Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and CHIP
This CMCS Center Informational Bulletin (CIB) discusses opportunities available under Medicaid and the Children’s Health Insurance Program (CHIP) to cover clinically appropriate and evidence-based services and supports that address health-related social needs (HRSN). As discussed in a CMCS CIB on this topic dated November 16, 2023, an individual’s HRSN are derived from a person-specific assessment of social determinants of health (SDOH), and extensive research has indicated that SDOH and associated HRSN can account for as much as 50 percent of health outcomes. While SDOH are broad environmental conditions, HRSN are specific to an individual and when unmet, these individual-level adverse social conditions contribute to poor health outcomes. These needs, when unmet, can drive lapses in coverage and access to care, higher downstream medical costs, worse health outcomes, and perpetuation of health inequities, particularly for children and adults at high risk for poor health outcomes, and individuals in historically underserved communities
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 10, 2024
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.