The Mandate for SDoH Legislation and Funding

Recent conference reveals proposed legislation focused on the social determinants of health.

Last week I got a bird’s eye view of all that is happening in the area of the social determinants of health (SDoH), while chairing RISE Association’s Annual SDoH Summit in Nashville. Among the most popular topics were ways upcoming federal and state legislation would support programs addressing the SDoH, along with continuing mandates for funding, reimbursement, and creative programming.

On the legislative landscape, the 117th Congress has seen a number of bills introduced focused on the SDoH. Of the major health equity packages, 28 bills focus on health disparities and equity, while 59 address maternal and infant health. 

Among the proposed bills for the 2022 fiscal year are:

• $153 million to the Centers for Disease Control and Prevention (CDC) SDoH program, an increase of $150 million from 2021;
• $200 million targeted to reduce maternal mortality and morbidity;
• $25 million to the Centers for Medicare & Medicaid Services (CMS) to address health equity, which includes steps to fulfill President Biden’s equity executive order on advancing racial equity and support for underserved communities; and
• $551 million for home or community-based healthcare services targeting increased funding for the Lifespan Respite Care Program and other programs for older Americans and individuals with disabilities.

This legislation and the associated dollars can’t come soon enough. A recent study from Castlight Health identified employees reporting barriers to accessing necessary health services, mental health services, and medication through their commercial insurance plans. This study is the first of its kind to explore the prevalence of SDoH-related barriers with associated clinical risk factors for common medical conditions within the large and diverse commercially insured population.

We’ve focused in prior articles on the growth and expansion of Medicare Advantage (MA) and Managed Medicaid plans. The focus of Castlight Health’s study was over 200 employers with employees in all 50 U.S. states, and represented industries across sectors, ranging from 1,000 to 500,000 employees. Insurance does not guarantee access to care or resources to preserve general health, behavioral health, and wellness. Specific to obstacles in accessing care are the following:

• 56 percent of those polled identified cost or insurance obstacles;
• 26 percent noted challenges with family, school, or work responsibilities; and
• 4 percent identified travel or transportation issues.

There was no consistency in how or to what extent the employer-sponsored resources addressed these needs. A total of 70 percent of employers provided behavioral health services through employee assistance programs (EAPs) and other programs, with 63 percent providing telehealth programs as an alternative. This is a big shift, and a direct result of COVID’s impact. However, despite this win, other pressing SDoH did not receive attention:

• Barely 1 percent of the commercial plans offered programs focused on healthy foods;
  • Just 7 percent offered financial programs; and
  • Less than 0.5 percent offered either child care or transportation support programs.

Our Monitor Mondays Listeners Survey asked our audience what SDoH benefits they would like to see added to commercial plans, with the results here.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting of SDoH issues every Monday during Monitor Mondays, 10 Eastern.