Medicare’s first-year payments for social needs showed high use by primary care but many claims were denied

In 2024, the first year Medicare paid for services that address patients’ health-related social needs, most care came from primary care doctors in office settings, but more than one in four claims were denied, showing barriers that could slow adoption of these new services, according to a study published today in JAMA Health Forum.

On January 1, 2024, Medicare began paying clinicians to help patients with health-related social needs such as unstable housing, food insecurity and transportation challenges. The change, finalized through the 2024 Medicare Physician Fee Schedule, marked a major shift in how the program addresses nonmedical drivers of health.

This initiative aimed to reduce poor health outcomes and higher costs linked to unmet social needs while encouraging greater care coordination and connections to community resources.

Because these factors can strongly affect patients’ health outcomes but have typically gone unaddressed in clinical care, researchers based at the University of Texas Southwestern Medical Center in Dallas, along with a Texas health policy program and a collaborator from National Taiwan University, examined how these new services were used in Medicare’s first year and whether clinicians were successfully reimbursed for providing them.

The study used 2024 Medicare claims data covering all professional services billed to traditional Medicare to look at early use of services that address patients’ social needs. Due to the analysis relying on existing claims data and not involving direct contact with patients, the University of Texas Southwestern Medical Center determined the study did not require institutional review board oversight or patient consent.

The researchers followed standard reporting guidelines for observational studies.

In the study, claims were identified by using billing codes for three types of services: social determinants of health risk assessments, community health integration services and principal illness navigation services. These services include screening patients for needs such as food or housing insecurity, helping patients connect with community resources, coordinating care and supporting patients with serious or high-risk conditions.

Researchers examined whether claims were paid or denied by Medicare and compared use of services by clinician type and care setting, including physician offices, hospitals and other facilities such as skilled nursing centers.

It was found that in 2024, 285,270 services addressing health-related social needs were delivered across the U.S. About 73% of these services were reimbursed, while more than one in four claims were denied.

Social determinants of health risk assessments were the most common service, followed by community health integration and principal illness navigation services. Most services were delivered by primary care doctors in office settings, with smaller numbers provided by advanced practice professionals, medical subspecialists, other specialists and nonphysicians.

The research from this study offers new insight into how Medicare’s first-year social needs services were used and shows the critical role of primary care in supporting patients. It also highlights barriers to providing these services, including administrative burdens, staffing challenges and workflow misalignment, which may contribute to denied reimbursements.

Limitations do exist, however, with the cross-sectional design and lack of practice- or patient-level data, which prevent conclusions about why claims were denied. Services may also be provided outside traditional Medicare through Medicare Advantage or state programs.

The authors suggest future studies should test ways to reduce barriers and improve access to services that address patients’ social needs.