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Medicaid Plans Tackle Social Determinants of Health but Barriers Remain

January 22, 2019

Medicaid Plans Tackle Social Determinants of Health but Barriers Remain
New report on unmet social needs highlights opportunities, challenges facing MCOs, other stakeholders

Washington, DC, January 22, 2019 – The Institute for Medicaid Innovation (IMI), the non-profit Medicaid research group, shed light on the economic and social conditions affecting health outcomes in underserved populations with a new report, “Innovation and Opportunities to Address Social Determinants of Health in Medicaid Managed Care.”

It is now widely known that non-medical factors such as housing, education, food insecurity, and poverty can adversely affect population health. The effects of these social determinants of health (SDOH) are most pronounced in the 70 mil­lion Americans covered by Medicaid. In this paper, the IMI highlights the opportunities for the Medicaid program and its stakeholders, especially the managed care organizations (MCOs) that cover the vast majority of its enrollees, to identify and address the social risk factors that can affect health outcomes of this vulnerable population. The report features case studies that showcase exemplary state-led initiatives that take on SDOH, but also describes the barriers that can impede progress.

Notable in the report are efforts by MCOs increasingly using care management and coordination, the hallmarks of their delivery model, to target social drivers of health outcomes like housing, behavioral health, substance abuse, and nutrition. Tactics range from screening and data collection to identify need, to coordinated partnership referral services that address social risks. Medicaid MCOs monitor key metrics along the way that have shown promising results including cost savings achieved by reductions in readmissions and emergency department visits.

Despite these successes there is still a long way to go, with several obstacles standing in the way of taking these initiatives to the next level, especially problems with financing and data sharing. However, these barriers also represent opportunities for MCOs, state Medicaid agencies, and community-based organizations to effect real change. Among the report authors’ clinical, research, and policy recommendations: standardizing SDOH information, exploring alternative care delivery approaches, identifying strategies to target at-risk populations; identifying sustainable funding sources, determining social intervention strategies that provide the most value; establishing a nationally standardized screening tool and quality metrics, and supporting multi-stakeholder engagement to integrate social interventions strategies.

“Medicaid agencies and their managed care organization partners are consistently in search of opportunities to improve the quality and value of care provided to Medicaid enrollees,” said Jennifer E. Moore, PhD, RN, executive director of the IMI. “Despite the increasing focus shown in our report on the role of social determinants on health care and outcomes, more needs to be done to create systems to address unmet social needs, especially finding sustainable funding to support these programs.”

Read the full report at, and read the report's one-pager here.

About the Institute for Medicaid Innovation
The Institute for Medicaid Innovation is a 501(c)3 nonprofit research organization that provides independent, nonpartisan information and analysis that informs Medicaid policy and improves the health of the nation.

Media contact:

Lydia Tonkonow