HHS Offers States Flexibility to Better Address Medicaid Enrollees’ Needs

As part of Biden-Harris Administration efforts to strengthen Medicaid, new guidance will help states expand access to health care services and tackle unmet social needs

Today, the United States Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is releasing guidance on an innovative opportunity for states to address health-related social needs for people with Medicaid coverage through the use of “in lieu of services and settings” in Medicaid managed care. This option will help states offer alternative benefits that take aim at a range of unmet health-related social needs, such as housing instability and food insecurity, to help enrollees maintain their coverage and to improve their health outcomes. The Biden-Harris Administration is committed to protecting and strengthening Medicaid. Today’s action is CMS’ latest step to drive innovation in the Medicaid program, strengthen access to care, improve population health, and reduce health disparities.

“We are deeply committed to strengthening Medicaid for the millions of Americans covered by it,” said HHS Secretary Xavier Becerra. “Today’s step ensures people with Medicaid receive the broader care they need to live safe and healthy lives. We call on all states to leverage these innovative options and stand ready to partner with them in providing essential health care services.”

“In partnership with CMS, states have been working hard to better meet the health-related social needs of people with Medicaid coverage,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s announcement is the next step in CMS’ effort to use every lever available to protect and expand coverage for all eligible individuals as we work with our state partners to offer whole-person care.”

This announcement supports the Biden-Harris Administration’s goal to end hunger and reduce diet-related diseases by 2030 – all while reducing disparities – and its corresponding National Strategy on Hunger, Nutrition, and Health. For example, under today’s guidance, states may adopt in lieu of services and settings to offer medically appropriate, cost-effective tailored meals for people with severe, chronic health conditions made worse by poor diet, living in “food deserts,” or not having access to nutritious food choices.

In addition to outlining this opportunity for states, today’s letter also establishes the requirements and guardrails states must meet to ensure these innovations are cost effective, medically appropriate, preserve enrollee rights and protections, and fulfill the objectives of the Medicaid program. These requirements empower CMS to ensure appropriate oversight and provide additional guidance to states on how to evaluate and monitor the impact of these in lieu of services and settings.

For more information or to read the state Medicaid director letter in its entirety, visit Medicaid.gov.