While the COVID-19 pandemic strained the healthcare system across the country, it catalyzed a refreshed and more informed approach to caring for Medicaid-eligible populations. This shift is rooted in the need to close the many gaps in health equity seen in the U.S. today.
Social Determinants of Health and Transportation
Now more than ever, addressing key social determinants of health (SDoH) domains are at the forefront for Medicaid programs as they march toward greater health equity. Social determinants of health cover a range of social, economic, and environmental factors that can impact a person’s health status and outcomes, sometimes even more than the administration of healthcare itself.
One SDoH that extends itself across all three domains– social, economic, and environmental– is transportation.
Transportation goes beyond being just one SDoH factor because of how multidimensional and complex it can be for people to physically get to the health care they need when they need it.
- Economic - Owning a vehicle is expensive, and it’s no guarantee that a Medicaid beneficiary or a household member owns or has access to a private vehicle. Without private vehicle access, transportation insecurity quickly rises relying on other forms.
- Social - Social contexts can be heavily influenced by transportation. Do individuals have transportation to safe social activities such as community gardens or community centers that improve physical and mental health? Without transportation, individuals may not interact with individuals outside of those nearby. Those around them may not be as well educated or have trouble accessing good education, which could lead to greater difficulty maintaining a good job and housing. This structural discrimination can also extend into individual discrimination on race, gender, disability, age, sexuality, gender identity, and more.
- Environmental - Urban and rural populations have very different transportation options. Especially in rural populations, communities may not be walkable or public transportation may be inaccessible or nonexistent. This may impact their ability to get to their healthcare appointments and even the access they have to nutritious food or opportunities for physical activity.
As social determinants of health such as transportation have the potential to impact multiple domains (economic, social, and environmental), it’s in Medicaid and CHIP programs’ best interest to find ways to address these. In January 2021, the Center for Medicare and Medicaid Services (CMS) shared a letter addressing opportunities for Medicaid state programs to address SDoHs. In short, this letter lays out how states can address health outcomes with existing programs and flexibilities, all while reducing costs of care in a push for value-based care.
Directing funds to non-medical services that potentially impact SDoH
With this recent guidance on providing value-based care and addressing SDoHs, state Medicaid managed care health plans are looking to maintain their high level of government compliance and regulation while balancing the added flexibility to pull levers to improve health outcomes in “non-health” areas that can potentially impact SDoH domains.
For years, Medicaid managed care health plans have been unable to direct funds to non-medical services so these new levers and options create a lot of opportunities while remaining in compliance with relevant regulatory environments. These opportunities are opening up across SDoH domains and needs – particularly in transportation.
The greatest enabler of further addressing SDoH needs for Medicaid beneficiaries is with Section 1115 demonstration waivers, which help Medicaid managed care health plans pursue “experimental, pilot, or demonstration projects” that advance objectives across eligibility, benefits, payments, or delivery systems. Transportation has grown as a value-added benefit within Section 1115 waivers, and while Medicaid managed care health plans are required to provide non-emergency medical transportation (NEMT), there is a growing focus on leveraging NEMT to get members to health-improving places such as gyms, grocery stores, active social events, and more. Not all state programs have leveraged this opportunity – stay tuned for the next blog post in this series – we’ll break down what goes into Section 1115 demonstration waivers with examples across different states and transportation-related use cases.
Making SDoH a priority
More and more Medicaid managed care health plans (and other health plans) are recognizing the value of supporting SDoH and are aligning with SafeRide's goal of increasing access and dignity to the care of our nation’s most vulnerable patient populations. For more on SDoH in Medicaid, our recent white paper (The State of Transportation for Medicaid Managed Care Health Plans) explores how Medicaid managed care health plans navigate non-emergency medical transportation and the latest trends in the transportation landscape.