Archive for social determinants of health


The Emergence of “Food as Medicine”

In both the public and private sectors, a growing movement is working to integrate food as part of medical treatment – and have health care payers foot the bill.

From the administration’s granting of Medicaid waivers to Arkansas, Massachusetts, and Oregon to use state and federal money to pay for food for some beneficiaries to Congress tucking $2 million into an appropriations bill for a “food is medicine pilot program” to the NIH developing a $140 million grant program that will lead to the designation of “food is medicine centers of excellence,” providers and policy-makers are showing unprecedented interest in the effects of nutrition on health and questioning whether medicine alone meets the needs of patients.  Some Medicare and Medicaid patients already receive what are known as “medically-tailored meals” or “medically-tailored groceries” and some Medicare Advantage plans are offering food and produce benefits to members with certain chronic medical conditions.

Impeding further development of greater use of food as medicine, and as a possible means of addressing social determinants of health and facilitating greater health equity, are the lack of research into the effectiveness of such endeavors; the lack of integration of food into medical practice; and the cost of …

Results of Annual Survey of State Medicaid Programs

The Kaiser Family Foundation has published the results of its annual survey of state Medicaid programs for the 2022 and 2023 fiscal years.  Among the survey’s findings (in language taken directly from the Kaiser report):

  • More than 3/4 of states that contract with MCOs [managed care organizations] enroll ≥75% of all beneficiaries in MCOs
  • Some states reported newly implementing or expanding MCO programs
  • States also report continued use of other service delivery and payment system reforms
  • Two-thirds of states are using strategies to improve race, ethnicity, and language data
  • About one-quarter of states are tying MCO financial incentives to health equity
  • States are also leveraging MCO contracts in other ways to promote equity-related goals
  • States report far more benefit expansions than benefit cuts
  • States are most frequently expanding behavioral health and pregnancy/postpartum services
  • Most states allow MCOs to cover “in lieu of” services, especially BH [behavioral health] and SDOH [social determinants of health] services
  • States have seen high telehealth utilization across Medicaid enrollees
  • States are addressing telehealth quality and other challenges
  • Most states are adopting permanent telehealth expansions, though some are considering limits

Other subjects addressed in the report include provider taxes and intergovernmental transfers, supplemental Medicaid payments, health equity, …

COVID Drugs Experiencing Arguably Inequitable Distribution

The distribution of COVID-19 drugs could be exhibit A in the argument that inadequate access to care is a major social determinant of health.

At least that’s a conclusion that might be drawn based on a new CDC study.

According to a new Centers for Disease Control and Prevention analysis, the rate at which COVID-19 drug therapies are being distributed “…were lowest in high vulnerability zip codes, despite these zip codes having the largest number of dispensing sites.”

The study observes that “The COVID-19 pandemic has highlighted and exacerbated long-standing inequities in the social determinants of health.”  Despite this, federal efforts to dispense COVID drugs in an equitable manner were not achieving their goals, and as a result, “…dispensing rates in high-vulnerability zip codes were approximately one half the rates in medium- and low-vulnerability zip codes.”

Why the disparity?  The study hypothesizes that

To access oral antiviral therapy, a patient must first receive a positive test result for SARS-CoV-2 (the virus that causes COVID-19), followed by a clinical assessment by a health care provider authorized to prescribe the drug (i.e., physicians, advanced practice registered nurses, and physician assistants). Although 47.5% of dispensing sites are located in high-vulnerability zip codes as

Using Medicaid Money to Pay the Rent?

Some people think the time has come for Medicaid to help pay for housing for the homeless in the name of health and health equity.

“In the last decade Medicaid has inched toward acknowledging the interconnectedness of housing and health,” the New York Times reports, adding that “It has encouraged more state Medicaid programs to cover housing-related costs like furniture or security deposits – basically everything except paying the rent.”

In addition, most conversations about social determinants of health identify housing insecurity as a major obstacle to good health and health equity.  The Bush and Obama administrations invested in creating supportive housing beds for the homeless, leading to a decline of one-third in chronic homelessness, but in recent years such spending has not increased even as chronic homelessness has risen more than 40 percent.

Now, local officials find themselves increasingly looking to Medicaid to help address homelessness, and they have two apparent success stories to point to as proof that such an approach can work:  Philadelphia and Arizona, which have found ways to support housing for the homeless while remaining within federal guidelines for how Medicaid money can be spent.

Learn more about this new interest in using Medicaid money …