Addressing the Health-Related Social Needs (HRSN) of Health First Colorado and CHP+ Members

The Department of Health Care Policy & Financing (HCPF) is actively working to better support the health-related social needs (HRSN) of Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) members, such as housing instability and food security, in an effort to recognize that a member’s health depends on more than health care alone. There is growing interest in supporting individuals' HRSN from other Colorado state agencies, community partners and our federal partners.

Goals of HRSN Efforts

  • Remove barriers that prevent people from accessing timely, quality care.
  • Understand and support members' HRSN.
  • Design HRSN service expansions in partnership with stakeholders.
  • Be a national leader in Medicaid and Children’s Health Insurance Program (CHIP) HRSN policy.

What are Health-Related Social Needs?

Health-related social needs (HRSN) describe social and economic factors impacting a person's overall health and well-being. For example, this might include a person's ability to access stable housing or nutritious food. Extensive research has indicated these factors can account for as much as 50% of health outcomes. 

HRSN are non-medical factors that influence a person’s health and well-being. Other programs use the term social determinants of health (SDOH) which is closely related. Consequences of unmet HRSN include lapses in coverage and access to care, high medical costs, and perpetuated health inequities. As a result, individuals may experience poor health outcomes and health disparities, which can be perpetuated across entire communities or generations. 

In recognition of the tie between social needs and health, the Centers for Medicare and Medicaid services (CMS) created new opportunities for states to use Medicaid authority to expand services that meet members’ HRSN. 

Examples of Health-related Social Needs include:

  • Nutritious and available food
  • Consistent Utilities
  • Economic Security
  • Affordable and Safe Housing
  • Reliable and Convenient Transportation
  • Freedom from Violence and Discrimination
  • Health Care Availability

Current HRSN Efforts and Covered Benefits

HCPF has ongoing and emerging initiatives to address the HRSN of Health First Colorado and CHP+ members. HCPF is committed to supporting members by removing barriers to care and expanding access to services that promote members’ health and well-being. 

Health First Colorado-covered benefits addressing HRSN

Additional HCPF and partner efforts addressing HRSN

Expanding HRSN Services and Supports

Legislative Directives to Explore Expanding HRSN through Feasibility Studies

HCPF has been directed through legislation to investigate and expand HRSN services that research demonstrates have the greatest impact on health and wellbeing. Initially, HCPF is focusing on housing and nutrition. Through feasibility studies and stakeholder engagement, HCPF will explore additional areas of focus, which may include transportation, utilities, and/or interpersonal violence. 

Colorado House Bill 23-1300 “Continuous Eligibility Medical Coverage” directs HCPF to study the feasibility of HRSN service expansions or additions and submit a report to the legislature by January 1, 2026. 

Colorado House Bill 24-1322 “Medicaid Coverage Housing & Nutrition Services” adds a study focusing on housing and nutrition HRSN service feasibility due to the legislature by November 10, 2024. This legislation authorizes HCPF to seek federal authority to expand certain housing and nutrition related services by July 1, 2025, if determined to be feasible. 

Health Related Social Needs 1115 Waiver Demonstration Amendment

Authorized by HB 24-1322, HCPF expects to submit an HRSN 1115 amendment to CMS in August. This timeline is significantly expedited compared to previously anticipated timelines, including that set out by HB 23-1300 and HB 24-1322. In coordination with the Governor’s Office, HCPF will pursue this expedited plan in order to capitalize on unprecedented support by CMS to expand certain housing and nutrition related services. CMS has strongly encouraged states to apply, and HCPF is well-positioned to put forth an amendment application sooner than anticipated. 

The August amendment, however, will not preclude HCPF from expanding HRSN services through future amendments based on stakeholder feedback and the information learned through the two required feasibility studies. Learn more about Colorado’s 1115 Substance Use Disorder Demonstration Waiver and the amendment work currently in progress on our 1115 waiver webpage.

Stakeholder Engagement Opportunities

HCPF is seeking input from stakeholders to ensure we include the voices and expertise of members, other state agencies, providers, advocates, and other partners throughout all phases of development, including analysis, design, and implementation. 

HCPF held an initial stakeholder event on March 11 to highlight existing and upcoming initiatives to expand, enhance, or pursue new HRSN services. Please find materials from this meeting below:

HCPF is looking to engage with individuals and organizations who may be impacted by these efforts, and who are available to provide input for several months to support the HRSN feasibility studies. This may include individuals using HRSN services, providing services, or managing services. These services include nutrition assistance such as home delivered meals or produce boxes, housing services like rent or utility assistance, or other areas to be identified. The full list of services that CMS allows states to consider is available here.

Participation may include:

  • Providing input on services and populations to be included in HRSN feasibility studies.
  • Identifying implementation factors such as administrative implications, member experience, and/or systems coordination.
  • Receiving updates on feasibility study progress and outcomes.

If you are interested, please contact hcpf_hrsn@state.co.us and subscribe to our newsletter for updates on additional opportunities.

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Colorado Resources

Federal Guidance

National Policy Overview Resources 

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