Brief offers roadmap for Medicaid coverage of social services

U.S. roadmap

Though Medicaid is primarily a health insurance program, increasing awareness of how social factors influence health outcomes requires state agencies to weave social interventions into their coverage, payment and delivery models, according to a new issue brief from the Milbank Memorial Fund’s Reforming States Group.

To offer guidance for state policymakers looking to do so, the brief first outlines the legal and regulatory authorities that could pave the way.

State plan amendments, it explains, are the simplest way to secure funding, and can be used when the Medicaid statute directly allows for coverage of a particular service or activity. State plan amendment-based options include case management and targeted case management services, preventive and rehabilitative services, habilitative services and home health services.

There also are several waiver opportunities, such as section 1115 demonstration program waivers and home and community-based services waivers. Finally, Medicaid managed care and other alternative payment models play a role, as managed care organizations are obligated to cover case management and any other social support services that are built into the state’s benefit package.

The brief also discusses social support and other services that Medicaid may be able to cover, including state-specific examples. They include:

  • Linkages to non-covered social services. In Colorado, for example, Regional Care Collaborative Organizations are paid to help beneficiaries navigate various appointments, refer beneficiaries to social service programs and work with local agencies to address community issues.
  • Housing services. States can take a page from Louisiana, which offers supportive housing services to certain individuals through its Permanent Supportive Housing Program, or Oregon, which provides housing supports through its 1115 waiver that established regional Coordinated Care Organizations.
  • Employment services. Maryland has led the way by providing 19 different habilitation services for children and adults with developmental disabilities through its Community Pathways Waiver. Covered services include job coaching, job training, and monitoring and evaluating performance at the workplace.
  • Peer support services. Georgia, the first state to cover peer support services in its Medicaid program, connects enrollees with serious mental illnesses to state-certified and trained peer support specialists, and New York added “peer specialists” to its list of authorized care team members in the state’s Health Home program.

These opportunities and examples are not the only ones possible, however, the brief adds, as states “may find that there are even more ways to use Medicaid to address social issues when it is cost-effective to do so.”

- read the brief (.pdf)