CMS Shares New SDoH Guidance and Strategies for Medicaid, CHIP

Recently, the Centers for Medicare & Medicaid Services (CMS) shared new guidance with state health officials to better address social determinants of health (SDoH) for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. The issued guidance is intended to improve health outcomes, reduce disparities of care, as well as lower overall costs of care.

“The evidence is clear: social determinants of health, such as access to stable housing or gainful employment, may not be strictly medical, but they nevertheless have a profound impact on people’s wellbeing,” said CMS Administrator Seema Verma.

Although the United States spends more on health care than most countries, statistics show reduced life expectancy, higher rates of chronic heart disease, and higher maternal and infant mortality rates.

“To address the contradiction between rising costs and low health outcomes, CMS has committed to accelerating the industry’s shift away from traditional fee-for-service payment models to value-based models that hold clinicians accountable for cost and quality,” the agency said in a press release.

Part of the issued guidance included state Medicaid directors being encouraged to incorporate more value-based strategies, which have been known to provide more opportunities to address SDoH among a patient population.

“[This] letter to state health officials highlights strategies by which states can promote a value-based system that fosters treatment of the whole person and lowers health care costs,” Ms Verma said in a press release. “Patients are more than a bundle of medical diagnoses, and it’s time our health care system treated them as such.”

The new SDoH guidance suggests how both CHIP and Medicaid can improve beneficiary outcomes by implementing different delivery approaches, benefits, and reimbursement methodologies. The agency also explained how states can utilize a number of federal authorities “that can provide them with flexibility to design an array of services to address SDoH and that can be tailored, within the constraints of certain federal rules, to address state-specific policy goals and priorities, including the movement from volume-based payments to value-based care.”

“While states have flexibility to design a number of different services to address SDoH,” concluded the agency, “the guidance focuses on a set of services and supports that states can cover under current law, including housing-related services and supports, nonmedical transportation, home-delivered meals, educational services, and employment supports. —Edan Stanley