C-TAC has long advocated for assessing and addressing people’s health-related social needs (HRSN) in addition to any medical ones. Encouragingly, the Centers for Medicare and Medicaid (CMS) has started requiring these assessments for most Medicare programs. Suggested assessments are for food and housing insecurity, transportation needs, or utility difficulties. A new billing code is now available to pay for them.
CMS has taken a stepwise approach to HSRNs by first requiring their assessment in Medicare programs, and now beginning to require providers to measure positive risk assessments. However, CMS does not yet require referrals to meet any identified HRSN’s. Further, if there are corresponding referrals, services are often in short supply.
Given that, these steps will put more people on waiting lists for social services instead of helping deliver those services. Community services have always been limited due to funding both governmental: Medicaid, Home and Community Based Services, HCBS, and the Older Americans Act’s Area Agencies on Aging (AAAs), and philanthropy. These already limited services are now being stretched further as more people are assessed and referred to them. A Kaiser Health News report last November noted that, “since 2016 there have been close to 0.7 million people on waiting or interest lists with a total of over 692,000 in 2023.”
What must happen is for CMS to not just go to the next logical step in the process, requiring referrals for positive screening, but to go beyond that to require providers to ensure that any referrals result in actual services being delivered. Obviously, it does no good to refer someone with food insecurity to a 5-month waiting list. Their health will be impaired long before the needed meals arrive.
Solutions to this include increasing funding for the AAAs in this year’s update to the Older Americans Act, and C-TAC is working on Capitol Hill to promote such increases. We also support state waivers to boost budgets for Medicaid and HCBS services, and recently wrote about some of the progress being made there. We will continue to advocate to CMS for adding mandatory referrals and ensuring those referrals are actually met with delivered services in any future regulatory comments. We see a future where people with serious illness get both the medical and social services they need to support their health and quality of life. A future without this will cost all of us dearly.
