CMS Pushes forward Efforts to Address Health-Related Social Needs

As states focus on advancing their 2024 Medicaid priorities, on many of those lists is likely to be Health-Related Social Needs (HSRN). The Centers for Medicaid and CHIP Services (CMCS) gave HSRN efforts a boost at the end of 2023 with the release of an Informational Bulletin that outlined opportunities to cover through Medicaid and the Children’s Health Insurance Program (CHIP) “clinically-appropriate and evidence-based” services and supports that address HSRN. CMCS noted that those services should be based on an individualized assessment of social conditions impacting a person that can lead to adverse health outcomes.

CMCS used the bulletin to note a wide range of support available via Medicaid and CHIP authorities, pointing out that its efforts are seeking to build on – and not supplant – existing, federal, state and local supports for HRSN. The support could include services and supports, care delivery transformations and performance improvement efforts.

Key information shared in the bulletin includes:

- Medicaid authorities that can be and have been used to cover HSRN services: state plan authorities, Section 1915 Home- and Community-Based Services (HCBS) waivers and state plan programs, Section 1115 Waivers, managed care In Lieu of Services and Settings (ILOS), and CHIP Health Service Initiatives (HSIs).
- Information about services and supports that can be used to address HRSN under Medicaid and CHIP, including related to: Housing/Home Environment and Nutrition
- Key populations of possible focus for state efforts: high-risk children and pregnant individuals, individuals who are or are at risk of being homeless, individuals with serious mental illness (SMI) and/or substance use disorders (SUD) and individuals experiencing high-risk care transitions.
- Fiscal limitations related to ILOS, Section 1115 Waivers

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Published by Lisa Kaplan Howe

Lisa Kaplan Howe (J.D.) is a Senior Advisor who has spent her career working in health law and policy. At PCG, she focuses on statutory and regulatory analysis and strategic advising, particularly related to health care policy. Lisa has provided subject matter expertise to support state health care reform efforts, including policy development and regulatory support for health insurance Marketplaces and state insurance plan management efforts, Medicaid expansion and Medicaid Waivers (including DSRIP Waivers) and State Innovation Waivers. Lisa led PCG’s work with the New Hampshire Insurance Department relative the state’s Section 1115 Medicaid Waiver to provide coverage to newly-eligible adults through the Marketplace and continues to support the states’ Marketplace plan management work. In those roles, Lisa has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze and lead strategic consideration of federal opportunities and requirements. Lisa is also part of the team helping to design Colorado’s Delivery System Reform Incentive Payment (DSRIP) program. Ms. Kaplan Howe also provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Lisa is a managing editor of PCG’s monthly health practice area newsletter, Health Policy News. Prior to joining PCG, Lisa served as Policy Director at New Hampshire Voices for Health, where she led legislative and regulatory analysis, strategic planning, and implementation of the organization’s policy agenda. Her work included drafting bills, amendments, testimony, and communications and testifying at hearings. Lisa also held the positions of Private Market Policy Manager and Consumer Health Policy Coordinator at Health Care for All of Massachusetts. While there, she managed private insurance market policy work and was a member of the organization’s internal health reform team. Lisa also practiced law in the Ropes & Gray health care department, advising health care provider and insurer clients. View all posts by Lisa Kaplan Howe

CMS Pushes forward Efforts to Address Health-Related Social Needs