Description

This brief explores the impact of several provisions of the Centers for Medicare and Medicaid 2016 updated Medicaid managed care rule’s influence states’ ability to address social determinants of health through managed care. Several provisions in the new Medicaid managed care rule signal CMS’s intent to increase access to high?value nonmedical interventions. For instance, the regulation financially incentivizes health plans to address these needs by allowing certain nonclinical services to be included as covered services when calculating the capitated rate and medical loss ratios. In addition, the regulation encourages states to improve care coordination, adopt alternative payment models, and provide long-term services and supports in the home and community for beneficiaries with functional limitations.