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:
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- 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