Comprehensive review of state managed care contracts and 1115 waivers detail effective SDOH integration strategies
Manatt, Phelps & Phillips, LLP, a multidisciplinary, integrated professional services firm, announced today the release of its latest survey, which provides a comprehensive review of states’ social determinants of health (SDOH) initiatives through Medicaid managed care contracts and 1115 waivers. The report, titled “In Pursuit of Whole Person Health: A Review of Social Determinants of Health (SDOH) Initiatives in Medicaid Managed Care Contracts and 1115 Waivers,” was conducted by Manatt Health, the firm’s healthcare legal and consulting group. With Medicaid being the largest payer of healthcare for the low-income populations that are disproportionately impacted by social and economic challenges, this report takes a deep dive into the ways states can effectively integrate SDOH into the Medicaid delivery system and leverage 1115 waivers to foster innovation.
“This pandemic—and its disproportionate impact on low-income communities and communities of color—has brought the need to address SDOH into sharp focus,” said Melinda Dutton, partner with Manatt Health, who coauthored the report alongside director Naomi Newman, manager Mandy Ferguson and partner Cindy Mann. Newman added: “Our report serves as a resource for states, health plans, provider organizations and other stakeholders looking to improve overall health for their most vulnerable populations.”
This report details how states are using their Medicaid managed care contracts and 1115 waivers to address unmet social needs and drive innovation in this space. Through an in-depth review of the contracts of each state and territory with Medicaid managed care (41 in total), Manatt identified the provisions and subsequent intervention methods related to SDOH, and categorized them by type of service or intervention (e.g., screening and referral requirements, quality metrics); targeted populations (e.g., pregnant women, children, people experiencing homelessness); and targeted domains (e.g., housing, food/nutrition, employment).
An infographic to help illustrate the findings can be found here. The full report, including detailed state profiles with contract language, can be located through a subscription to [email protected] Health, an original content information service providing a wide range of premium analysis and data on breaking industry news and trends; in-depth evaluation of state and federal health policy changes; detailed summaries of Medicaid, Medicare and Marketplace regulatory and sub-regulatory guidance; and 50-state surveys on critical industry issues.
This report was compiled through an analysis of the contracts and 1115 waivers of each of the 41 states and territories with Medicaid managed care conducted between October 2019 and June 2020. In certain instances when states’ managed care organization (MCO) model was not released, Manatt utilized the state’s MCO “request for proposals” to understand the scope of SDOH-related requirements on plans. Of the 41 states and territories, two requested that their profiles be withheld from this publication due to ongoing MCO procurements and contract amendments.
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