Medicaid tackles social determinants of health, but challenges lay ahead

social determinants of health

State Medicaid programs are successful in deploying programs to address the social determinants of health (SDOH), but are facing concerns about sustainable funding and community health partnership, according to a new research published in Health Affairs.

Researchers said that State Medicaid programs are in a position to support activities that address patients’ social needs. Under current Medicaid regulations, all states have the option to pay health care organizations to connect patients with basic social supports, like food or housing resources.

In addition to the general structure of Medicaid contracts, 1115 waivers and other value-based care initiatives are extending state agencies the flexibility to cover social programs that encourage population health.

Inspite of the fact that Medicaid programs have the ability and intent to address the social determinants of health, there is no clear path chalked out to reach that end. Efforts to address the SDOH are nascent, with few state agencies serving as an example for creating social programming.

The researchers took initiatives to learn more about these efforts through qualitative assessments of the Oregon and California Medicaid programs, because both enjoy flexibilities that enable SDOH initiatives.

Coordinated Care Organizations (CCOs) use capitation payments to allow more extensive care coordination than in traditional settings. These models allow for one-time social expenses that can improve a patient’s health. For example an air conditioner for an asthmatic patient’s apartment.

Both California and Oregon’s programs used funding for direct services and capacity building.

Direct services included:

  • Care coordination

  • Housing

  • Food security services

  • Legal services

It could provide patients with something to fill a social need.

Capacity building investments include making it easier for an organization or community partner to deliver a certain social service or good. These included:

  • Staff training

  • Community-based organizing

  • Community engagement

  • Data and technology

As healthcare continues to account for the SDOH, it is vital that key policy making groups consider the resources needed to address these factors. More structured payment programs need to be made to allow organizations to build community-specific SDOH programs. This will be the key to integrate social and physical health.