Insurers’ national association America’s Health Insurance Plans (AHIP) has called for giving more flexibility to Medicaid managed care organizations. In a recent brief, AHIP said that as the federal-state program provides access to essential health care to “over 77 million low-income adults, children, pregnant women, elderly adults, and people with disabilities”, Medicaid has a unique opportunity to address the social risk factors that disproportionately impact these vulnerable populations. The association has listed policy recommendations to advance work that addresses socioeconomic needs.
- AHIP has called for increasing flexibility in Medicaid waivers. “Modernizing existing Medicaid policies that permit states to broaden the scope of covered services to include specific nonmedical services and interventions will help address the social determinants of health,” says the brief.
- The second recommendation is creating a pathway for interdisciplinary/interagency waivers. It says the state Medicaid agencies should be allowed to partner with other state agencies (such as housing or employment) to request interdisciplinary waivers and associated funding from multiple federal agencies under a combination of federal titles and funding sources.
- It further calls for broadening the interpretation of quality improvement activities for purposes of calculating Medicaid plan medical loss ratios (MLRs) to include expenditures for interventions that address social determinants of health so that these activities are treated as health-related instead of being categorized as administrative costs.
- The fourth recommendation is for greater latitude in the use of “in lieu of services” (ILOS). “Medicaid MCOs are permitted to provide some services that are not normally covered by the Medicaid state plan if those services are appropriate to the individual’s needs and substitute for a covered service at a lower cost. Enhancing flexibility to build best practices on addressing social determinants of health will advance innovation,” says the brief.
- The final recommendation is about extending flexibilities to allow Medicaid MCO providers to participate in pooled funding arrangements with others in the community, such as state social service agencies, to more easily bring different funding sources together to have a greater impact on social determinants of health.