A December 10th, 2024, Informational Bulletin from the Centers for Medicare & Medicaid Services (CMS) underscores the opportunities for states to leverage Medicaid and Children’s Health Insurance Program (CHIP) authorities to deliver critical services that address individual-level Social Determinants of Health (SDOH).
CMS continues its commitment to advancing health equity and improving health outcomes by addressing Health-Related Social Needs (HRSN). This innovative approach aims to reduce disparities, enhance care access, and improve outcomes for vulnerable populations.
Comprehensive research released by HHS’ Office of the Assistance Secretary for Planning and Evaluation (ASPE) shows that SDOH and the associated HRSN can influence up to 50 percent of health outcomes.
Breaking Down HRSN Coverage in Medicaid and CHIP
CMS outlines several avenues for states to fund HRSN services under Medicaid and CHIP, including:
- Managed Care In Lieu of Services and Settings (ILOSs): Enables cost-effective, clinically appropriate substitutes for traditional medical services, such as tenancy support or sobering centers.
- Home and Community-Based Services (HCBS) Waivers and State Plan Programs: Offers a broad array of supports like home modifications and caregiver respite.
- Section 1115 Demonstrations: Facilitates experimental programs, such as short-term housing with clinical services, while allowing states flexibility in defining targeted populations.
- CHIP Health Services Initiatives (HSIs): Provides funding for public health programs aimed at improving children’s health, such as nutrition and housing interventions.
The framework includes interventions ranging from housing and utility assistance to medically tailored meals and case management. Strict guidelines can ensure these services complement rather than replace existing social services, protecting fiscal and program integrity.
The Importance of Addressing HRSN
Addressing unmet HRSN is essential for improving care continuity, reducing health inequities, and lowering long-term costs. CMS highlights the critical role of targeted services in stabilizing housing and nutrition, particularly for populations at high risk of adverse health outcomes. This approach not only improves health outcomes but also strengthens connections to Medicaid-covered services, mitigating enrollment churn and creating a more stable healthcare ecosystem.
Breakdown of Eligible HRSN Coverage in Medicaid and CHIP
CMS provides a framework for states to address Health-Related Social Needs (HRSN) through Medicaid and CHIP. Below is a breakdown of eligible coverage categories, highlighting the types of services that can be funded under these programs:
| Coverage Categories | Description | Examples |
|---|---|---|
| Case Management for HRSN | Coordination of care and services to address social needs that impact health. | Assessment, service referrals, and follow-ups. |
| Housing/Home Environment Interventions without Room and Board | Support services that help individuals maintain stable housing or improve living environments, excluding payment for room and board. | Home modifications, pest control, utility assistance, and tenancy support. |
| Housing Interventions with Room and Board | Short-term or transitional housing combined with Medicaid-covered clinical services. | Temporary housing for individuals post-discharge with accompanying health services. |
| Room and Board Only | Coverage for basic shelter costs in specific scenarios, such as for individuals experiencing homelessness. | Shelter costs in emergency settings or transitional housing. |
| Nutrition without Provision of Food | Nutritional counseling and support services to address dietary needs and improve health outcomes. | Nutrition education and meal planning support. |
| Nutrition with Provision of Food | Services that include direct food assistance to address critical nutritional gaps. | Medically tailored meals or groceries delivered to high-risk individuals. |
How HORNE Can Help States Navigate HRSN Policies
At HORNE, we understand the complexities of implementing innovative Medicaid policies. Our team can assist states in designing, implementing, and ensuring the integrity of  HRSN programs to ensure compliance with CMS guidelines and achieve meaningful outcomes.
Our services include:
- Program Design: Guiding states through the complexities of HRSN policies to develop compliant, effective program frameworks that address health outcomes and optimize funding opportunities.
- Braided Funding: Leveraging expertise to coordinate multiple federal, state, and local funding streams while maintaining compliance with distinct reporting and eligibility requirements.
- Implementation & Support: Ensuring operational readiness for delivering new interventions.
- Accountability & Oversight: Monitoring financial and quality performance, managing risks, and evaluating program impacts and improvement.
Together, we can navigate the complexities of HRSN coverage and foster innovation to improve health equity and outcomes.
Closing Thoughts
CMS’s expanded guidance on HRSN underscores a transformative moment for Medicaid and CHIP programs. States now have unprecedented opportunities to address social determinants of health, drive innovation, and improve lives.
To learn how HORNE can support your HRSN initiatives, reach out to us today.
HORNE IS HERE TO HELP!
Contact Kade Moody | Managing Partner, Healthcare
888.821.0202 | [email protected]
References:
- Updated CMCS Informational Bulletin: Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and CHIPÂ (December 10, 2024)
- Informational Bulletin on Opportunities for Improving Access to Mental Health and SUD Services for Medicaid and CHIP Enrollees Experiencing Homelessness (May 10, 2024)
- Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts (April 1, 2022)
- Health Related Social Needs | CMS
