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Health Related Social Needs

As part of the U.S. Department of Health and Human Services’ ongoing efforts to assist states with addressing various health-related social needs (HRSN), as discussed in a State Health Official Letter about addressing Social Determinants of Health (SDOH) released in 2021, the Centers for Medicare & Medicaid Services (CMS) encourages states to utilize authority under section 1115(a) of the Social Security Act to test a variety of options to more effectively address enrollees’ unmet HRSN and the downstream health impacts.

CMS will consider state requests to use section 1115 demonstration flexibilities to cover certain evidence-based services designed to mitigate the negative health impacts of unmet HRSN.  Using this demonstration authority allows states to take a more nuanced approach to defining target populations for HRSN services than is permitted through other CMS authorities.  HRSN services have unique treatment under budget neutrality, and in order to cover HRSN services, states must agree to additional requirements and guardrails, as well as systematic monitoring and robust evaluation.