Every American deserves access to affordable, high-quality health care. Unfortunately, disparities in health outcomes continue to negatively impact racial, ethnic, and cultural communities at alarming rates. As an essential safety net program, Medicaid plays an outsized role in addressing the root causes of these disparities and driving health equity.
How Social Determinants of Health Influence Health Disparities
Significant racial and ethnic health disparities persist throughout the United States. Black and American Indian/Alaska Native (AIAN) individuals have lower life expectancy, on average, than white people. Additionally, Black and AIAN communities are at higher risk for many chronic health conditions, including diabetes and hypertension. The COVID-19 pandemic has only exacerbated these disparities, with average life expectancies for Black and Hispanic individuals falling more sharply compared to white individuals.
Further, new research has shown significant health disparities affect the LGBTQIA+ community:
- Chronic diseases are more prevalent among lesbian, gay, and bisexual adults than among heterosexual adults.
- Bisexual adults are more likely to report having asthma compared to heterosexual adults.
- LGBTQIA+ adults are more likely to have a mental illness or substance use disorders compared to heterosexual adults.
For years, advocates have been raising awareness about the vital role that socioeconomic factors — such as inadequate access to nutritious food, lack of affordable housing, lack of convenient transportation options, and limited opportunities for quality education and meaningful employment — have on an individual’s overall health and wellness.
These social determinants of health (SDOH) can impact a person’s ability to live a healthy life, access quality health care, and put them at greater risk of developing health issues. On a large scale, unaddressed SDOH are driving more severe health disparities, poorer health outcomes, more hospital admissions, and higher costs.
Driving Innovation in Medicaid
As a vital part of the country’s health care system, Medicaid is uniquely situated to directly address risk factors facing the most vulnerable populations. Medicaid managed care organizations (MCOs) — which serve more than three-quarters of Medicaid enrollees — are helping drive innovation within the program by working with community partners to address the full spectrum of patient needs, including housing instability, food insecurity, lack of transportation, and social isolation.
Notable examples of successful MCO initiatives to address SDOH include:
- Partnering with local organizations to provide homeless members with medical care, mental health support and recovery-focused services, peer support, case management, housing navigation services, life skills training, and stability while helping to connect members with long-term permanent housing.
- Providing members with screening and referrals for socioeconomic needs, leading to a 26% reduction in inpatient hospital admission rates.
- Helping address the problem of social isolation in schools by hosting virtual and in-person events throughout the spring to encourage inclusion and teach children how to combat isolation.
- Developing a Community Health Advocate program to better understand member needs; assess unmet social needs, such as housing and food, using a social determinants of health survey tool; and, make referrals to community resources and advocates for additional resources.
Strengthening Medicaid for the Future
While these initiatives have shown encouraging results for Medicaid enrollees, there are significant legislative and regulatory opportunities to further strengthen Medicaid’s ability to address SDOH and reduce longstanding disparities in health care.
Extending postpartum coverage, streamlining enrollment and renewal requirements, and identifying appropriate funding to leverage managed care arrangements to carry out programs aimed at addressing SDOH are just some of the ways policymakers can further strengthen Medicaid’s ability to reduce health disparities.
As we celebrate important strides in addressing SDOH, we also recognize the role of Medicaid in helping ensure underserved communities have access to the affordable, high-quality care they deserve.