Testing Medicaid Coverage of Health Related Social Needs

HFS

Illinois Department of Healthcare and Family Services

Our vision for the future

We improve lives.

  • We address social and structural determinants of health.
  • We empower customers to maximize their health and well being.
  • We provide consistent, responsive service to our colleagues and customers.
  • We make equity the foundation of everything we do.

This is possible because:

  • We value our staff as our greatest assets.

We do this by:

Fully staffing a diverse workforce whose skills and experiences strengthen HFS.

Ensuring all staff and systems work together.

Maintaining a positive workplace where strong teams contribute, grow and stay.

Providing exceptional training programs that develop and support all employees.

  • We are always improving.

We do this by:

Having specific and measurable goals and using analytics to improve outcomes.

Using technology and interagency collaboration to maximize efficiency and impact.

Learning from successes and failures.

  • We inspire public confidence.

We do this by:

Using research and analytics to drive policy and shape legislative initiatives.

Clearly communication the impacts of our work.

Being responsible stewards of public resources.

Staying focused on our goals.

Waivers under Section 1115 of the Social Security Act provide expenditure authority for state Medicaid programs to demonstrate impact of proposed innovations that would otherwise not be allowed under traditional Medicaid rules.

1115 Fundamentals

Approval

  • Allows the addition of new services or introduction of flexibilities that would ordinarily not be allowable under Medicaid.
  • Allows services and flexibilities to be targeted to priority populations, geographic areas, or designated pilot initiatives to demonstrate impact.

Funding

  • Authorizes federal MATCHING to offset state expenditures on approved demonstration services and flexibilities.
  • Matching available only for state expenditures that are not otherwise supported by another federal funding source.
  • Match rate is 51.09%; for every $100 of state-only funding spent on HRSN, the federal government will return $51.09 to the State.

1115 Transformation Waiver - Proposal

In June 2023, HFS requested Section 1115 authority to address social determinants of health in various ways. If approved, Illinois will:

  • Add new services that address health-related social needs (HRSN), and
  • Pilot HRSN services in existing initiatives and new demonstrations to test their impact on Medicaid members.

Addressing Health Related Social Needs (HRSNs)

Unmet Health Related Social Needs are connected to worse health outcomes and higher health care spending

Recent policy guidance from the Centers for Medicare & Medicaid Services (CMS) acknowledges this link and provides opportunity to request federal match for expenditures on HRSNs

1115 - Proposed HRSN Benefits

  • Housing support
  • Violence prevention and intervention; addressing adverse childhood events
  • Medical respite
  • Community reintegration: transition from incarceration and institutions
  • Food and nutrition services
  • Employment assistance
  • Non-medical transportation

Priority Benefits for 1st Wave of Implementation

Collaboration and Engagement

HFS seeks to leverage community-driven solutions, incorporating community-based and non-traditional Medicaid providers using flexible and streamlined approaches that promote access and quality.

Implementation planning will include engagement with providers and external stakeholders to inform implementation design.

Housing Supports

Available to Medicaid eligible individuals who are experiencing:

  • Homelessness
  • Are at risk for homelessness or institutional placement
    • individuals fleeing domestic violence, assault
    • and meet medical criteria established by CMS

Eligibility for HRSN benefits

Medicaid eligible enrolled in managed care

  • 80% of Medicaid members are enrolled in managed care in Illinois

Eligibility for specific benefits tied to clinical and social criteria

HFS is taking a broad and inclusive approach to eligibility for HRSN benefits

Explainer document available for more detail on all proposed benefits

1115 Materials Available