MACPAC Addresses SDOH for Medicaid Recipients

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?

To learn how others have responded to the Monitor Mondays listener survey, click here.

Programming Note: Listen to Tiffany Ferguson live reporting on the SDOH every Monday on Monitor Mondays at 10 Eastern.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Tiffany Ferguson, LMSW, CMAC, ACM

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the ACPA Observation Subcommittee. Tiffany is a contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group. Tiffany received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

Related Stories

Hospital Closures: A Gordian Knot

Hospital Closures: A Gordian Knot

The acceleration of hospital closures in the United States indicates an evolving restructure of the healthcare delivery system. What are some of the effects on

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →