Addressing Health-Related Social Needs Through Medicaid: Findings From 1115 Waivers Across States

Session Submission Type: Panel

Abstract

States are increasingly using Section 1115 Medicaid demonstration waivers to address enrollee health-related social needs (HRSNs), such as food insecurity, housing instability, and transportation barriers. This panel brings together three studies that offer complementary perspectives on the design, implementation, and impact of Medicaid HRSN waiver programs across multiple states.

Our first paper uses Medicaid claims to characterize the prevalence and distribution of HRSNs among Medicaid enrollees in New York state and identifies subgroups of beneficiaries with co-occurring HRSNs using latent cluster analysis. The study finds that HRSNs cluster into distinct, clinically meaningful subgroups, highlighting the importance of targeted approaches that account for the complexity and co-occurrence of social needs among diverse Medicaid populations.

Our second paper examines barriers and facilitators to implementation of HRSN benefits in Oregon and finds that benefit complexity, short runway from program design to launch, lack of organizational capacity, and requirements for assessments prior to receiving services were significant challenges to implementation. These findings offer practical lessons for states currently designing and scaling similar programs under their own 1115 waiver authorities.

Our third paper uses Medicaid claims and encounter data to evaluate the impact of nutrition supports on utilization and outcomes in Massachusetts. It finds that nutrition supports were associated with a reduction in hospitalizations and emergency department visits compared to eligible non-participants, and that healthcare cost savings offset program costs for adults enrolled for at least 90 days, suggesting meaningful return on investment for sustained program participation.

Together, these studies illustrate both the promise and the challenges of using Medicaid 1115 waivers to address HRSNs. They suggest that effective HRSN policy can reduce preventable utilization and expenditures, but requires well-designed programs that target interventions to populations most likely to benefit, allow for realistic implementation timelines, and invest in sufficient organizational capacity to support successful rollout and sustained impact.

Policy Area

• Health Policy

Chair

• Sherry Glied, New York University

Discussants

• Jennifer Haley, Urban Institute

• Ruochen Sun, University of Southern California

Individual Presentations

• How do social needs cluster? Evidence from Medicaid beneficiaries in New York before 1115 waiver implementation - Presenting Author: Sarah Lieff, New York University; Non-Presenting Co-Author: David Asher Ilouz, New York University; Non-Presenting Co-Author: Sherry Glied, New York University

• Learning from the Implementation of Oregon’s Pioneering Medicaid Benefits to Address Health-Related Social Needs - Presenting Author: Danielle Hessler Jones, University of California, San Francisco

• Medicaid Nutrition Supports Associated with Reductions in Hospitalizations and Emergency Department Visits in Massachusetts - Non-Presenting Co-Author: Matthew Alcusky, UMass Chan Medical School; Presenting Author: Kurt Hager, UMass Chan Medical School

• Medicaid 1115 Waivers and Access to SUD Treatment and Supportive Services - Presenting Author: Abergaile Cliffe, The University of Chicago; Non-Presenting Co-Author: Shelby Jan Steuart, University of Maryland, College Park; Non-Presenting Co-Author: Lauren Andren Peterson, Boston University; Non-Presenting Co-Author: SunJung Yoon, University of Maryland, College Park; Non-Presenting Co-Author: Amanda J. Abraham, University of Georgia; Non-Presenting Co-Author: Colleen M Grogan, University of Chicago; Non-Presenting Co-Author: Harold Alexander Pollack, University of Chicago

Organizer

• Sarah Lieff, New York University