DHS Proposes Medicaid Coverage for Health-Related Social Needs
The Pennsylvania Department of Human Services (PA DHS) is seeking to use its Medicaid program to offer targeted supports and services to certain Pennsylvanians through Bridges to Success: Keystones of Health for Pennsylvania (Keystones of Health).
DHS' goal for Keystones of Health is to improve health and quality of life for Pennsylvania's Medicaid beneficiaries by helping with health-related social needs, which can improve a person's quality of life and offset the need for more costly, intensive acute care.
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DHS submitted its application for Bridges to Success: Keystones of Health for Pennsylvania, a Section 1115 Medicaid demonstration waiver for the January 1, 2025, to January 1, 2030, demonstration period.
1115 demonstrations allow states to develop programs in coordination with the federal Centers for Medicare and Medicaid Services (CMS) that provide services and benefits not normally allowed in state Medicaid plans.
Focus Areas
Under Keystones of Health, DHS will develop a set of services and benefits in four focus areas:
Reentry - Improve transitions to the community for beneficiaries reentering society from correctional facilities. The available services, 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.
Housing – Add new Medicaid services to help beneficiaries without stable housing find and keep a place to live. 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 – Provide food and nutrition services to specific Medicaid populations facing food insecurity, including pregnant beneficiaries and beneficiaries with diet-sensitive conditions. Services would include direct food support such as medically tailored meals or groceries with a goal of also connecting eligible beneficiaries to long-term food assistance, like the Supplemental Nutrition Assistance Program (SNAP).
Multi-Year Continuous Coverage for Children Under 6 Years of Age – Provide continuous Medicaid coverage for children from birth or older but under 6 years of age to reduce gaps in coverage that interrupt access to essential health care services, such as preventive care. This proposal provides eligibility from birth, or when a child first receives Medicaid, through the last day of the month in which they turn 6 years of age.