This is the second blog post in our series on the landscape of transportation in Medicaid. If you missed the first blog post, we encourage you to check it out: How Medicaid Managed Care Health Plans Can Better Address SDoHs Including Transportation

New opportunities to address social determinants of health

State Medicaid managed care health plans are seeking to maintain their high level of government compliance and regulation while improving health outcomes in “non-health” areas that can potentially impact social determinants of health (SDoH).

For years, Medicaid managed care health plans have been unable to direct funds to non-medical services while remaining in compliance with relevant regulatory environments. New opportunities are opening up across SDoH domains and needs, particularly in transportation.

Experimental pilot programs addressing SDoH needs

The greatest enabler of further addressing SDoH needs for Medicaid beneficiaries is with Section 1115 demonstration waivers, which help Medicaid managed care health plans pursue experimental pilot programs targeting a variety of SDoH needs from housing to food delivery.

Transportation has grown as a value-added benefit within Section 1115 waivers, and there's a growing focus on leveraging NEMT to get members to health-improving places such as gyms, grocery stores, active social events, and more. Medicaid managed care health plans are required to provide non-emergency medical transportation, but the focus on non-medical transportation to get to health-driving places like gyms, social events, and grocery stores has grown.

The specifics behind Section 1115 demonstration waivers

According to the Social Security Act, Section 1115 initiatives pursue “experimental, pilot, or demonstration projects” that promote the Medicaid program’s objectives. Section 1115 demonstration waivers are applied for and given on a state level for Medicaid programs for initiatives that look to transform a part of the state’s Medicaid system whether that’s eligibility, benefits, payments, or delivery systems. While the onus is on the applying state to research the returns and effectiveness of the Section 1115 waiver, it’s standard to have these waivers be budget neutral for the federal government (although not required), given that the majority of these program applications include federal fund matching.

Examples of Section 1115 demonstration waivers involving transportation in different states

To date, not all state programs have leveraged this opportunity - but a few notable states to have successfully applied for a Section 1115 waiver with transportation opportunities are highlighted below.

California. In 2016, California launched its “Whole Person Care” pilot program with a holistic approach to member wellness. The statewide pilot program launched targeting those with complex care and high needs targeting criteria, including: frequently utilizing unnecessary emergency facilities, two or more chronic conditions, substance abuse challenges and/or mental illnesses, homeless, and more. From housing assistance to transportation to appointments, there was a range of services offered throughout the programs statewide.

In early evaluations, the Whole Person Care program proved to be widely beneficial helping across risk assessments and enrollment, data sharing and collection, care coordination, and overall health outcomes.  The Whole Person Care program wrapped up in 2020 but has played a foundational role in a person-centered approach - and the second iteration of this program informed the California Advancing and Innovating Medi-Cal program that launched in early 2022.

North Carolina. In 2018, North Carolina launched the “Health Opportunities Pilot” centered around enhanced abilities to address social needs that are demonstrated to be connected to health outcomes. As outlined by their program presentation, the Health Opportunities Pilot implemented a multi-pronged approach to addressing SDoH by meeting housing, transportation, food, employment, and interpersonal safety. By addressing transportation insecurity for individuals, this program directly contributes to the long-term health outcome of individuals.

Oregon. In 2022, after a successful five-year pilot program, Oregon Health Plan’s Section 1115 waiver was up for renewal. A key focus in this renewal process was further addressing SDoH for at-risk populations in periods of transition who would be eligible for these SDoH-focused services, including: the homeless (or at risk to be), transitioning from Medicaid to dual-eligibility under Medicaid and Medicare, recently incarcerated, youth with special health care needs, and youth in the foster home system. For these potentially at-risk members, Oregon seeks to cover multiple health-related non-medical transportation benefits, including:

1. Linking to existing transportation resources
2. Payment for multiple forms of transportation like bus passes or rideshare credits that support access to SDoH services
3. Health-related non-medical transportation services (separate from NEMT)

In addition, Oregon is looking to provide specific transportation services as needed for members such as to employment services or escaping climate events (wildfires, ice storms, etc.).

Making SDoH a priority

All of the above states are at different stages of their Section 1115 waiver application process and all may have slightly different criteria and approaches. However, one thing remains the same for these programs: innovative delivery of care to the most vulnerable members with access to transportation. As of late September 2022, over half of the 50 U.S. states (16 approved and ten pending approval) have utilized Section 1115 waivers to address SDoH for their most vulnerable populations.

At SafeRide, we’re pleased to see Medicaid managed care health plans across the U.S. recognize the value of these waivers and continue aligning with our goal of bringing access and dignity to the care of our nation’s most vulnerable populations. For more on SDoH in Medicaid, our recent white paper (The State of Transportation for Medicaid Managed Care Health Plans) explores how Medicaid managed care health plans navigate non-emergency medical transportation and the latest trends in the transportation landscape.

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