Pennsylvania is seeking permission for a pilot program to address health-related social needs through the Medicaid program.

If approved, the waiver would allow the state greater flexibility to address issues such as mental health, substance abuse, housing, nutrition and continuous care for young children.

“Health-related social needs are things that affect people’s health and well-being that are not purely medical,” according to the state Department of Human Services website. “These include different social, economic, and environmental factors such as having healthy food to eat or a safe place to live. Health-related social needs are often external to the health care system but play a crucial role in shaping an individual’s health status and quality of life.”

Under Section 1115 of the Social Security Act, states can apply to work in conjunction with the federal Centers for Medicare and Medicaid Services to design and evaluate new programs to provide benefits and services not usually allowed in state Medicaid plans. Such programs are known as 1115 demonstrations.

Pennsylvania is dubbing the proposal Bridges to Success: Keystones of Health for Pennsylvania.

While still subject to change, the state proposal focuses on issues with inmate re-entry, housing supports, food and nutrition supports and providing continuous medical coverage for children up to age six. Specifics of the program are still being worked out and final program design would need to be coordinated with the federal government if a waiver is approved.

INMATE SUPPORTS

According to the Department of Human Services, inmates leaving correctional facilities and attempting to re-enter the community face a higher risk of health issues. DHS data indicates two-thirds of incarcerated individuals have a history of substance abuse and are at 12 times risk of death upon release.

The proposal would “which will require a legislative amendment, will focus on improving transitions to community-based health care and social services with a particular emphasis on those with significant health care needs such as serious mental illness and substance use disorder,” According to DHS.

HOUSING SUPPORTS

Under the proposal, DHS is seeking to put programs in place to help homeless individuals obtain and keep a place to live.

“Stable housing, a recognized cornerstone of good health, can serve as a bridge for homeless adults with chronic illnesses, leading to a nearly 30 percent reduction in hospital stays,” according to DHS. “Having stable housing makes it easier to find and use health care. These services will focus on beneficiaries with behavioral health issues and chronic conditions where health outcomes are greatly impacted by improved consistency of care and medication access.”

FOOD AND NUTRITION SUPPORTS

According to DHS, food insecurity can cause and exacerbate chronic health issues. Addressing the issue in a preventative fashion can prevent more costly acute care later. According to DHS data, addressing food insecurity can reduce the instances of hospital admissions among those with chronic medical conditions by half.

“Keystones of Health proposes to provide food and nutrition services to specific Medicaid populations facing food insecurity, including pregnant beneficiaries and beneficiaries with diet-sensitive conditions,” according to DHS. “Services would include direct food support such as medically-tailored meals or groceries.”

The program would also work to connect individuals with food security issues with benefit programs such as the Supplemental Nutrition Assistance Program.

MULTI-YEAR CONTINUOUS COVERAGE FOR CHILDREN UNDER 6

The waiver would allow provision of continuous coverage for children from birth or older up to six years of age through Medicaid for preventative care and essential health services.

It would take effect either from birth or whenever a child first receives Medicaid through the last day of the month in which a child turns six. Currently, failure to submit forms or a change in household circumstances can interrupt early childhood Medicaid coverage.

Currently, the waiver is in a public comment period until Jan. 2, 2024. During the period, the public can review the draft waiver application and provide comments. Program details, links to the draft application and instructions for providing comment are available at www.dhs.pa.gov/Keystones-of-Health.