Housing reimbursement may be on the way for Medicaid

Addressing social determinants of health continues to improve patient outcomes and lower overall costs in Medicaid, Medicare and Medicare Advantage. Soon, expanded benefits could include paying for housing among Medicaid beneficiaries, according to HHS Secretary Alex Azar, who spoke about the impact of social determinants of health during a speech with the Hatch Foundation for Civility and Solutions on Nov. 14.

Azar hinted that CMS could soon expand benefits to Medicaid recipients in a greater effort to take care of the whole person in a value-based care world. Medicaid, which covers low-income people, does not currently cover housing benefits, but the program has continually changed over time to meet evolving needs.

A model launched by the Center for Medicare and Medicaid Innovation (CMMI), the Accountable Health Communities model, screened for social determinants of health, such as food insecurity, domestic violence risk and transportation, among high utilizers of healthcare services. CMMI will assess if meeting non-health needs can make connections between health improvements and lower health spending.

“What if we provided solutions for the whole person, including addressing housing, nutrition and other social needs?” Azar asked during the speech. “What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea ... I want you to stay tuned to what CMMI is up to.”

Expanding benefits

Medicare Advantage plans, which cover approximately one-third of all Medicare beneficiaries, were given more flexibility when it comes to addressing social determinants of health when CMS expanded supplemental benefits in April. Plans could cover additional services, including more home care, respite care and adult day care, in 2019.

While not all plans have added these extra services for 2019, some have, and enrollees will have more options. In addition, CMS plans to add telehealth coverage for MA plans in 2020.

Some MA plans may already be covering services like transportation and food delivery to beneficiaries who have trouble getting around or are isolated at home. Addressing these social determinants of health can improve health by ensuring people are getting to their appointments and have nutritious food. By limiting adverse health events, MA plans are also saving themselves money.

Azar acknowledged the growing opportunity to address social determinants of health in MA during the speech.

“So we are eager to think about social determinants of health throughout the Medicare program, and one of the best ways we can do that is through the flexible, accountable, individual-driven system we already have: Medicare Advantage,” he said.