New CMS SDoH Resource: More Memorandum than Roadmap?

The roadmap is a comprehensive and exhaustive review of all services and supports available to Medicaid recipients.

Last week’s report on the state of the social determinants of health

(SDoH) offered my crystal ball of what healthcare organizations and systems can expect for the year to come. Most are still waiting for sound Centers for Medicare & Medicaid Services (CMS) guidance to tackle the SDoH, or at least point them in the right direction. With Medicaid expenditures over $600 billion for 2020 and expected to keep rising in 2021, there’s plenty of pent-up demand for strategic action in this area. CMS’s new Medicaid Social Determinants of Health Roadmap is being touted as an important step to mitigate fiscal and clinical gaps for providers.

On Jan. 7, letters were sent to state officials by federal officials. For those who either tossed the document aside or deleted the email, the subject heading was: Opportunities in Medicaid and CHIP to Address Social Determinants of Health (SDoH). The letter frames opportunities for Medicaid and Children’s Health Insurance Program (CHIP) programs to best address the SDoH and support states with requisite programs, benefits, and services that will improve population health, reduce disabilities, and lower healthcare costs.

The letter described:

  • Principles that CMS expects states to adhere to within programs, when offering services and supports that address the SDoH
  • Such services and supports commonly covered in Medicaid and CHIP programs, including:
    • Housing-related items, such as accessibility modifications or one-time community transition costs from institutional or other provider-operated congregate living arrangements (group homes or homeless shelters, for example) to community-based living arrangements in a private residence at the recipient’s expense;
    • Non-medical transportation;
    • Homecare through waiver programs;
    • Home-delivered meals for older adults and individuals with disabilities;
    • Individualized education plans for children with disabilities;
    • Employment incentives; and
    • Community integration and case management programming.
  • Federal and other opportunities under Medicaid and CHIP that states can use toward SDoH efforts, including but not limited to:
    • Services offered at federally qualified health centers and rural health clinics;
    • Targeted case management programs;
    • Home and community-based services for older adults, people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses; and
    • The Program for All-Inclusive Care of the Elderly (PACE).

The document is lengthy: 36 pages, followed by a 15-page tables that summarizes all the information. There is no magic wand in the accompanying envelope or email that providers can wave to automatically implement the recommendations. To be fair, the Roadmap is a comprehensive and exhaustive review of all services and supports available to Medicaid recipients, plus a solid resource tool for my case management colleagues. Monitor Mondays listeners were asked how much they anticipated the new Roadmap would benefit their organizations; the results were telling.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the social determinants of health on Monitor Mondays, 10 a.m. Eastern.


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