Many in the healthcare community are starting to take notice and are working to better understand and to address how social determinants impact health. Health plans have invested in care management services, as well as direct services like medical transportation, nutrition, or employment services. Meanwhile, governors, public health officials and others throughout the country have engaged in efforts to better integrate social determinants of health into the healthcare system – including into the Medicaid program, which now covers over 74 million Americans, including elderly and disabled adults, children, pregnant women, and others.
States have taken steps to address social determinants in Medicaid by using Medicaid dollars to pay for critical services like supportive housing or social service referrals. However, the Medicaid statute does restrict the use of Medicaid funding for services other than medical services, limiting the extent to which the Medicaid program can address social determinants on its own.
Further, the way that the funds flow from the federal government to states creates significant barriers to cross-agency and cross-program coordination. Current federal programs and services to address factors like housing, health care, nutrition, or transportation are siloed in terms of both funding and administration, meaning that efforts to provide consumers with combined and coordinated services addressing their full needs are often stymied.
Those who run state programs agree that one of the greatest challenges to realizing a comprehensive approach to addressing whole person health is the fragmented nature of federal and state funding.