Addressing social determinants of health via Medicaid managed care contracts and section 1115 demonstrations

The conditions in which people live, learn, work, and play affect health in myriad ways. State Medicaid agencies are increasingly exploring opportunities to address these social determinants of health (SDOH) in an effort to provide more efficient care and improve health outcomes. As states begin to support these efforts, they are thinking strategically about how best to align SDOH-related activities with other reforms — such as value-based purchasing, care transformation, and the development of cross-sector partnerships.

This report, developed by the Center for Health Care Strategies for the Association for Community Affiliated Plans (ACAP), examines 40 Medicaid managed care contracts and 25 approved § 1115 demonstrations across the country to identify common themes in state approaches to incentivizing and requiring SDOH-related activities. These requirements or incentives most often encourage managed care plans and other health care organizations to adopt SDOH-focused systems and partnerships to screen for social needs and provide linkages to community resources.

In the report, CHCS outlines policy recommendations to support investments in SDOH, including: Make it easier for vulnerable populations to access needed health services; Enhance agency collaboration at the federal level; Provide guidance on addressing SDOH through managed care; Approve § 1115 demonstrations that test strategies to address SDOH; and Support outcomes-based payment for SDOH interventions.