Biden HHS Expected To Beef Up Social Determinants Of Health Efforts

January 20, 2021

The Biden administration is expected to fortify existing policies and increase funding to deal with social determinants of health. In the weeks leading up to Wednesday’s inauguration, President Joe Biden and Vice President Kamala Harris spoke about a need to address social determinants as the country tries to recover from COVID-19.

“I think that [the Biden] administration may end up being the most supportive of Medicaid public health partnerships to address social determinants that we've ever had,” J.T. Lane, chief population health and innovation officer for the Association of State and Territorial Health Officials recently told Inside Health Policy.

Pennsylvania Secretary of Health Rachel Levine, who was tapped Tuesday (Jan. 19) to be assistant secretary of health, spoke about social determinants in a Jan. 12 press call with the Center for American Progress, further signaling the Biden administration will devote attention to these issues.

“Lack of transportation availability is a health issue. Of course, the environment is a health issue, nutrition is a health issue, educational opportunity, those are all health issues,” Levine said on the call.

Stakeholders were pleased that Trump’s CMS recently encouraged states to tackle social determinants of health through Medicaid and CHIP, but they hope to see more tangible efforts -- and funding -- for such efforts from the new Biden team.

CMS wrote to state health officials earlier this month encouraging them to use Medicaid and CHIP to take on social determinants of health. Then CMS Administrator Seema Verma published a blog post on Tuesday (Jan. 19) highlighting the agency’s moves to address social determinants over the last four years and reiterating the points in the earlier letter.

The Jan. 7 letter listed Medicaid programs that could help states address food, housing and education access, which can affect health. However, the memo did not outline any new opportunities for states; it simply highlighted their already existing options.

For example, the letter said, states can provide non-medical transportation services, home-delivered meals and several other supports to beneficiaries through Section 1915(c) home- and community- based services waivers. The letter also reminded states that the Program of All-Inclusive Care for the Elderly can be used to provide meals and nutritional counseling, social work services, transportation and more to some elderly individuals.

The letter affirmed that many services can be provided via telehealth, and the agency encouraged states to figure out if unnecessary restrictions prevent programs from being delivered through that way.

CMS also pointed to 1115 demonstrations as another way states can get a handle on social determinants. But it remains to be seen whether many state agencies will implement innovative programs through such waivers, since the demonstrations as of now would have to be budget neutral to get CMS’ approval, said Abner Mason, founder and CEO of ConsejoSano, which specializes in Medicaid and Medicare health plan member outreach.

Still, Mason was pleased to see the letter said federal matching funds are available for programs that are designed to identify and enroll eligible individuals.

Despite the lack of new options, having a document that lays out programs to address social determinants is still helpful for state officials, said Matt Salo, executive director of the National Association of Medicaid Directors.

Medicaid directors were beginning to pay more attention to social determinants prior to the COVID-19 pandemic and the economic downturn, Salo said, but the efforts lost steam during the health emergency. But the pandemic has laid bare the inequities in America, he added.

"If we as a society are going to get serious about addressing some of those inequities and disparities, it seems increasingly clear that things like the social determinants of health are going to have to be front and center,” Salo said.

Indeed, the letter shows that CMS is committed to keeping the conversation around social determinants going, said Jerry Vitti, founder and CEO of Healthcare Financial, Inc., which connects people with public benefit programs. He wants to see more substantial action from the agency, though.

But he also said carrying through requires money.

"To do all this stuff requires investment,” he said. “And you can write a terrific publication, but unless it's backed by concrete dollars, unfortunately it's just a continuation of a lot of talk.”

That’s where potentially more funding from the Biden administration could come into play, stakeholders say. -- Maya Goldman (