Benefits are largely dictated by how each state manages its Medicaid program.
The MACPAC (different from the RACs, or Recovery Audit Contractors) stands for the Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission. This organization released an issue brief last month on “Financing Strategies to Address the Social Determinants of Health in Medicaid’.”
The brief set out to address the extent to which Medicaid beneficiaries experience social risk factors that affect their health. It then focused on the primary mechanisms for how these factors could be addressed, either through state plan benefits, contracts with managed care plans, and/or state waivers or grants.
So, here is what we learned about our Medicaid population: first, in 2020, the rate of food insecurity for low-income households was more than double the national average. In 2019, Black, Hispanic, and Indigenous American beneficiaries were more likely than their white counterparts to pay unaffordable rent, be unemployed, and lack high-speed Internet, and were more likely to obtain Supplemental Nutrition Assistance Program benefits.
When it comes to financial benefits that could be provided to Medicaid recipients, the options were all over the place. A key factor is the logistics of how each state manages its Medicaid program, who they consider eligible for services, and how they choose to delegate funding, either through a state-run plan or a managed care plan. Generically, the federal government has offered across-the-board services, such as options for case management and non-emergency medical transportation; however, there are still limitations in even these options. For instance, a mother needing medical transport may or may not be able to allow her child to ride along to the appointment, depending on her state, and thus may have to find childcare. Some states, such as Colorado, provide additional case management services for individuals transitioning from institutional settings back into the community; however, in other states, where managed care organizations (MCOs) run the Medicaid plans, case management services are strictly maintained through the payors.
I am just reading the report, and I am already overwhelmed by the red tape and logistics of determining the possibility of benefits (or lack thereof). Being poor is a full-time job, and as reported by The Hastings Center, “being poor with chronic illness is two full-time jobs.” Poor people are often so preoccupied with the challenges of daily living that they have less “bandwidth” to care for or maintain their health. Anyone who has tried to arrange a ride through a transport company for their Medicaid patients understands the logistical difficulties with multiple switchboards, entities that although contracted do not want to accept Medicaid patients because there is no tip, and often learning that there is a four-hour window for when the ride will actually arrive.
So, I ask, do you think Medicaid should help cover social determinants of health (SDOH) services for their recipients such as housing and food support?
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