States make SDoH strides with new Medicaid benefits, programs

By Robert Pittman

As COVID-19 spread throughout the United States, Americans of all walks of life felt the economic impact of the pandemic as businesses were forced to terminate staff, and in some cases, close their doors for good. With little opportunity available—and the added responsibility of having to take care of children home from school or another family member—many were unable to maintain or find steady income. This reality drove many Americans who would never have qualified for Medicaid in the past to enroll in the program for the first time.

As of May 2021, over 75 million people in the U.S. were enrolled in Medicaid services, representing 18% of the U.S. population. With Medicaid rolls hitting record numbers, Medicaid programs began to face significant fiscal challenges and the concept of taking a holistic view of the influences occurring outside of the clinical setting and in the member’s everyday life became more prevalent.

As a result, Medicaid policies have shifted and adapted to the changing times, with many states looking to enact more expansive initiatives to address longstanding issues. These changes are highlighted in the results of the 21st annual KFF survey of state Medicaid directors, which provides a look inside evolving Medicaid policies, spending and enrollment for the current fiscal year.

Possibly the most striking information found in the report revolves around initiatives to address social determinants of health (SDoH) or the conditions in which people are born and live that affect their quality of health. Lack of necessities such as transportation, housing, food, access to medication and needed at-home care exacerbate preexisting financial struggles which may lead to below-average health, growth in health inequities and an increased need for services beyond what many states currently provide. While social determinants of health (SDoH) have become increasingly present over time in the decision-making involving whole-person care, their importance has never been more apparent than it is today.

States making SDoH advances

In an effort to prevent another pandemic, this one social, Congress elected to enhance the federal match rates (FMAP) state Medicaid programs received, providing states with significantly more resources and flexibility to address key SDoH factors. Using these funds, more than half of responding states reported an expansion of programs prompted by the pandemic, particularly focused on housing improvements. This influx of state initiatives also indicates a concentrated effort to combat racial and ethnic disparities in health outcomes, with a particular focus on behavioral health, maternal and infant health and COVID vaccination rates. Of the states who responded to the survey, three-quarters reported enacting new initiatives to address these outcomes.

In total, new or enhanced benefits were reported by 22 states in fiscal year 2021 with 29 states adding or enhancing benefits moving into fiscal year 2022. An example of a key benefit adopted by states involves the use of telehealth services, which have been especially beneficial for behavioral health recipients in need of critical counseling or care while health practices were closed.

Other initiatives of note include North Carolina’s “Healthy Opportunities Pilots,” which covers non-medical services to address SDoH such as housing instability, lack of transportation and food insecurity. In Tennessee, in order to better identify critical factors impacting quality health, the state has launched a number of programs designed to screen and track social needs to enhance awareness of these determinants on the front end of a patient’s care.

Positive long-term impact

While in the coming months we will likely see the sun set on the public health emergency and states’ FMAPs normalize, the efforts many Medicaid programs have taken throughout the pandemic will have long-term benefits for those populations that SDoH initiatives have targeted.

If Medicaid programs across the country can find the means to continue to support these initiatives, the impact on those populations who struggled to see positive health outcomes previously may find the means to take ownership of their healthcare and reduce overall costs not just for themselves but for the programs in which they are enrolled.

Addressing SDoH means tackling healthcare inequity at its root and it’s heartening to know that this focus has the potential to help so many people nationwide.

Robert Pittman is Senior Vice President of Government Affairs at Modivcare.