Medicaid Food Security Policy Dashboard

About the Medicaid Food Security Policy Dashboard

The Medicaid Food Security Network is a group of healthcare and food security stakeholders, mobilizing Medicaid systems to become a key partner in addressing food and nutrition insecurity, with an emphasis on closing the enrollment gap in SNAP and WIC. To support the network, we have reviewed 1115 waivers, Medicaid Managed Care Contracts, and other policy documents across the country to develop a compendium of examples of how Medicaid is addressing food insecurity among children and families.

This tool is not an exhaustive list of programs and policies that address food insecurity through Medicaid. As the focus of this tool is children and families, we excluded programs that would not serve most children and their parents (such as programs with very high clinical acuity criteria or programs focused on people needing long term services and supports) and in our descriptions of the policy, we included the details necessary to show how the policy would impact this population. To see full eligibility and service criteria we have linked the original sources. The page numbers that are listed in the citations refer to the page number on the document which may not match the page number of the pdf.

How To Use the Medicaid Food Security Policy Dashboard

Policy Categories

• Medicaid Managed Care Organization (MCO) Procurement Processes – States often purchase health care services from private insurance companies (typically managed care organizations) for their Medicaid beneficiaries by conducting a competitive selection process. This process is governed by individual state rules and requirements. These types of procurements are among the largest state purchasing efforts. A small number of states select health plans through non-competitive processes where organizations that meet certain criteria can participate. 

• • • RFP Questions – The mechanism used to procure these services is usually a Request for Proposal (RFP), although different states may have different names for the solicitation/procurement document such as Request for Qualifications, Request for Application, Invitation to Negotiate, or Request for Information. The RFP often contains very specific questions a bidder must answer that are designed to elicit detailed information about the bidder’s approach to providing and managing health care services for beneficiaries.
    • RFP Case Scenarios – In addition to questions, RFPs will also include a description of a common situation and problems a beneficiary may encounter. The bidder is expected to describe how they would address and resolve the situation.
    • Definitions – Contracts typically include a list of definitions of important terms. These definitions might give important context around a state’s vision or intent related to certain topics. Request for Procurement documents often contain the full text of the planned contract. 

• Food Insecurity Screening & Referral
  • • Health Risk Assessment – Medicaid Managed Care Plans are required to conduct a health risk assessment within 90 days of enrolling a new Medicaid enrollee per 42 CFR 438.208(b)(3). A health risk assessment is a tool that is used to collect medical and non-medical data that can be used to evaluate the health status and health risks of an individual. States can use this requirement to identify health-related social needs, such as food insecurity, and form the basis for making referrals to other services to address these needs. For the purposes of this tool, all MCO-based social needs screening has been categorized as “Health Risk Assessment,” although some of these activities go far beyond the federal minimum standard. 
    • Social Needs Screening and Referral – Social needs screening or referral that occurs in clinical settings (such as hospitals, primary care or behavioral health settings). 
    • Community Resource Directory – A listing of community resources that can address a beneficiary’s identified health-related social needs. These listings are typically developed at the state or local level and reflect resources specific to the community where the beneficiary lives.
    • Staff Training – Requirements pertaining to the training of staff who are conducting social needs screening. 

• SNAP & WIC Enrollment Infrastructure
  • • SNAP Coordination – Supplemental Nutrition Assistance Program. Funded by the United States Department of Agriculture (USDA) Food and Nutrition Service. Administered at the state and local level, SNAP provides food benefits to low-income families to supplement their grocery budget. 
    • WIC  Coordination– Special Supplemental Nutrition Program for Women, Infants and Children. Funded by the United States Department of Agriculture (USDA) Food and Nutrition Service. Provides federal grants to states, supplemental foods, health care referrals, and nutrition education for low-income pregnant women, breast-feeding and non-breast-feeding postpartum women, and to infants and children up to age 5 who are found to be at nutritional risk. State and local administration.
    • Initiatives to Increase Public Awareness – Activities conducted by Medicaid funded organizations to increase public awareness of benefits. 

• Assistance & Navigation
  • • Community Health Workers – Community Health Workers (CHWs) (inclusive of promotoras/es and community health representatives) are frontline workers who have close relationships with the communities they serve who provide some type of care coordination or care navigation support. Because of this closeness to the local community, they are often viewed as a trustworthy source of information. This allows them to interact with beneficiaries and connect them to the health care system and social services network. CHW services are often paid for through public health and community-based organizations. However, sometimes they can be reimbursed by Medicaid if the state has obtained federal authority to cover the service.
    • Care Coordination – Organization of a beneficiary’s care across multiple providers. 
    • Community Based Organization Partnerships – Formal relationships across Medicaid Managed Care and/or Medicaid-serving healthcare entities and community organizations providing support around food needs. 
    • Cross-Agency Collaboration – In some states, public health, human services (the entity administering food and nutrition benefits), and Medicaid are separate agencies. This category refers to examples of coordination across state agencies supporting health and food needs. 

• Data, Evaluation & Continuous Improvement
  • • Quality Improvement Projects – Federal regulation 42 CFR 438, requires that Medicaid Managed Care entities must engage in activities to improve the quality of care.  This includes requirements around drafting a quality strategy. One strategy for improving quality is focused Performance Improvement Plans where plans and their provider network will focus on improving performance on a specific metric.  Some states are using Quality Improvement strategies to develop and improve activities around social needs. 
    • Population Health and Social Drivers of Health Plans – Plan that sets forth strategies for improving health for a defined community. Population health strategies typically focus on societal factors, such as poverty, housing, or food insecurity that may lead to disease and other problems
    • Coding – Z codes are ICDM-10-CM diagnosis codes that document SDoH data. (CMS)
    • Health Information Exchange/Closed Loop Referral Systems – Electronic health information exchange (HIE) and Social Information Exchange allows doctors, nurses, pharmacists, other health care providers, social services providers and patients to appropriately access and securely share a patient’s vital medical information electronically, improving the speed, quality, safety and cost of patient care. Closed Loop Referral systems are systems that support bi-directional information sharing and communication that allows health care providers and community-based social services to make and follow-up on referrals for HRSN identified when beneficiaries are screened. The closed-loop allows for confirmation that the service was rendered.
    • Data Aggregation/Use/Sharing – Any activity where data around food needs, enrollment in food benefits, information on care plans, or other food need-related information is aggregated, used or shared with the goal of supporting accountability, coordination and improvements in health outcomes. 

• Investments and Benefits  
  • • Value Added Services – Non-medical services funded by health plans’ administrative dollars. (MACPAC)
    • Community Reinvestment – Requirement in a health plan contract with a state Medicaid agency to reinvest a certain percentage of the health plan’s capitation revenue or profit in the community served. The investment cannot duplicate any allowable Medicaid expense and is typically expected to address a need in the community that will have a positive impact on population health.
    • 1115 Waiver Benefits – Section 1115 of the Social Security Act provides broad flexibility to states to, with the approval of the Centers for Medicare and Medicaid Services, waive almost any Medicaid state plan requirement. This includes adding benefits not otherwise covered by Medicaid. 
    • Value Based Payment – Payments based on quality or some other outcomes rather than the quantity of services rendered.
    • In Lieu of Services – Medically appropriate, cost-effective alternatives to Medicaid state plan services. 
    • Hospital Financing-Related Projects – Medicaid has specific funding streams intended to finance hospital care. Some states are leveraging hospital-specific funding streams to implement new strategies around social needs. This category also includes one example of State Directed Payments.  In general, states are not permitted to direct the expenditures of a Medicaid managed care plan under the contract between the state and the plan or to make payments to providers for services covered under the contract between the state and the plan (42 C.F.R. §§ 438.6 and 438.60). Under 42 CFR 438.6(d), CMS permits exceptions that allow states to make payments directly to providers or direct managed care plan expenditures for plan-covered services. 
    • Medical Loss Ratio – The share of total health care premiums spent on medical claims and efforts to improve quality of care. Federal regulations require that states set capitation rates such that 85% of healthcare premiums are spent on medical claims and quality of care (42 CFR 438.8).