Approaches for addressing non-medical health drivers through Medicaid managed care

With growing recognition that health outcomes and healthcare costs are impacted by nonmedical factors, particularly in lower-income populations, an increasing number of states are finding ways to address these factors through their state Medicaid programs. Milliman was engaged by the Episcopal Health Foundation (EHF) to complete a landscape study of the various approaches through which state Medicaid programs are working to address nonmedical drivers of health. Nonmedical drivers of health include the conditions and environments in which people live, work, learn, and play that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

In this report, Milliman also completed an actuarial analysis of cost drivers for selected groups of Medicaid beneficiaries in Texas who may experience higher medical and nonmedical risks. This includes individuals with high-risk pregnancies in the State of Texas Access Reform (STAR) program, individuals with serious mental illness in the STAR+PLUS program, and children in foster care in the STAR Health program.

After reviewing the literature on programs currently underway or in planning stages in state Medicaid programs around the country, Milliman identified several dimensions on which these efforts varied.

These dimensions include:
– The style of governance
– Policy levers used to authorize support for nonmedical drivers of health
– Levels of interventions put in place around those drivers
– The specific types of needs addressed
– The types of populations targeted

Milliman found a mixed environment in terms of whether executive or legislative actions are required to authorize changes to state Medicaid programs. States can address nonmedical drivers of health in different ways, including through Section 1115 waivers, contract flexibilities in managed care programs, or through other options such as home and community-based services (HCBS) waivers.

Based on this research, many states are focused on collecting information through screenings and connecting beneficiaries to existing community resources, and fewer are involved with directly funding nonmedical support services beyond HCBS. Needs related to food or nutrition, transportation, housing, and employment are currently the most common nonmedical focus areas for state Medicaid programs in states that are seeking to address nonmedical health needs. Besides screening programs, most states are focusing their efforts on higher-risk populations with distinct needs, rather than their entire Medicaid-eligible populations.

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