Community Investments in West Virginia through Medicaid Managed Care
Medicaid managed care plans work to improve clinical and non-clinical factors that contribute to the health and wellbeing of Medicaid members and their communities. Plans are well situated to improve the whole health of individuals, making them an important partner in investing in under-resourced communities.
In 2021, West Virginia’s Bureau for Medical Services (BMS) modified its Medicaid managed care contracts to allow health plans to develop strategies to address Social Drivers of Health (SDOH) and include spending for those strategies in the Medical Loss Ratio (MLR) numerator.
This brief provides an example of how UniCare Health Plan of West Virginia, an Elevance Health affiliated Medicaid plan, leveraged the SDOH MLR contract changes to maximize its community investments. Those changes eliminated a significant barrier for managed care plans in West Virginia to invest in whole health. Policymakers could consider various options to amend MLR requirements to support increased investment in SDOH-related activities.
Related Public Policy Research
For beneficiaries experiencing or at risk of experiencing homelessness, Medicaid plans may offer services beyond traditional healthcare that help to remove barriers to securing housing.
Data show that individuals had more outpatient visits and saw improvements in medication management following integration of MH/SUD and physical health through Medicaid MCOs.
Social drivers are perceived differently. Individuals emphasize drivers that affect them daily while researchers and journalists focus on structural factors like education and income level.