Medicaid Food Security Policy Dashboard

Policy Categories

• 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 screenings or referrals that occur in clinical settings (such as hospitals, primary care, or behavioral health settings).

• Assistance & Navigation
  • • Care Coordination/Care Management – Organizing and managing a beneficiary’s care across a diverse network of providers.
    • Community Health Workers (CHWs) – 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.

• Quality Improvement, Population Health, and Social Drivers of Health Plans
  • • Community Based Organization (CBO) Partnerships – Formal relationships across Medicaid Managed Care and/or Medicaid-serving healthcare entities and community organizations providing support around food needs. 
    • SNAP Coordination – The Supplemental Nutrition Assistance Program (SNAP), a USDA Food and Nutrition Service (FNS) , provides food benefits to families living on low incomes. SNAP Coordination refers to Medicaid organizations  connecting eligible individuals and families with SNAP through education, outreach, and activities to assist Medicaid enrollees with the application process. 
    • WIC Coordination –The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded program by USDA FNS. The USDA provides supplemental foods, healthcare referrals, and nutrition education. WIC serves pregnant women, breastfeeding and non-breastfeeding postpartum women living on low incomes, and infants and children up to age five who are identified as nutritionally at risk. Like SNAP Coordination, WIC Coordination refers to Medicaid organizations connecting eligible families with WIC, such as through education, outreach, and activities to assist Medicaid enrollees with the application process.
    • Performance Improvement Plans (PIP) -Federal regulation 42 CFR 438 requires Medicaid Managed Care entities to engage in activities that 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 utilizing Quality Improvement strategies to develop and enhance activities addressing social needs.

• Investments and Benefits  
  • • 1115 Waiver -Section 1115 of the Social Security Act provides states with broad flexibility, subject to approval by the Centers for Medicare and Medicaid Services, to waive nearly any Medicaid state plan requirement. This includes adding benefits not otherwise covered by Medicaid.
    • 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.
    • In Lieu of Services (ILOS) – In accordance with 42 CFR §§ 438.3(e)(2) and 438.16, states have the flexibility to approve specific strategies to substitute new services, including nutritional supports, that are medically appropriate and cost-effective alternatives for traditional managed care plan services (read more in the CMS guidance).
    • 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).
    • Value-Added Services – Non-medical services aimed at improving the health and wellness of health plan members are offered by MCOs in addition to standard Medicaid coverage. These services are funded by the administrative dollars of health plans and are generally not included in the capitation rate-setting process, though some value-added services may be counted in the MLR if they are considered
      activities that improve health care quality (MACPAC).
    • Value-Based Payments – Payments based on quality or other outcomes rather than the quantity of services rendered.
    • 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.