Bachrach, D., Guyer, J., Meier, S., Meerschaert, J., & Brandel, S. (2018, January 31). Enabling sustainable investment in social interventions: A review of Medicaid managed care rate-setting tools. Washington, DC: The Commonwealth Fund.

Year: 2018


This article explores practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues using a literature review, interviews with stakeholders, and analysis of federal regulations. The following strategies were identified: 1) classify certain social services as covered benefits under the state’s Medicaid plan; 2) explore the additional flexibility afforded states through Section 1115 waivers; 3) use value-based payments to support provider investment in social interventions; 4) use incentives and withholds to encourage plan investment in social interventions; 5) integrate efforts to address social issues into quality improvement activities; and 6) reward plans through higher rates for effective investments in social interventions. More needs to be done, however, to assist interested states in using these options and identifying pathways to braid Medicaid dollars with other social services funding.

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