Section 1115 waiver watch: Approvals to address health-related social needs

Section 1115 demonstration waivers provide states an avenue to test new approaches in Medicaid and generally reflect changing priorities from one presidential administration to another. The Biden Administration has encouraged states to propose waivers that expand coverage, reduce health disparities, and/or advance “whole-person care,” including by addressing health-related social needs (HRSN), also commonly referred to as social determinants of health (SDOH). In particular, both states and the federal government have identified addressing SDOH as a key Medicaid priority. The Administration recently provided more insight into how states can use Section 1115 authority to address enrollees’ social needs by approving waivers in four states (AR, AZ, MA, and OR) that include specified HRSN services for targeted populations; these HRSN initiatives encompass a small share of the overall Medicaid population and Medicaid spending. In all four approvals, CMS writes that the approved HRSN services are “expected to promote coverage, access to and quality of care, improve health outcomes, reduce health disparities, and create long-term, more cost-effective alternatives or supplements to traditional medical services.” This issue brief provides an overview of how waivers have been used to help address social needs, including a summary of these recent approvals.