The Mandate for SDoH Legislation and Funding

Recent conference reveals proposed legislation focused on the social determinants of health.

Last week I got a bird’s eye view of all that is happening in the area of the social determinants of health (SDoH), while chairing RISE Association’s Annual SDoH Summit in Nashville. Among the most popular topics were ways upcoming federal and state legislation would support programs addressing the SDoH, along with continuing mandates for funding, reimbursement, and creative programming.

On the legislative landscape, the 117th Congress has seen a number of bills introduced focused on the SDoH. Of the major health equity packages, 28 bills focus on health disparities and equity, while 59 address maternal and infant health. 

Among the proposed bills for the 2022 fiscal year are:

  • $153 million to the Centers for Disease Control and Prevention (CDC) SDoH program, an increase of $150 million from 2021;
  • $200 million targeted to reduce maternal mortality and morbidity;
  • $25 million to the Centers for Medicare & Medicaid Services (CMS) to address health equity, which includes steps to fulfill President Biden’s equity executive order on advancing racial equity and support for underserved communities; and
  • $551 million for home or community-based healthcare services targeting increased funding for the Lifespan Respite Care Program and other programs for older Americans and individuals with disabilities.

This legislation and the associated dollars can’t come soon enough. A recent study from Castlight Health identified employees reporting barriers to accessing necessary health services, mental health services, and medication through their commercial insurance plans. This study is the first of its kind to explore the prevalence of SDoH-related barriers with associated clinical risk factors for common medical conditions within the large and diverse commercially insured population.

We’ve focused in prior articles on the growth and expansion of Medicare Advantage (MA) and Managed Medicaid plans. The focus of Castlight Health’s study was over 200 employers with employees in all 50 U.S. states, and represented industries across sectors, ranging from 1,000 to 500,000 employees. Insurance does not guarantee access to care or resources to preserve general health, behavioral health, and wellness. Specific to obstacles in accessing care are the following:

  • 56 percent of those polled identified cost or insurance obstacles;
  • 26 percent noted challenges with family, school, or work responsibilities; and
  • 4 percent identified travel or transportation issues.

There was no consistency in how or to what extent the employer-sponsored resources addressed these needs. A total of 70 percent of employers provided behavioral health services through employee assistance programs (EAPs) and other programs, with 63 percent providing telehealth programs as an alternative. This is a big shift, and a direct result of COVID’s impact. However, despite this win, other pressing SDoH did not receive attention:

  • Barely 1 percent of the commercial plans offered programs focused on healthy foods;
    • Just 7 percent offered financial programs; and
    • Less than 0.5 percent offered either child care or transportation support programs.

Our Monitor Mondays Listeners Survey asked our audience what SDoH benefits they would like to see added to commercial plans, with the results here.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting of SDoH issues every Monday during Monitor Mondays, 10 Eastern.

Facebook
Twitter
LinkedIn

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.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.

December 3, 2025

Proactive Denial Management: Data-Driven Strategies to Prevent Revenue Loss

Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.

November 19, 2025
Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.

September 24, 2025

Trending News

Featured Webcasts

Surviving Federal Audits for Inpatient Rehab Facility Services

Surviving Federal Audits for Inpatient Rehab Facility Services

Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.

November 13, 2025
E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.

August 26, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24