SDOH Coverage Increasing in 2021

SDOH Coverage is continuing to increase in 2020 and 2021 with new features or expansion in health insurance plans.  Notably Medicare Advantage (MA) and Medicaid are making changes for 2021 to include SDOH coverage for reimbursable services.

Coverage for items such as:

• Adult Day Health Services
• In-Home Support
• Integrated Hospice
• Meal Delivery
• Transportation
• Palliative Care
• Therapeutic Massage

will be covered by some plans that are extending their coverage of SDOH conditions.

More and more healthcare professionals are seeing how non-medical factors such as social determinants of health are impacting population health.  Access to necessities such as nutrition and housing are critical to a baseline level of health.  Health plans are slowly increasing their SDOH coverage options to help improve SDOH conditions.  

CMS started allowing more SDOH coverage in 2019 to allow MA insurance plans to be reimbursed.  In 2021, I expect to see an continued increase in plan expansion to cover some of these conditions.  How are plans tracking the needs of their members?  Do they know exactly what SDOH conditions are negatively impacting their members?  These are critical data points that must be collected and stored to allow plans to start improving member health due to SDOH.