Crumley, D., Lloyd, J., Pucciarello, M., & Stapelfield, B. (2018). Addressing social determinants of health via Medicaid managed care contracts and section 1115 demonstrations. Hamilton, NJ and Washington, DC: Center for Health Care Strategies, Inc. & the Association for Community Affiliated Plans.

Year: 2018


This report examines Medicaid managed care contracts or requests for proposals (RFPs) in 40 states, in addition to 25 approved section 1115 demonstrations. Incentives and requirements related to the social determinants of health (SDH) are compiled, common themes in the states’ approaches are identified, and recommendations are developed for federal policymakers, including the Centers for Medicare & Medicaid Services (CMS). Though states do have some flexibility under existing law, this review of managed care contracts suggests that states have, for the most part, not taken full advantage of this flexibility. The following themes were identified: 1) there is a growing focus on SDH in state managed care contracts; 2) most states do not provide detail on how MCOs can use flexibilities under federal law to provide services that address SDH; 3) payment incentives linked to SDH are not yet commonplace.

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