Recent legislation
Federal programs and agencies
Managed-care standards and supports
Center for Medicaid and CHIP Services (CMCS), Medicaid Enterprise System (MES):
Federal grant initiatives related to managed care:
Recent legislation such as the American Rescue Plan Act and CARES Act provided both CDC and ACF funding:
The CDC received funding for public-health modernization investments, making a grant here more feasible to explore. The ACF received funding to advance children, family, and community efforts in light of COVID-19
Justification: While not direct funding, resources from recent legislation provide justification for potential funding from federal programs and agencies
While managed care itself is not a federal funding mechanism, states can access federal support through grant initiatives related to managed care as available, such as past State Innovation Model (SIM) grants
Federal standards affecting managed care and innovation flexibility:
Federal standards can also affect managed care such as medical-loss ratios (MLRs); quality-improvement activities may include wellness and SDoH. States have flexibility to encourage innovation in SDoH across managed-care organizations (MCOs) such as in value-added services or "in lieu of" services
Justification: Investing in SDoH data and infrastructure aligns with managed-care objectives of improving population health quality outcomes and providing lower costs
Justification: Funding is a federal match for both start-up and ongoing costs. The effort aligns with MES and Medicaid objectives because investment can improve outcomes and lower costs
Potential grant and partnership opportunities to bolster public health infrastructure and advance health equity particularly as it relates to unmet basic needs
Federal match to support set up of the platform, then ongoing maintenance
Potential grant and partnership opportunities to support vulnerable children and families (eg, TANF² block grant)
Justification: Aligns with the agencies’ focuses and strategic objectives (eg, resource connection to support families in need)
Justification: The CDC is increasingly focusing on public health infrastructure modernization, health equity, and SDoH, and such a partnership can advance both the CDC and the state’s aims
Federal programs and agencies
Managed-care standards and supports
Recent legislation
Justification: Funding can be unlocked to demonstrate impact of the innovation, with potential for renewal and more continuous support. Aligns with Medicaid’s program objectives and benefits the target population (eg, improved care management, seamless ways to connect individuals with supportive programs and keep them independent)
Grant to test whether the SDoH referral platform improves outcomes, lowers costs, and keeps the target population independent
Medicaid 1115 demonstration waiver:
Waivers and authorities
Waivers and authorities
Federal funding mechanisms can be combined to optimize impact.
Illustrative example
A state that would like to support a closed-loop SDoH¹ referral system considers what federal funding supports are available.
¹
Social determinants of health.
Centers for Disease Control and Prevention (CDC):
Administration for Children and Families (ACF):
²
Temporary Assistance for Needy Families
²
Temporary Assistance for Needy Families.