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Barriers to Addressing Social Determinants

In addition to the relatively low level of social service spending in relation to healthcare spending, there are a number of other barriers that limit the federal government’s ability to help address social determinants.

The federal government funds over 80 programs that provide aid to people with low incomes, ranging from programs that provide healthcare services, behavioral healthcare services, food benefits, cash assistance, transportation assistance, energy assistance, among many others.

The authority, funding and administration of many of these programs was established and has evolved differently over time, creating a number of different programmatic siloes at the federal level, as well as at the state or local implementation level.

Siloed programs creates inefficiencies in program administration and also adversely impact peoples’ experience with government, due to often duplicative or conflicting application or program requirements.

Further, siloes have significant implications for efforts to better coordinate or integrate services as part of a whole-person approach – impeding attempts to blend funding across programs, or to innovate or modify the way in which services are delivered.

Below are some examples of commonly raised barriers:


  • Inflexible funding, siloes – over 80 federal programs provide aid to people with low incomes
  • Burdensome regulations and statutory requirements
  • Burdensome, duplicative and complex reporting requirements, varying measures of success
  • Siloed program administration – lack of comprehensive central data systems for eligibility, tracking, etc.
  • Non-standardized eligibility thresholds, definitions (ex: income thresholds), reporting systems tools/measures, reimbursement mechanisms.
  • Social determinants are often not tracked at the healthcare level, arming clinicians, health plans, or states with minimal information with which to help address the issues.
  • Diffusion of responsibility and delivery systems – state, managed care organizations, Accountable Care organizations, providers, community health workers, human services departments, etc.

Consumer Experience

  • Complex applications and eligibility processes, and multiple points of entry.
  • Misaligned objectives and benefit cliffs, and little incentive to decrease use of programs.
  • Varying requirements to maintain eligibility (e.g. work requirements) and in use of benefit.
  • Different household members may be eligible for difference programs.