Annual Report Highlights Medicaid Managed Care Organization Programs and SDoH

The report provides detailed information on successful Medicaid initiatives across the states.

Much has been written this past year about Medicaid’s response to issues associated with the social determinants of health (SDoH). Whether in an expansion state or not, all Medicaid programs have seen dramatic increases in enrollment due to pandemic-related unemployment, disability, food insecurity, and other factors. These realities were highlighted in the latest 50-state Medicaid Budget Survey for 2021 and 2022.

The survey is a collaboration by the Kaiser Family Foundation, Health Management Associates, and the National Association of Medicaid Directors. Data on Medicaid program spending was compiled from Medicaid officials in all 50 states and Washington, D.C. during summer 2021, the timeframe immediately prior to the COVID-19 Delta variant’s onslaught, and latest wave of COVID transmission, hospitalizations, and deaths.

The SDoH figure prominently among other key themes addressed in the report: delivery systems, benefits and telehealth, provider rates and taxes, and pharmacy factors. SDoH content highlights include the following:

• Relevant managed care organization (MCO) and non-MCO policies;
• Initiatives to address health disparities; and
• COVID-19 vaccine efforts.

The following data points were of note:

• >75 percent of Medicaid beneficiaries were enrolled in MCOs.
  • Children and adults (particularly those in expansion states) were more likely to be enrolled in MCOs than elderly individuals or individuals with disabilities.

• Benefits expanded dramatically across Medicaid plans, particularly behavioral health services, care for pregnant and postpartum women, dental benefits, and housing-related supports. All 50 states allow Medicaid reimbursement for some aspect of live video telehealth visits. On a side note, the National Conference of State Legislatures offers current information on the scope of coverage across the states.

• 75 percent of responding states cited initiatives to address health and racial disparities, many focused on specific health outcomes, including maternal and infant health, behavioral health, and especially COVID-19 outcomes and vaccination rates. 

• In addition:
  • 33 percent of MCOs screen for behavioral health
  • 31 percent provide enrollees with distinct social service referrals
  • 27 percent partner with community-based organizations
  • 24 percent screen for social needs
  • 11 percent use uniform SDoH questions within their screening tools
  • 10 percent employ community health workers
  • A disappointing 7 percent of state MCO plans captured SDoH data using the ICD-10-CM Z codes, while 9 percent plan to integrate the codes in 2022 – so we’ve got work to do, Dr. Erica Remer!
  • 5 percent track outcomes of social services referrals; that doesn’t speak well for closing the loop!
  • 6 percent require community investment

The report itself provides detailed information on successful Medicaid initiatives across the states, and it’s worth the read. The report also presented an opportunity to query our Monitor Mondays listeners on whether their organizations capture SDoH data using the ICD-10-CM Z Codes; the responses appear here.

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