A new bill that would require Medi-Cal health plans to cover social determinants of health (SDOH) screenings and provide access to community health workers is gaining support in the California Legislature.
Assembly Bill 2250 would build on Medi-Cal’s ramped up efforts to incorporate health-related social needs into the traditional medical setting. It was approved by the Assembly’s Health Committee on April 3.
SDOH are conditions that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Research shows that SDOH accounts for 80 percent of an individual’s health outcomes.
“It is horrific that in this country and in this state, your zip code determines your life expectancy. SDOH screening tools in clinical practice help identify the social and economic risk of patients that are usually unknown to us—who are healthcare providers—but they are a critical piece and often the missing link to successfully presenting, preventing, or managing health conditions,” AB 2250 sponsor Dr. Akilah Weber (D-La Mesa) said.
Weber provided an example of how a care plan could be developed around a patient’s SDOH. If a provider screens a patient and discovers that they live in a food desert, the patient’s nutrition recommendations would need to be altered in order to achieve successful results. Unaddressed SDOH challenges exacerbate existing health disparities and lead to increased healthcare costs, she added.
While ACEs (Adverse Childhood Experiences) screenings are available through the federal Center for Medicare and Medicaid Services (CMS), SDOH screenings cover a broader range of social and environmental factors that display one’s healthcare risks throughout their entire life, rather than a specific subset of adverse childhood experiences.
“By requiring coverage for screenings and access to community health workers, AB 2250 ensures that Medi-Cal beneficiaries benefit from these essential services,” Weber added.
Dr. Adia Scrubb, a family medicine physician in Solano County, said she learned early in her career that community physicians must consider factors that impact patients beyond clinic walls. She said AB 2250 would ensure that providers have resources to better understand the factors that impact a patient’s health.
“If I am informed that a patient does not have reliable transportation, then I [will] try to select medicines that require less follow-up and monitoring. If I am informed that I have a patient who is an unhoused diabetic that doesn’t have access to refrigeration for their insulin, then I have to maximize treatment with oral medications.”
— Scrubb
Scrubb noted that there are obstacles outside of clinical settings that can interfere with a patient’s ability to complete treatment, and said providing them with a warm handoff to a community health worker will further discussions of the patient’s needs and follow-up appointments.
“While progress has been made in addressing SDOH through initiatives such as the community health worker benefit under Medi-Cal, (and) the inclusion of SDOH codes under CalAIM, there’s still gaps that persist that AB 2250 seeks to fill,” said Tiyesha Watts, legislative and policy advocate for the California Academy of Family Physicians.
Watts said AB 2250 would empower primary care physicians to efficiently screen for social needs, and builds upon existing initiatives like Medi-Cal’s community health workers benefit.
“As the first, and often most consistent, point of contact in the healthcare system, SDOH screenings are typically conducted by primary care physicians, however Medi-Cal does not currently cover or reimburse those services,” Watts said.
The committee passed AB 2250 by a vote of 15-0, and sent it to the Appropriations Committee.