Additional Guidance on Use of In Lieu of Services and Settings in Medicaid Managed Care (SMD 23-001)
This guidance addresses an innovative option states may consider employing in Medicaid
managed care programs to reduce health disparities and address unmet health-related social
needs (HRSNs), such as housing instability and nutrition insecurity, through the use of a service
or setting that is provided to an enrollee in lieu of a service or setting (ILOS) covered under the
state plan. On January 7, 2021, the Centers for Medicare & Medicaid Services (CMS) published
a State Health Official (SHO) letter (SHO#21-001)3 that described opportunities under Medicaid
and the Children’s Health Insurance Program (CHIP) to better address social determinants of
health (SDOH).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 04, 2023
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.