The U.S. Department of Health and Human Services (HHS) defines social determinants of health (SDOH) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” SDOH often refers to community-level circumstances that affect health outcomes. A community’s underlying SDOH influence individual health-related social needs (HRSN), such as food security, housing stability, and health care access.
Three years into its tenure, the administration of President Joe Biden has directed federal agencies through executive orders to address SDOH and promote racial equity. Reflecting this commitment, HHS released a Strategic Approach to Addressing the Social Determinants of Health to Advance Health Equity, which aims to make health outcomes more equitable by better coordinating health and human services and by addressing the underlying systemic and environmental factors that affect health status.
The Centers for Medicare & Medicaid Services (CMS) also released the CMS Framework for Health Equity 2022-2032, laying out the agency’s commitment to advancing health equity, expanding health coverage, and improving health outcomes; and the Blueprint for Addressing the Maternal Health Crisis, including actions to strengthen economic and social supports for people before, during, and after pregnancy.
This policy brief discusses how HHS has leveraged its authority under Medicaid and Medicare to advance policies aimed at addressing SDOH and HRSN.
Policy Brief – Social Determinants of Health in Medicaid and Medicare Policy
Key takeaways:
- While federal Medicaid rules prohibit expenditures for most nonmedical services, CMS has provided flexibility for state Medicaid programs to identify and address SDOH and associated enrollee HRSN.
- There are several mechanisms in Medicaid statute and regulations through which managed care plans can address SDOH, including Section 1915(b)(3) services, state directed payments, incentive payments, and more.
- In Medicare, CMS is actively addressing SDOH by restructuring provider reimbursement to include payments for services that actively promote equity and address underlying societal factors impacting health outcomes.
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