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State expectations and Medicaid Managed Care Organizations' efforts to address the social needs of Medicaid enrollees

Opoku ST, Owens CF, Apenteng BA, Kimsey L, Peden AH
Med Care Res Rev

Existing work on states' efforts to address the social needs of Medicaid enrollees indicate the implementation of several state-level strategies to move Medicaid Managed Care Organizations (MMCOs) toward the provision of whole-person care. However, less is known about how these expectations drive MMCOs' SDOH efforts. To address this gap, we interviewed representatives of eight MMCOs (N=28) and 12 state Medicaid offices (N=17). Participants described varying state-implemented instruments for encouraging an SDOH-focus among MMCOs, including both coercive (e.g., contractual mandates) and subtle approaches (e.g., request for proposal process and performance measurement expectations). However, regardless of states' expectations, MMCOs, driven by organizational and industry-related factors, recognized the importance of addressing SDOH as part of a holistic approach to health care. Collectively, regulatory pressures, organizational strategy, and market forces influenced MMCOs' efforts to address SDOH leading to a normalization of their role in addressing members' social needs within a medical paradigm.

Opoku ST, Owens CF, Apenteng BA, Kimsey L, Peden AH. State expectations and Medicaid Managed Care Organizations' efforts to address the social needs of Medicaid enrollees. Med Care Res Rev. 2022 Jun 2:10775587221096262. DOI:10.1177/10775587221096262. Epub ahead of print. PMID: 35652530.

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Publication year
Resource type
Peer Reviewed Research
Outcomes
Process
Population
Medicaid-insured
Study design
Other Study Design