What HRSN means in a Medicaid context
Health-Related Social Needs (HRSN) is the term Medicaid programs use for the social and economic factors — housing, food, transportation, utilities, interpersonal safety — that a state's Medicaid demonstration or managed care contract requires plans to screen for, address, and report on. It sits alongside the broader term Social Determinants of Health (SDOH), which describes the underlying conditions; HRSN is specifically the individual-level need Medicaid programs are accountable for addressing.
The screening-to-service workflow
A Medicaid HRSN program typically moves through five stages: screening (structured HRSN assessment at a clinical or community touchpoint), eligibility and consent (confirming benefit coverage and member consent to share information), referral (routing the identified need to a capacity-aware community provider), service delivery and verification (confirming the service was actually provided, not just referred), and outcome attribution (linking the resolved need back to health and cost outcomes for state and CMS reporting). A common failure point is the gap between step 3 and step 4 — referrals that are sent but never confirmed as completed, sometimes called referral leakage.
Why closed-loop tracking matters for compliance
Most state Medicaid HRSN reporting requirements — for 1115 waiver demonstrations, in-lieu-of-services (ILOS) tracking, and managed care quality measures — require plans to demonstrate that a referral was not just made but completed, with an auditable trail. A platform that only tracks referral creation, without service verification and outcome capture, cannot support that reporting requirement.
How Relay Helps
Relay was built around the full HRSN lifecycle, not just referral creation: eligibility checks, capacity-aware routing to community organizations, closed-loop status tracking through acceptance, service delivery, and outcome capture, plus the financial operations (authorizations, encumbrances) and reporting dashboards Medicaid Lead Entities and managed care organizations need for regulatory and quality reporting.