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Social Determinants of Health— Medicaid Coverage and Payment

Resource Topic: Promising/Best Practices

Resource Subtopic: —Social Determinants of Health (SDOH), Sustainability, Health Equity, Policy and Advocacy, Value-Based Payment.

Keywords: Medicaid, Policies and Procedures, Reimbursement, Screening.

Year Developed: 2022

Resource Type: Publication.

Primary Audience: C-Suite (DEOs, CFOs, CIOs, CMOs, COOs, etc.); PCAs
Secondary Audience: Board of Directors

Language(s): English

Developed by: National Association of Community Health Centers (See other resources developed by this organization).

Resource Summary: Recent guidance from the Centers for Medicare and Medicaid Services (CMS) provides new clarity on Medicaid and SCHIP authority for reimbursement of SDOH screening and interventions in particular circumstances. This publication demonstrates opportunities to use SDOH screening tools such as PRAPARE to improve the delivery of care through enhanced data collection and relationships with safety-net programs.

Resource Details: Screening for and addressing social determinants of health (SDOH) are widely recognized as essential for delivering whole person care, improving health equity, lowering total costs of care, and participating in value-based care. Current events underscore the critical importance of addressing SDOH, with populations served by Health Center Program grantees and look-alikes being disproportionately impacted by COVID-19. The health center model of care uniquely positions health centers to play active roles in integrating SDOH services and aligning with community-based organizations. Furthermore, health centers are committed to improving health equity. Recent guidance from the Centers for Medicare and Medicaid Services (CMS) provides new clarity on Medicaid and SCHIP authority for reimbursement of SDOH screening and interventions in particular circumstances. This publication demonstrates opportunities to use SDOH screening tools such as PRAPARE to improve the delivery of care through enhanced data collection and relationships with safety-net programs.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,625,000 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.