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COVID-19 Plan Could Lead Medicaid To Cover More Social Determinants

February 03, 2021

President Joe Biden’s national COVID-19 response plan commits to expanding the social service safety net to provide for unmet basic needs exacerbated by the pandemic, which experts and advocates say will likely translate into broadening Medicaid to cover more social determinants of health down the road. But while Medicaid advocates and state officials agree access to nutrition, stable housing and other social needs should be expanded, they don’t think Medicaid should absorb all the costs.

The COVID-19 pandemic has highlighted the link between social determinants like nutrition, housing and employment and health. The strategy plan shows the administration’s understanding of that connection, said Manatt Health Partner Melinda Dutton.

“I think what we're seeing from the administration is a recognition of that and a commitment to being more thoughtful and more directive in terms of how we're addressing those needs,” she said.

A White House spokesperson said on a press call last Thursday (Jan. 28) that the administration is committed to addressing social determinants and making sure Medicaid properly serves beneficiaries, but the spokesperson did not share any concrete plans for broadening Medicaid coverage to tackle social determinants.

The administration already took action to strengthen Medicaid and improve access to the health care option through an executive order signed last week. The administration has also placed a focus on increasing health equity. Abner Mason, CEO of Medicaid and Medicare health plan member outreach startup ConsejoSano, said this focus ties directly into increasing social determinant programs.

“Broader coverage of SDOH services will go a long way in reducing health disparities and promoting health equity in the Black and brown communities most affected by COVID,” Mason said in an email.

J.T. Lane, chief population health & innovation officer at the Association of State and Territorial Health Officials, said it makes sense the administration would want to increase the kinds of services paid for by safety net programs like Medicaid to improve health outcomes during the pandemic. The government has already invested in these services through the CARES Act and other pandemic response legislation, he said.

“There's a major opportunity to strengthen the services that are there with additional investment to help people make it to that place where they can bounce forward and fully recover from this,” he said.

Lane previously told Inside Health Policy the Biden administration could end up becoming the most supportive administration of Medicaid public health partnerships to cover social determinants. Matt Salo, executive director of the National Association of Medicaid Directors, said the strategy plan’s commitment to strengthening safety net programs will probably lead to the administration broadening Medicaid coverage of social determinants down the road.

But while Salo agrees access to nutrition, stable housing and other social needs should be expanded, he isn’t convinced Medicaid should absorb all the costs.

“Medicaid is probably poised to more quickly and effectively address these issues,” Salo wrote in an email. But he added that it’s “not sustainable, however, for the world to rely on Medicaid to solve all social ills.”

Medicaid is well positioned to take on social determinants when they can be tailored to an individual or small group, he said. Covering nutrition or housing for all beneficiaries would balloon Medicaid costs.

Other stakeholders agreed Medicaid can’t be a catch-all. It’s important to figure out the most efficient way to improve a beneficiary’s situation, Dutton said. For example, it might make sense to pay for a nutritious food box for a diabetic whose condition is worsened without healthy food, she said. But coordination between CMS and other federal agencies is necessary to fully tackle social determinants.

Lane said the national strategy plan shows a commitment to this coordination by pledging to support efforts to align health and social interventions.

"To me, that says that while we want to expand and strengthen that net, we can't expand without supporting, and even in many in some cases requiring, greater coordination across the federal apparatus, at the state level and the local level,” Lane said. -- Maya Goldman (mgoldman@iwpnews.com)