Early Adoption of Services for Health-Related Social Needs in Medicare

AUTHOR 

Jessica I. Billig, Joseph H. Joo, Jennifer R. Cardin, Michael D. Dang, Ching-Ching Claire Lin, Jim P. Stimpson, Joshua M. Liao

JOURNAL   JAMA HEALTH FORUM, 2026;7;(1):e256261. 

Abstract

Introduction

Health-related social needs (HRSNs), such as housing instability and food insecurity, are unmet nonclinical needs that can adversely affect patients’ ability to maintain health and well-being but, if addressed, can promote better outcomes.1,2 In 2024, Medicare began reimbursing clinicians for HRSN-related activities, including social determinants of health (SDOH) risk assessment, community health integration (CHI), and principal illness navigation (PIN).3 Although prior work evaluated HRSN services, this study aimed to examine their early utilization and reimbursement in Medicare.

Methods

We used 2024 Medicare data encompassing 100% of professional services billed to and reimbursed by traditional Medicare.4 The University of Texas Southwestern Medical Center IRB deemed this cross-sectional study exempt from review and informed consent because it was not human participant research. We followed the STROBE reporting guideline.

Healthcare Common Procedure Coding System codes were used to capture SDOH risk assessment (code G0136), which must involve standardized, evidence-based tools that at a minimum assess for food or housing insecurity, transportation needs, and utility difficulties; CHI (codes G0019, G0022), which includes facilitating access to community-based resources, home- and community-based care coordination, and patient self-advocacy promotion; and PIN (codes G0023, G0024, G0140, G0146), which supports patients with serious, high-risk conditions expected to last at least 3 months and put patients at substantial risk of functional decline, death, or acute care utilization.

We assessed services submitted to and reimbursed or denied by Medicare. Utilization was stratified by specialty type and place of service. Specialty type included physician grouping (primary care [eg, family practice, internal medicine], medical subspecialty [eg, cardiology, oncology], and other specialty [eg, surgery]) and nonphysician grouping (advanced practice professional [eg, nurse practitioner, physician assistant] and other [eg, licensed clinical social worker]).5 Place of service was categorized as physician office, outpatient hospital, inpatient hospital, and other setting (eg, skilled nursing facility).

Results

In 2024, 285 270 HRSN-related services were delivered across the US. Of those, 208 819 services (73.2%) were reimbursed through $5 007 978 in aggregate payments (Table 1). SDOH risk assessment services were most frequently delivered (82.7% [235 974]), followed by CHI (14.5% [41 362]) and PIN services (2.8% [7934]).