Hot Topics / Priority Issues

TUESDAY, DEC 14, 2021

Medicaid Managed Care: Strategies to Address Social Determinants of Health & Health Equity

Social factors such as income, education, food, housing and employment – commonly referred to as the social determinants of health (SDOH) – are key drivers of health outcomes. Challenges in meeting social and economic needs can lead to poor health outcomes, driving up health care costs and contributing to disparities. Given this impact, Medicaid programs are increasingly focused on addressing SDOH and health equity. Health equity is when everyone has the opportunity to be as healthy as possible and efforts are undertaken to remove social and economic barriers to health. Broader flexibility exists under managed care versus fee-for-service (FFS) to address these issues; additionally, managed care provides the benefit of a single entity responsible for centralized care coordination. States can encourage or require managed care organizations (MCOs) to address SDOH and health equity via contract requirements. To understand how states are addressing SDOH through MCO contracts we reviewed 10 recent requests for proposals (RFP) which revealed an overarching commitment by states to address SDOH and health equity through their contracting arrangements. Key themes identified among reviewed RFPs are highlighted in the report.