OBJECTIVES: To critically analyze social work’s role in Medicaid reform.
METHODS: We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods.
RESULTS: Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work’s practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work’s involvement in systems-level practice include lack of visibility, insufficient clarity on social work’s role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy.
CONCLUSIONS: Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.
Methods of article
Through interviews with key informants (e.g., NASW, Medicaid officials, public health associations/agencies) from 10 states that are implementing systemic Medicaid reform, the researchers identified limited social work involvement in Medicaid reform. Interviews also revealed a number of barriers and opportunities to social work’s participation
All respondents indicate that social workers have a unique skill set that could be used in Medicaid reform (e.g., SDOH). In some cases, social workers are acting as an intermediary levels, providing care management or navigator services. At the state-level, social workers are involved in administration, management, research, and advocacy
Social workers’ contributions in trauma-informed care may effectively reduce ED utilization when applied to Medicaid beneficiaries with complex care needs
There is a gap between practice-level and systems-level involvement. As a result, social workers’ involvement has been largely reactive. Barriers to proactive engagement include lack of resources, competing demands, and lack of technical expertise. Additionally, there is limited data demonstrating the impact of social work
Additionally, social work is not visibly involved in Medicaid reform. This is related to the above barrier, in which social work is absent from systems-level changes. Visibility is hindered by lack of cohesion among social work organizations, lack of a state-level entity that represents social work, and limited connection between social work and the Medicaid agency.
Moreover, many do not understand what social workers actually do and how they might support SDOH
Finally, there is a need for training amongst social workers in health transformation models. Social workers have limited information about emerging Medicaid payment models and how they can influence access to services
Because addressing SDOH remains a high priority for state and federal policymakers, it will be important to address these barriers and better incorporate social workers in reform