CMS Provides New Medicaid Rules To Address Social Needs


The Centers for Medicare and Medicaid Services have updated their recommendations for states on how to deal with the social needs of Medicaid recipients that are related to their health. With the use of in lieu of services and settings in Medicaid managed care, this is being accomplished.

The choice will assist states in providing alternative benefits to address needs resulting from food insecurity and housing instability. According to CMS, states may implement in lieu of services and settings to provide personalised, medically appropriate meals for individuals who have severe, chronic illnesses that are exacerbated by poor diet, living in a food desert, or not having access to a variety of nutrient-dense foods.

The advice lays out guidelines that governments must adhere to in order to guarantee that the advances are both economically and medically appropriate. They must also uphold the safeguards and rights of enrolees and accomplish the goals of the Medicaid program. The new guidance expands on the efforts made by individual jurisdictions to replace services with activities. For instance, according to the Commonwealth Fund, CMS last year accepted a California proposal to offer asthma remediation in the home, food, and housing deposits in place of treatments.

When it is both medically necessary and financially advantageous to do so, in lieu of services permits health plans to pay for non-medical services instead of typical Medicaid benefits, the research stated. According to the Georgetown University Health Policy Institute, states can include clauses in their risk contracts that permit the managed care organisation to provide services in place of those offered with the beneficiary’s approval.

The cost of such a service is taken into account when a state incorporates it into a risk agreement with the MCO, according to the paper.

Most Medicaid recipients are registered with MCOs.

As reported by the Georgetown University Health Policy Institute, in 2021, more than two-thirds of managed care states included elements relevant to SDOH, such as mandates to screen participants for behavioural health issues, in their contracts with MCOs. According to the research, individual MCOs are creating their own initiatives, such as donations to food banks and other community-based organisations.

The effort, according to CMS, supports the National Strategy on Hunger, Nutrition, and Health and the Biden-Harris Administration’s goal to eliminate hunger and reduce diet-related diseases by 2030 while reducing inequities.

According to CMS Administrator Chiquita Brooks-LaSure, states have been constantly working to better fulfil the social and medical needs of people with Medicaid coverage. This announcement is the latest step in CMS’s effort to use every tool at its disposal to expand and protect coverage for all eligible people as they collaborate with the state partners to provide whole-person care, said a CMS spokesperson.