On November 16, 2023, the Centers for Medicare & Medicaid Services (CMS) released new guidance detailing the coverage pathways for services and supports to address health-related social needs (HRSN) services, such as housing and nutrition interventions, in Medicaid and the Children’s Health Insurance Program (CHIP). This guidance responds to growing nationwide momentum to address negative health outcomes, rising health care costs, and deepening disparities by incorporating HRSN into patient care and was released as part of the Biden-Harris Administration Action to Improve Health and Wellbeing by Addressing Social Determinants of Health.
The Center for Health Law and Policy Innovation (CHLPI) has created a summary of the new policy changes here. The guidance also includes an associated table detailing allowable HRSN services. The guidance and table explain four coverage pathways: (1) In Lieu Of Services and Settings, (2) Home and Community-Based Services authorities, (3) Section 1115 Demonstrations, and (4) CHIP Health Service Initiatives; and analyzes ten housing/home environment interventions and five nutrition interventions for each of these coverage authorities, noting coverage limitations, exceptions, and examples for several services.
Stakeholders will note several policy clarifications of interest. For example, CMS has stated that under section 1115 demonstrations, coverage for nutrition interventions that involve the direct provision of food, e.g., medically tailored meals and produce prescriptions, can be provided for up to six months and “may be renewed for additional 6-month periods if the state determines the beneficiary still meets the clinical and needs-based criteria.” Read more about this and other policies of note, here.
To further explore the guidance and provide stakeholders with analyses of potential on-the-ground implications for Medicaid managed care agencies, community-based organizations, and others seeking to address HRSN in Medicaid and CHIP, CHLPI will be hosting a webinar with a panel of experts.
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