Social Determinants of Health Priorities of State Medicaid Programs

Chisolm D, Brook D, Applegate M, Kelleher K
Source: BMC Health Services Research
Publication Year: 2019
Patient Need Addressed: Financial insecurity, Food insecurity, Homelessness/housing, Transportation, Trauma
Population Focus: Low income, Medicaid beneficiaries
Type of Literature: White


Insights Results

Overview of article

  • Through online surveys and brief face-to-face, semi-structured interviews of Medicaid medical directors, this study explored the how social determinants of health are being considered within State Medicaid Programs

Methods of article

  • Authors employed a mixed-methods design, combining online surveys and brief face-to-face semi-structured interviews of Medicaid medical directors, to explore how SDOH are being considered within State Medicaid Programs
  • An online survey was designed to collect information on present state and desired future state for collection and use of SDOH data within Medicaid programs using a list of 10 evidence-based SDOH topics identified through a review of previously published literature The following SDOH topics were included: 1) housing instability; 2) utility needs; 3) family and social support; 4) education and/or literacy; 5) food insecurity; 6) employment; 7) transportation needs; 8) criminal justice involvement; 9) intimate partner violence; and 10) interpersonal safety
  • Medicaid representatives from 21 states attended the meeting in November 2017. At this meeting all state representatives present were invited to participate in face-to-face semi-structured interviews, regardless of having completed the online survey


  • Over half of respondents reported that they are currently collecting and using SDOH data for their Medicaid programs, with the most commonly identified topics being housing instability and food insecurity
  • All respondents said they plan to start or continue SDOH data collection in the future with criminal justice involvement and intimate partner violence being the topics with the greatest planned growth
  • Areas with the greatest intended expansion were monitoring managed care plans or providers, incentivizing managed care plan or provider performance, stratifying health outcomes measures, and setting overall population health goals
  • Limiting factors to data collection include aging data systems, organizational silos, lack of standardization of data formats and definitions, and lack of standardized SDOH screening questions
  • Other barriers include policy and politics in the healthcare policy landscape, and tight state budgets

Key takeaways/implications

  • There are opportunities and barriers for SDOH in the state Medicaid landscape. Barriers include the instability and uncertainty of the health policy environment while opportunities include adding community engagement and work requirements to Medicaid eligibility criteria through 1115 waivers
  • Many State Medicaid programs use SDOH data currently or plan to in the future as a strategy to address the social drivers of healthcare expenditures, but also barriers to sustainability
  • Research yielded 4 call to action items: 1) Development of validated measures of SDOH related risks and outcomes; 2) Reconsideration of privacy and confidentiality policies that block individual level data sharing within and across agencies; 3) Development of pilots or demonstration projects that allow spending across health and social service silos; and 4) Need for an infrastructure and funding mechanism allowing states to share best practices and conduct research on what works
  • Limitations to this work include limited representativeness of all Medicaid programs and lack of generalizability