Addressing Social Determinants of Health via Medicaid Managed Care Contracts and 1115 Waivers

Through a review of managed care contracts and § 1115 demonstrations, the Center for Health Care Strategies (CHCS) identified how states have required or incentivized activities related to social determinants of health (SDOH). These requirements or incentives most often encourage managed care plans and other health care organizations to adopt SDOH-focused systems and partnerships for care coordination and management — to screen for social needs and provide linkages to community resources. Some states have begun to expect actual investment in SDOH interventions, but this work is nascent and concentrated in only a few states.

In the resulting report, CHCS provides several recommendations to advance and support investments in SDOH, including:

  • Make it easier for vulnerable populations to access needed health services. CMS can suggest modifications to § 1115 demonstrations to help reduce eligibility churn and improve member engagement.
  • Enhance agency collaboration at the federal level. Targeted federal partnerships and cross-agency councils can support collaboration on SDOH.
  • Provide guidance on addressing SDOH through managed care. CMS can help clarify how managed care plans can get “credit” for investments in SDOH.
  • Approve § 1115 demonstrations that test strategies to address SDOH. CMS can approve state § 1115 demonstrations that test targeted SDOH interventions in managed care.
  • Support outcomes-based payment for SDOH interventions. CMS can clarify how states and plans can pay for the health outcomes an SDOH intervention achieves.
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