Key Points
- Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program (CHIP) programs.
- Under this authority, the Secretary may waive certain provisions of the Medicaid law to give states additional flexibility to design and improve their programs.
- CMS has published a framework of services and supports to address health-related social needs (HRSN) that CMS considers allowable under specific Medicaid and CHIP authorities.
- Health-related social needs are an individual’s unmet, adverse social conditions that contribute to poor health outcomes.
- These needs, when unmet, can drive lapses in coverage and access to care, higher downstream medical costs, worse health outcomes, and perpetuation of health inequities, particularly for children and adults at risk for poor health outcomes, and individuals in historically underserved communities.
FIM Opportunities
HRSN services included in 1115 Demonstrations, including those relevant to food and nutrition, must be "integrated with existing social services," and state spending on social services pre-1115 must be maintained or increased.
Under this framework, nine states have been approved for an 1115 Demonstration that includes food and nutrition. Several states have pending applications.
Evaluations of 1115 Demonstrations that incorporate Food Is Medicine can inform other programs seeking to implement Food Is medicine interventions.