Medicaid coverage of services that address Health-Related Social Needs (HRSNs), such as housing, transportation, nutrition and employment, has shown positive outcomes in improving participant health and reducing the need for acute hospital care and long-term care placements. While the Centers for Medicare and Medicaid Services (CMS) previously encouraged states to utilize Section 1115 waivers for HRSN services, a March 2025 bulletin from the Center for Medicaid and CHIP Services (CMCS) rescinded prior guidance and limited new approvals to a case-by-case basis. This shift has created uncertainty for states attempting to navigate Medicaid funding to support these social needs.
Decision Factors in Pursuing Approval of HRSN Coverage
States seeking to initiate or enhance coverage of HRSNs must consider a variety of factors that may point to strategic trade-offs when implementing these programs:
- What is the target budget for the program?
- Which populations is the program meant to target?
- Which services do the target populations need?
- Which providers will offer these services?
How A&M Can Help
Our Public Sector team has hands-on experience in helping states develop applications for novel 1115 demonstration benefits and identifying ways to meet unique needs via programmatic authorities. Further, our team of operators has the experience to help your team implement the HRSN initiative once approved.
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