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Medicare AdvantageĮffective 2020, the Centers for Medicare and Medicaid Services (CMS) is offering new flexibilities for private Medicare Advantage plan sponsors to provide special supplemental benefits for chronically ill enrollees, including benefits “that are not primarily health related” and that may be tailored to enrollees based on individual needs. Many of these models build on the progress and momentum achieved under the Innovation Center initiatives of the previous administration, such as the Accountable Health Communities Model. Since that time, the Innovation Center has rolled out several integrated care models that include features designed to address the physical, behavioral, and social needs of at-risk populations (for example, the Integrated Care for Kids model, the Maternal Opioid Misuse model, and the Primary Care First model options, and so forth). In November 2018, HHS Secretary Alex Azar delivered a speech on America’s social determinants of health, in which he highlighted increased focus on social determinants within demonstration programs run by the Center for Medicare and Medicaid Innovation (Innovation Center) created under the Affordable Care Act (ACA). And, on the face of it, the Trump administration has made select progress on advancing these goals under limited demonstrations and for segments of enrollees under certain programs, which we outline below. Top HHS officials have spoken at length on efforts to better address beneficiaries’ social determinants of health. Select Progress On Social Determinants of Health In execution, however, they have done so inequitably, seeking simultaneously to shrink and weaken health and safety-net programs that are best positioned to provide social determinant-related services to the beneficiaries who need them most.
In step with the growing popularization of the term in US health policy, Trump administration health officials have frequently espoused a commitment to more fully address social determinants of health within federal health coverage programs. It was created to identify and serve the most vulnerable among the world’s populations and to address the inequities that disproportionately impact their lives and their health.
The Department of Health and Human Services (HHS) defines the social determinants of health as the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” The concept, which comes from the global public health field, is at its best when it is understood to encompass an individual’s social location-their race, ethnicity, sex, class, ability, orientation, culture, and how each of these identities impact them in their community context.