Medicaid as a Multiplier
This report from LISC Research & Evaluation shows how Medicaid can fund community interventions to improve the social determinants of health. The model is paving the way for community-based organizations to collaborate with hospitals and insurers to promote health equity and lower healthcare costs in the bargain.
Executive Summary
In the United States, the COVID-19 pandemic not only brought longstanding health inequities to greater awareness, but also exacerbated them, to devastating effect. While factors within healthcare systems directly contribute to these inequities, for some time, there has been a growing recognition of the importance of addressing health inequities “upstream.” These factors are collectively called social determinants of health (SDoH), and are defined by the World Health Organization (WHO) as the “conditions where people are born, grow, live, work, and age.”
While addressing social determinants may reduce spending and improve equitable outcomes, medical providers do not often possess the in-house skills, resources, or staffing necessary to address the complex non-medical needs of their patients. Nor will Medicaid generally fund these non-medical services without a special waiver.
To accomplish this task, healthcare providers often create partnerships with community-based organizations (CBOs) to provide services that address housing, employment, food access, substance use disorder, and alternatives to incarceration. As social-service providers grounded in neighborhoods, community-based organizations are often very well positioned to intervene in these SDoH domains, at the community level or at the individual level of social needs. However, partnerships between healthcare organizations (HCOs) and CBOs do not always meet their full potential.
This paper uses original interviews, case studies, and a literature review to examine Medicaid-funded partnerships that address SDoH, and the potential role of community development intermediaries in advancing them. Drawing on case study research, it finds that 1) establishing clear and trusted roles, 2) creating effective coordination vehicles, 3) supporting CBOs with health-related intervention experience, and 4) ensuring funding and institutional support were all critical components of successful partnerships. Intermediaries have supported and can continue to support SDoH partnerships by 1) helping plan and coordinate complex initiatives, 2) building service capacity and leveraging resources, and 3) helping cement institutional support on the part of both CBOs, hospitals, and insurers.
Actions by the federal government can both incentivize SDoH partnerships and address the capacity needs of community organizations. They include:
- Establishing a social determinants of health capacity-building program.
- Funding planning and technical-assistance grants that advance evidence-based SDoH interventions.
- Establishing integrated social-needs referral networks in communities.
- Strengthening nonprofit hospitals’ community health needs assessments.
- Incentivizing community development activities among health insurers.
