Medicaid coverage of social interventions: A road map for states

Extensive research demonstrates the impact of social factors—such as income, access to food and housing, and employment status—on the health and health
outcomes of Americans, particularly lower-income populations. These findings are not lost on federal and state officials who seek to provide Medicaid beneficiaries with quality, cost-effective care. In developing strategies to address both the medical and social determinants of health, states face several challenges, including, primarily, how to provide a revenue stream to cover the cost of the social services. After all, Medicaid is first and foremost a health insurance program. Nonetheless, under some circumstances, Medicaid is available to cover the costs of social service interventions linked to the health of Medicaid enrollees.

Faced with mounting evidence about these social factors, state Medicaid agencies are looking for ways to integrate social interventions into their coverage, payment, and delivery models. As federal and state Medicaid officials look to improve health outcomes and to do it cost effectively, they must decide how far to go in tackling social issues, recognizing that Medicaid is not a social services program, and that there are limits on how it can be used.

This issue brief was prepared at the request of the Milbank Memorial Fund’s Reforming States Group (RSG), with support from the New York State Health Foundation, to help policymakers better understand Medicaid coverage for social interventions. Supported by the Fund since 1992, the RSG is a bipartisan group of state executive and legislative leaders who, with a small group of international colleagues, meet annually to share information, develop professional networks, and commission joint projects.