Medicaid managed care has the potential to help states address social determinants of health by expanding coverage of value-based services, according to a new report.
The report was put out by Together for Better Medicaid and Health Management Associates (HMA). The analysis reviewed 10 recent state requests for proposals, from 2020 and 2021, and revealed that state Medicaid agencies are increasingly committed to addressing SDOH and health equity.
“States looking to address social determinants of health and health equity are increasingly turning to the managed care model for its flexibility and ability to incentivize better, more equitable health outcomes,” HMA Regional Vice President Kathleen Nolan said in the announcement. “Our review of states’ recent contracting processes demonstrates that they see the value in managed care because of its ability to support the health of vulnerable communities.”
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Managed care organizations (MCOs) are not tied to a fee-for-service model, the report explains, and with features like care coordination are therefore better suited to address SDOH and health equity. They can also offer value-added services beyond the medical benefits authorized under the state plan. States can mandate that they work on these areas, the report noted, through contract requirements. For instance, Hawaii requires MCOs to utilize predictive analytics to identify enrollees who could benefit from their services. States can also create financial incentives for MCOs based on outcomes.
The report found that many states have implemented screening requirements for social needs and require MCOs to incorporate them into their quality assessment and performance improvement programs. Related to that work, states are also requiring MCOs to partner with community-based organizations to address social needs.
States have also begun to require MCO staff to be trained on SDOH, disparities, diversity and inclusion. Thirty-three Medicaid managed care states have contract requirements related to SDOH in place, the report found, while an additional 18 indicated their intent to incorporate some in the coming fiscal year.
Seven in 10 Medicaid managed care plans said in a recent survey that they offered a plan that aimed to address health inequities over the past year as the pandemic caused plans to stretch resources. The survey found that a large majority of plans (95%) gave targeted services to members' social needs that include housing support as well as food and nutrition services.