Module 5
Health-Related Social Needs
No payer has pushed housing and food into covered benefits like Medicaid. The two authorities that make it possible, and why delivery is the hard part.
By the end of this module, you will be able to:
- Explain why Medicaid leads other payers in covering health-related social needs
- Distinguish in-lieu-of services from social-needs coverage under Section 1115
- Identify why screen-and-refer programs fail without funded community capacity
- Why Medicaid Leads on Social Needs No payer has pushed social needs into covered benefits as hard as Medicaid. This lesson explains why the program is the natural place for it to happen. About 4 min
- HRSN Benefits and In-Lieu-Of Services Medicaid covers social needs through two authorities that work differently and have different stability. This lesson distinguishes them. About 5 min
- Delivering Social Care Covering social needs is the easy part. Getting the service delivered, through organizations outside healthcare, is where it succeeds or fails. About 4 min
Module quiz
Answer all questions to see your score.
1. Why is Medicaid the payer most likely to cover health-related social needs?
The strongest business case for addressing social needs sits where the population faces the most barriers and someone is at financial risk for the resulting cost.
2. For a managed care plan to offer an in-lieu-of service, the state must determine it is:
The cost-effective, medically appropriate substitute test (42 CFR 438.3) is what lets a plan offer housing or nutrition support in place of more expensive covered care.
3. What most reliably determines whether a screen-and-refer program works?
Screening identifies needs, but the referral only helps if the community organization on the other end has the capacity to act.