Reps. Lisa Blunt Rochester, D-Delaware, and Gus Bilirakis, R-Florida, introduced HR 4621, the Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019, on Oct. 9.

This legislation would require the Department of Health and Human Services to provide guidance to states to address social determinants of health under Medicaid and the Children’s Health Insurance Program.

There is growing recognition in the field of public health that reducing long-standing disparities in health outcomes is dependent on systemically addressing the social, economic and environmental factors that influence overall health and wellness. Examples of social determinants of health include: socioeconomic status, education, physical environment, employment, social support networks and access to healthcare.

The legislation will provide guidance to state Medicaid programs regarding how to implement research-proven strategies to optimize social determinants of health under existing Medicaid authority or waivers, especially for pediatric populations. This legislation builds upon the success that some state Medicaid programs have already had since testing innovative delivery and payment models designed to improve health outcomes while reducing costs.

“Research shows that the conditions where people live, learn, work and play, also known as the social determinants of health, play an outsized role in health outcomes and cost,” said Blunt Rochester. “We also know that this is particularly true for children. The impact of social determinants can be felt by our young people through lifelong consequences for their health and well-being. Addressing social determinants of health that affect children can reduce unnecessary use of resources, lead to better outcomes for chronic diseases, such as asthma, and set young Americans up for healthier lives as adults. Some state Medicaid programs are implementing strategies to do this under existing Medicaid authority, but there is not clear guidance on what states can do. There is an opportunity for more states to address social determinants in Medicaid and CHIP by leveraging existing and waiver authorities.”

Specifically, this legislation will direct the HHS secretary to provide guidance to states about strategies to address social determinants of health through Medicaid and CHIP; how to encourage and incentivize managed care organizations to address social determinants of health; and examples of how states are currently addressing social determinants of health.

The full text of the bill is available at