On December 10, CMS released an updated Center Informational Bulletin (CIB) that refines CMS' descriptions of opportunities for states to cover clinically appropriate and evidence-based services and supports that address health-related social needs (HRSN) in Medicaid and the Children's Health Insurance Program (CHIP). This "HRSN Framework" was initially introduced in a November 2023 bulletin and supporting framework. The December 2024 CIB supersedes the earlier guidance and updates the framework, reflecting the ongoing experience of CMS and the ten states with approved Section 1115 demonstration waivers for HRSN services (as of November 2024).
The November 2023 guidance emphasized the impact of unmet HRSN on health outcomes and health equity. It introduced mechanisms for states to provide targeted interventions via Medicaid and CHIP to address these needs, highlighting the programs' importance in reducing health disparities and enhancing access to care. This 2024 guidance reiterates Medicaid and CHIP's existing mechanisms for addressing HRSN, which include state plan authorities, Section 1915 home- and community-based services authorities, managed care in lieu of services and settings, Section 1115 demonstrations, and CHIP Health Service Initiatives.
This updated 2024 guidance adds further detail to prior service definitions and eligibility criteria. In particular, CMS provides clarity around service durations and allowable activities for all housing services. In addition, CMS establishes expectations for state oversight for the quality of nutrition services.
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