access to food and housing, and employment status, have a significant impact on the health and health outcomes of Americans, particularly lower-income populations. Federal and state officials who seek to provide Medicaid beneficiaries with quality, cost‐effective care acknowledge the need to address these social determinants of health. In developing strategies to do so, states face several challenges, including how to provide a revenue stream to cover the cost of social services, as Medicaid is first and foremost a health insurance program. Nonetheless, under some circumstances, Medicaid is available to cover the costs of social interventions linked to the health of Medicaid enrollees.

The issue brief is based on a review of the relevant laws and regulations, as well as interviews with leading state and federal experts. It offers guidelines for policymakers who want to know when and how states can use Medicaid to facilitate access to social services. Using a pragmatic approach, the issue brief can serve as a road map for clinicians and administrators to navigate the unchartered territory of social interventions through Medicaid.