Medicaid Authorities and Options to Address Social Determinants of Health

1/29/2024 – Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. While there are limits, states can use Medicaid – which, by design, serves a primarily low-income population with greater social needs – to address social determinants of health. To expand opportunities for states to use Medicaid to address health-related social needs, The Centers for Medicare & Medicaid Services or CMS announced new flexibilities available to states to through managed care and through Section 1115 demonstration waivers. New CMS guidance accompanies the Biden-Harris Administration’s release of the U.S. Playbook to Address Social Determinants of Health and HHS’s Call to Action to Address Health-Related Social Needs. While health programs like Medicaid can play a supporting role, CMS stresses the new HRSN initiatives are not designed to replace other federal, state, and local social service programs but rather to complement and coordinate with these efforts. The resources provided to date through Medicaid are relatively modest in comparison to the social needs that exist. This brief outlines the range of Medicaid authorities and flexibilities that can be used to add benefits and design programs to address the social determinants of health (Figure 1).

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