On July 25, the Milbank Memorial Fund released a new issue brief, “Medicaid Coverage of Social Interventions: A Road Map for States,” that provides useful guidance for states interested in using Medicaid to address social determinants of health.
Mounting evidence shows that social and economic factors such as employment, stable housing and food access have a significant impact on health outcomes. In fact, research shows that up to 40 percent of health outcomes are determined by these nonmedical factors. This is especially true for Medicaid beneficiaries, who are low-income and face greater challenges affording food, housing and clothing. Because Medicaid enrollees are so disproportionately affected by these upstream factors, Medicaid has an important role to play in addressing the nonmedical determinants of health. Medicaid is limited in the types of services it can pay for, however, making it challenging for policymakers and advocates to figure out the most effective avenues for connecting enrollees with the social services and supports they need.
This brief examines four areas of social support services: linkages to social service programs; stable housing; employment and job security; and peer and community supports. For each of these areas the report provides:
- A comprehensive list of the legal and regulatory authorities that could be used to cover social services.
- Information about specific social services that Medicaid can cover under these different authorities.
- Examples of ways states are using these authorities to cover social services: Michigan recently updated managed care contracts to require the use of community health workers to help enrollees who have behavioral health issues or complex co-morbidities connect with social services such as housing and heating assistance; Louisiana is using a Home and Community-Based Services Waiver to provide supportive housing services to individuals with disabilities, serious mental illness or who are in treatment for a substance use disorder.
A new perspective article [subscription required] in the New England Journal of Medicine discusses the impact of payment system changes on primary care providers and specialists, especially as the importance of primary care physicians grows, with greater responsibility for coordinating care. In a related blog post, the article’s authors argue that primary care physician incomes are likely to increase as they get bonuses, profits from capitation, or shared savings. Paying primary care physicians more could potentially reverse long-standing shortages of such doctors if higher incomes result in more medical school graduates pursuing careers in primary care. While the authors point out that higher incomes for primary care doctors will likely mean lower incomes for specialists and lower overall revenues for hospitals, they are optimistic that new payment systems will ultimately result in better clinical outcomes for patients.