Updated on: March 4, 2021

Medicaid Managed Care Organizations Address Healthcare Disparities

Original story posted on: March 3, 2021

New AHIP report touts Medicaid MCO action for SDoH.

While pressure continues for states to rein in costs associated with health and behavioral health, strategies to leverage Managed Medicaid are getting fierce attention. America’s Health Insurance Plan’s (AHIP’s) latest report, Social Determinants of Health and Medicaid, is a worthy read for organizations ready to flex their advocacy muscles with the facts.

Medicaid provides access to essential healthcare and behavioral healthcare for more than 77 million low-income adults, children, pregnant women, elderly citizens, and persons with disabilities. As a result, there is unique opportunity to address disparities that disproportionately impact vulnerable populations.

Primary policy recommendations encompass five actions:

    1. Increase flexibility in Medicaid waivers.
    2. Create pathways for interdisciplinary and interagency waivers, such as partnering with state agencies that have oversight for housing and employment. In this way, a state’s Medicaid and housing agencies could apply to the Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Housing and Urban Development (HUD) for joint waivers to provide integrated health homes for homeless individuals with severe mental illness, pairing comprehensive medical and behavioral healthcare with housing assistance.
    3. Broaden interpretations of quality improvement activities for the purposes of calculating Medicaid plan medical loss ratios (MLRs) to include expenditures for interventions that address the social determinants of health (SDoH); this will allow these activities to be treated as “health-related” versus being categorized as “administrative costs.”
    4. Permit greater latitude in the use of “in lieu of services” (ILOS).
    5. Extend flexibilities allowing Medicaid Managed Care Organization (MCO) providers to participate in pooled funding arrangements with others in the community.

The report also lists documented return on investment from managed Medicaid programs in action:

      • A Midwest MCO saved more than $10,000 per member annually by providing short-term, transitional housing and healthcare through 50 single-room units provided to their homeless members. Hospital and skilled nursing facility inpatient stays for individuals in the program declined by 40 percent. Members received medical care, behavioral health and recovery-focused services, peer support, case management, housing navigation services, life skills training, and stability, with eventual connection to long-term permanent housing.
      • A Northwest Medicaid MCO provided weekly delivery of ready-to eat meals to dually eligible Medicaid and Medicare members. Savings yielded $753 per member, per month from decreased inpatient admissions and fewer nursing facility admissions; it added up to a 16 percent reduction in costs.
      • Among the biggest fiscal wins came from provision of non-emergency medical transportation; this benefit linked members with limited transportation access to medical appointments and necessary follow-up care. A total of $40 million in savings per month from 30,000 Medicaid beneficiaries was identified, making for more than $480 million in savings a year.

The reports list program examples and validation, and is available on the AHIP website. Our Monitor Mondays Listeners Survey recently asked: how would Medicaid MCO benefits for the SDoH and mental health impact your target populations? The results appear here.

Programming Note: Listen to Ellen Fink Samnick’s reporting on SDoH every Monday on Monitor Mondays, 10 a.m. Eastern.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

This email address is being protected from spambots. You need JavaScript enabled to view it.

Related Articles

  • SDoH: Eviction Moratoriums Extended to June 2021
    Loopholes in rental and lease agreements may force individuals and families into crowded living situations. I value when our Monitor Monday and RACmonitor  listeners reach out to me on social media; many did after last week’s broadcast and article on…
  • Kaiser Family Foundation Brief Highlights Ongoing Employment, Poverty Challenges
    More people are expected to struggle with ongoing hardships. There continues to be considerable news focused on ongoing health disparities and inequities. First, the Kaiser Family Foundation recently released a report titled One Year in the Pandemic: Implications of COVID-19…
  • Robert Wood Johnson Foundation Advances Guidance to Address SDoH
    The iconic foundation has published three Federal Policy Recommendations to Advance Health Equity. First, I’d like to follow up on last week’s article about The Gravity Project’s presentation on social risk ICD-10-CM code changes at the March 10 Centers for…