Medicaid Managed Care Organizations Address Healthcare Disparities

New AHIP report touts Medicaid MCO action for SDoH.

While pressure continues for states to rein in costs associated with health and behavioral health, strategies to leverage Managed Medicaid are getting fierce attention. America’s Health Insurance Plan’s (AHIP’s) latest report, Social Determinants of Health and Medicaid, is a worthy read for organizations ready to flex their advocacy muscles with the facts.

Medicaid provides access to essential healthcare and behavioral healthcare for more than 77 million low-income adults, children, pregnant women, elderly citizens, and persons with disabilities. As a result, there is unique opportunity to address disparities that disproportionately impact vulnerable populations.

Primary policy recommendations encompass five actions:

    1. Increase flexibility in Medicaid waivers.
    2. Create pathways for interdisciplinary and interagency waivers, such as partnering with state agencies that have oversight for housing and employment. In this way, a state’s Medicaid and housing agencies could apply to the Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Housing and Urban Development (HUD) for joint waivers to provide integrated health homes for homeless individuals with severe mental illness, pairing comprehensive medical and behavioral healthcare with housing assistance.
    3. Broaden interpretations of quality improvement activities for the purposes of calculating Medicaid plan medical loss ratios (MLRs) to include expenditures for interventions that address the social determinants of health (SDoH); this will allow these activities to be treated as “health-related” versus being categorized as “administrative costs.”
    4. Permit greater latitude in the use of “in lieu of services” (ILOS).
    5. Extend flexibilities allowing Medicaid Managed Care Organization (MCO) providers to participate in pooled funding arrangements with others in the community.

The report also lists documented return on investment from managed Medicaid programs in action:

      • A Midwest MCO saved more than $10,000 per member annually by providing short-term, transitional housing and healthcare through 50 single-room units provided to their homeless members. Hospital and skilled nursing facility inpatient stays for individuals in the program declined by 40 percent. Members received medical care, behavioral health and recovery-focused services, peer support, case management, housing navigation services, life skills training, and stability, with eventual connection to long-term permanent housing.
      • A Northwest Medicaid MCO provided weekly delivery of ready-to eat meals to dually eligible Medicaid and Medicare members. Savings yielded $753 per member, per month from decreased inpatient admissions and fewer nursing facility admissions; it added up to a 16 percent reduction in costs.
      • Among the biggest fiscal wins came from provision of non-emergency medical transportation; this benefit linked members with limited transportation access to medical appointments and necessary follow-up care. A total of $40 million in savings per month from 30,000 Medicaid beneficiaries was identified, making for more than $480 million in savings a year.

The reports list program examples and validation, and is available on the AHIP website. Our Monitor Mondays Listeners Survey recently asked: how would Medicaid MCO benefits for the SDoH and mental health impact your target populations? The results appear here.

Programming Note: Listen to Ellen Fink Samnick’s reporting on SDoH every Monday on Monitor Mondays, 10 a.m. Eastern.


Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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