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States Using Section 1115 Demonstration Projects to Enhance Medicaid Support for Maternal and Child Health

CMS approved use of section 1115 demonstrations to provide housing and nutrition services for 9 states with 8 more pending

Value based payments

July 1, 2024  – States across the U.S. are turning to Medicaid Section 1115 demonstration projects to tackle the social determinants of health, a new report  from Georgetown University reveals. These projects aim to fill the gaps in health-related social needs (HRSN), such as housing instability and inadequate nutrition, which are crucial for maintaining the health of pregnant and postpartum women and young children.

The report released June 13, 2024, by health policy analysts Allexa Gardner, Tanesha Mondestin, and Nancy Kaneb, provides a comprehensive analysis of state efforts to implement HRSN services through Medicaid. It highlights a trend where states are authorized, or seek approval, to support vulnerable populations by integrating health services with social care.

Historically, Medicaid initiatives, like those started in Massachusetts and North Carolina in 2018, allowed for limited coverage of transitional housing costs and essential nutritional support. However, the scope of these services expanded under the Biden Administration in 2022. Under the new administration, Medicaid programs can now include up to six months of rent and delivery of meals or groceries for eligible individuals.

According to the study, as of May 2024, nine states (Arizona, Arkansas, Delaware, Massachusetts, New Jersey, New York, North Carolina, Oregon, and Washington) have received CMS approval to provide housing or nutrition support for the targeted populations. Eight additional states are awaiting approval for similar initiatives.

Despite these expansions, the provision of HRSN services is bound by strict guidelines to ensure that medical care remains the primary focus of Medicaid. For example, there is a cap limiting HRSN spending to no more than three percent of total Medicaid expenditures, and only individuals identified with both a social risk factor and a clinical need are eligible for these enhanced services.

The implementation of these services is an important step toward mitigating the maternal and infant health crisis in the U.S. by providing more than just basic medical care. States are exploring various additional supports, such as supplying diapers to further aid families in need.

This evolving landscape of Medicaid-funded social support is a testament to the vital role that addressing social needs plays in promoting health equity and improving long-term health outcomes for some of the most vulnerable populations. The ongoing expansions and modifications of these programs reflect an understanding that health starts in homes, schools, and communities, not just at the doctor’s office. 

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