States Call for Managed Care to Prioritize Rural Health

As Medicaid agencies reprocure managed care programs, states are increasingly pressing health plans to address the challenges of rural health care deserts. Molly Dean, MSW, policy advisor at Siftwell, discusses how states have encouraged managed care entities to invest in local communities, build partnerships with nonprofits, and support social determinants of health initiatives in an interview with The American Journal of Care®. However, with Coronavirus Aid, Relief, and Economic Security (CARES) funds gone and financial pressures mounting, states must now reconsider how they structure requirements for managed care organizations to ensure sustained access to care in rural areas.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Can you discuss the efforts aimed at improving managed care in rural health care deserts?

I think a couple of things that we've seen over the last several years, it's been a really rich time of Medicaid agencies reprocuring their managed care programs. Many states have looked to that opportunity to ask managed care entities this very question: What are you going to do about the rural areas of the state? Oftentimes, that looks like either a requirement or a strong recommendation to invest, to think through collaboratives, to understand the not-for-profit community, who is doing work. How do you fund them? How do you make that an extension of what you're making available by virtue of resource and the provision of health care services in these rural communities. That's everything from supporting local food banks, domestic violence shelters, what have you.

There has been an intentional request of the managed care plans to take their resources, their relationships, their competencies, and establish a presence, if you will. But also, more importantly, relationships with provider communities and entities that help care for social determinants of health gaps, that's been requested. We have seen that. I think the other piece of that is the "now"—like, now what? We are at a time where, for most states, the managed care rates, there's no longer a cushion, the CARES Act dollars have gone away. There's a squeeze that managed care entities are feeling there from a financial standpoint, all have requirements to invest back in states, back in people.

That's long standing on the other side of the Affordable Care Act. But what does that look like now? And I think it is going to be really important that states consider what they are requiring and expecting their managed care companies to maintain in terms of these relationships, particularly the relationships that are forged in these rural areas to ensure that people have the access to both the provision of health care again, as well as the social determinant of health needs being met by virtue of these relationships.

In some areas, it's been kind of voluntary; states haven't been very prescriptive in what they're asking of the health plans. But I think absent the ability to use direct Medicaid funding to pay for some of these things that that's going to be an ask, which then goes back to the real importance of understanding the value of, "we're no longer able to just throw money to all the various sundry, community-based organizations, because it looks good when I'm applying For an RFP [request for proposal]." The strategy, and the strategic nature, have to be in play, so that the investments for these managed care entities are thoughtful, but more importantly, informed by understanding the real needs of members, and to your question, the real needs of members in rural locations that otherwise will not have access to to care.