New Report Highlights Policy Options to Address Social Determinants of Health Needs for Dual Eligibles

FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515,



WASHINGTON— A new report from The Association for Community Affiliated Plans (ACAP) assesses the Special Supplement Benefit for the Chronically Ill (SSCBI) and offers policy suggestions to better equip Dual Eligible Special Needs Plans (D-SNPs) to address the social determinants of health (SDOH) needs of their beneficiaries in a meaningful way. The research was funded by a grant from Arnold Ventures and written by the Center for Health Care Strategies.

The Centers for Medicare & Medicaid Services (CMS) will allow D-SNPs to cover some SDOH services, such as like inadequate or unsafe housing, inability to access healthy foods, and lack of transportation, via an SSCBI. Dually eligible individuals have been shown to have higher levels of SDOH-related needs than other Medicare Advantage beneficiaries, which tend to result in higher medical costs and poorer clinical outcomes.

A gap analysis found that most ACAP D-SNPs use a combination of assessment tools and community or vendor partnerships to address the extensive SDOH needs of their members. While these plans view SSCBI as having potential to enhance care, it is unlikely to be the primary mechanism to address SDOH needs. Many plans choose not to offer SSCBI; those that do not cited inflexibility, uncertainty around the potential return on investment, and the need to spend limited rebate dollars on other, more traditional supplemental benefits such as vision, dental, and hearing as reasons why they chose not to offer SSCBI.

ACAP plans submitted policy alternatives to address SDOH needs to recommend to federal and state lawmakers. They include:

  • Making SSCBI more flexible by allowing D-SNPs to tailor SSBCI to different groups of members or offer SSBCI to all D-SNP members. As D-SNP members are, by definition, low-income and could benefit from services to address their SDOH needs, the latter option would be especially useful.
  • Allow Plans to Retain a Larger Percentage of their Rebate Dollars to put towards SSBCI by redesigning the comparison groups for awarding Star Ratings through Peer Grouping, allowing SDOH needs— which can impact Star Ratings—to be taken into account in the quality measurement system. CMS could also add an “SDOH add-on” to the rebate percentage.
  • Adding Indicators of SDOH Need to the Medicare Advantage Risk-Adjustment Model. This could increase payments to plans that enroll beneficiaries with higher SDOH needs that are associated with increased Medicare costs.

“ACAP-member plans know that their ultimate goal is to deliver better health. Social determinants of health can have profound impacts on health outcomes,” said ACAP CEO Margaret A. Murray.  “The SSCBI represents a first effort to for Medicare to formally acknowledge efforts to address social determinants of health. We look forward to working with our federal partners to continue that effort and make this resource—and others—work better for our plans and their beneficiaries’ SDOH needs.

“We gratefully acknowledge the support of Arnold Ventures in our efforts.”

About ACAP
ACAP represents 77 health plans which collectively provide health coverage to more than 20 million people. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly-sponsored health programs. For more information, visit