The Department of Health and Human Services (HHS) has implemented efforts to better address social determinants of health (SDoH) for certain programs and groups of people, but others face worsened conditions, according to a Health Affairs blog post.

HHS officials have spoken at length on efforts to implement integrated care models to address the physical, behavioral, and social needs of at-risk populations. This attention has led to improvements in certain areas, but neglect of more vulnerable groups, write Wynne Health Group’s Taylor Cowey and Josh LaRosa in a blog post  published by Health Affairs.

The authors note that select progress has been made with demonstration programs (such as the Primary Care First Model), flexibilities for Medicare Advantage plans to offer additional benefits for chronically ill members and supplemental benefits to address non-medical needs that influence health, and the use of Z codes to collect data on SDoH in patient outcomes.

However, the Trump administration has paid less attention to Medicaid programs, which are well-positioned to address SDoH, write Cowey and Josh LaRosa. "Rather than seeking to amplify, facilitate, or accelerate state innovation around the social determinants of health, the Trump administration has instead championed—often in ways that stretch the bounds of its legal authority—Medicaid reforms that increase barriers to care, leave fewer people enrolled, and that will likely strip billions of dollars from state budgets if fully implemented,” they write.

  • Among the areas of concern: Medicaid work requirements that require “able-bodied” beneficiaries to meet and report up to 80 hours of work or community engagement each month. If the requirement is not met, they will lose their health coverage entirely.
  • Medicaid block grants: States can now apply for block grants to receive a capped federal contribution for any optional coverage group, including the Medicaid expansion population, and to waive certain optional and mandatory benefits and services. But the authors note that block grants have been proven to cause state budget shortfalls, which can lead to a modification of benefits and services available to enrollees.
  • Medicaid transportation benefits: CMS is now reevaluating the longstanding mandatory program requirement for states to provide non-emergency medical transportation. Several states have been permitted to waive the requirement for expansion group adults, and a larger decision regarding a broader group of Medicaid enrollees is pending.

Although the federal government’s new aimed focus on SDoH is important, the authors call for more aggressive action for Medicaid enrollees and the millions of low-income people who receive benefits under the Supplemental Nutrition Assistance Program or SNAP.

“If the concept of the social determinants of health is most aggressively brought to bear only where it is most likely to yield shared savings for providers and health systems, profit margins for managed care plans, or taxpayer savings, then it isn’t of much use to the people it was designed to describe and serve,” Cowey and LaRosa write.

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