Leveraging Medicaid to Address the Social Determinants of Health

In recent years, there has been an increasing emphasis on improving health outcomes by addressing the social determinants of health — the environmental and social conditions, like access to safe and affordable housing, education and employment opportunities, and good nutrition – that influence people’s overall health.

While siloed programs and funding streams, conflicting priorities, and lack of coordination and communication across agencies have historically impacted the ability of public programs to work together effectively to address social determinants, Medicaid programs across the country are beginning to tackle the challenge.

Over the past several years, Harbage Consulting has supported clients in implementing innovative Medicaid initiatives that address the social determinants in an effort to improve health outcomes.

Below are a few examples of programs we have been proud to contribute to that link people to the social supports they need to lead healthier lives.

Whole Person Care

California’s Whole Person Care (WPC) Program consists of 25 pilots that are working to coordinate physical health, behavioral health, and social services for Medi-Cal beneficiaries across multiple providers, county entities, and community-based organizations. The WPC pilots are addressing the social determinants of health by connecting individuals to health care, housing, and a full range of community resources and social services. Here are some of the ways WPCs are connecting members to services beyond the traditional health care system:

• Housing: Pilots with a focus on their community’s homeless population are coordinating physical and behavioral health services and addressing housing instability by providing tenancy support services. This can include: help finding housing, help with landlord relations, legal advice, funds for security deposits and first month’s rent, educational resources, and more.

• Social Services: Some pilots are helping their enrollees connect to other social services like Supplemental Security Income (SSI), CalFresh (food stamps), and their county-administered General Assistance/General Relief programs.

• Reentry/Justice-Involved: Pilots that are targeting individuals recently released from incarceration are providing enhanced care coordination services and working closely with their local law enforcement, corrections, and/or probation departments to facilitate the reentry process. The goal is to connect members to needed health, mental health, and social services immediately upon release without experiencing a lapse in care. Pilots have set up offices in probation departments, sent care coordinators to meet individuals upon release or at court hearings, and incentivized providers to conduct assessments prior to release.

The WPC pilots are testing innovative strategies for addressing the social determinants of health. Harbage Consulting is helping to spread pilots’ innovative ideas and address challenges by facilitating the WPC Learning Collaborative on behalf of the California Department of Health Care Services (DHCS).

B’More for Healthy Babies

In 2009, Baltimore City had one of the highest infant mortality rates in the country. That year the city launched B’More for Healthy Babies (BHB), a public-private partnership led by the Baltimore City Health Department that provides high-quality, coordinated maternal and infant health services and support to first-time and high-risk mothers during pregnancy and after the baby is born.

BHB is a comprehensive strategy designed to address the social determinants of health that influence birth outcomes in Baltimore. Pregnant women and new mothers receive support in their communities – including at neighborhood mom’s clubs, breast feeding support groups, and B’More Fit exercise classes – as well as through home visits during and after pregnancy. Since the implementation of BHB in 2009, the city’s infant mortality rate has declined by 35 percent – from 13.5 deaths per 1,000 live births in 2009 to 8.8 in 2016. Harbage Consulting has supported the Baltimore City Health Department with identifying opportunities for long-term sustainability of BHB including connecting more effectively to Medicaid.

Health Homes Program

The California Health Homes Program (HHP) is designed to connect Medi-Cal patients with multiple chronic conditions and/or a serious mental illness to an enhanced set of care management and coordination services. One of the core services provided under the HHP is ensuring that patients are connected to community resources and social service agencies that help them address their non-medical needs, such as accessing nutrition programs, employment training, and legal services. The HHP also places a strong emphasis on connecting patients to housing and transportation supports, as these are major barriers to improving health. The HHP is in its early stages and Harbage Consulting is supporting DHCS with program design and implementation. This includes policy analysis as well as developing communication and outreach materials for providers, Medi-Cal members, and community-based organizations.

Vision To Learn

Approximately 1 in 5 school-aged children in the U.S. have a vision problem, and low-income and minority children are disproportionately likely to have unmet vision needs. Uncorrected vision can have numerous health and social consequences — including poor school performance and interference with emotional development — which perpetuate long-standing disparities in low-income communities. Glasses are an easy way to improve vision quickly and can positively impact academic and lifetime achievement.

Harbage Consulting has provided policy and legal analysis, as well as operational and communications support, to the national non-profit organization Vision To Learn (VTL) since 2016. Vision To Learn provides eye examinations and glasses to public school students through mobile clinics on-site, at no cost to families. Our team has worked in support of VTL programs in Los Angeles, CA, Baltimore, MD, Detroit, MI, and Charlotte, NC. We are proud of our work to support children’s access to vision care and to promote the long-term sustainability of this effort to advance health equity across the country.

Addressing the wide range of social determinants of health is a new frontier in the world of health program administration. Harbage Consulting is excited to provide our expertise in Medicaid policy and financing to help our clients discover opportunities to address the social determinants of health through Medicaid and other social service initiatives. Our hope is that through this work, we can play a part in reducing health disparities and improving health outcomes across the county.

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Authors

Lucy Pagel [Director]

Megan Thomas [Managing Principal]