Addressing social determinants of health through dual-eligible special needs plan: Gap analysis and policy developments

The more than 12 million Americans who are dually eligible for Medicare and Medicaid often have multiple chronic medical and behavioral health conditions, long-term care needs, and significant social determinant of health (SDOH) needs. Addressing their SDOH needs could help dually eligible individuals by improving access to and the effectiveness of their Medicare and Medicaid benefits, improving health outcomes and quality of life, and reducing health care costs.

Increasing recognition of the impact of non-medical factors on health and health outcomes led Congress and the Centers for Medicare & Medicaid Services (CMS) to create pathways for addressing Medicare beneficiaries’ non-medical needs. Recent CMS guidance described Special Supplemental Benefits for the Chronically Ill (SSBCI), which can include non-primarily health-related supplemental benefits (e.g., meals, food and produce, non-medical transportation, pest control, indoor air quality equipment and services, structural home modifications) that could address SDOH needs. Beginning in 2020, Medicare Advantage plans could offer SSBCI to members with certain chronic conditions.