Keystones of Health Waiver Approval: Advancing Health Outcomes by Addressing Health-Related Social Needs
On December 26, 2024, the federal Centers for Medicare & Medicaid Services (CMS) granted approval for the remaining parts of Pennsylvania’s Medicaid waiver demonstration known as “Keystones of Health”, aimed at enhancing health outcomes and reducing costs by tackling health-related social needs.
Section 1115 Waiver Demonstrations like this one allow states to collaborate with CMS to establish programs that deliver health-related services and benefits typically excluded from Medicaid coverage. Addressing unmet social needs—such as housing instability, homelessness, and food insecurity—is crucial, as these factors create significant barriers to accessing health care and directly affect health outcomes and care costs.
CMS’ approval specifically encompasses three vital components of Pennsylvania’s proposal:
- Reentry Supports (Fact Sheet)
- Housing Supports (Fact Sheet)
- Food and Nutrition Supports (Fact Sheet)
Additionally, a fourth component—continuous eligibility for children up to age 6 and certain individuals transitioning from incarceration—was separately approved by CMS in November.
In January, state Medicaid officials indicated they were reviewing the special terms and conditions included in the federal approval. The implementation of these essential components of the Keystones of Health waiver, as well as the continuous coverage provisions previously approved, will hinge on funding being appropriated through the state budget process.
PHLP is committed to providing ongoing updates on this important development as new information becomes available.
