State Expectations and Medicaid Managed Care Organizations’ Efforts to Address the Social Needs of Medicaid Enrollees

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 MM...

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Bibliographic Details
Published in:Medical care research and review 2022-12, Vol.79 (6), p.811-818, Article 811
Main Authors: Opoku, Samuel T., Owens, Charles F., Apenteng, Bettye A., Kimsey, Linda, Peden, Angela H.
Format: Article
Language:English
Subjects:
Coercion
Coercivity
Evaluation
Government programs
Health care
Holistic approach
Humans
Managed care
Managed Care Programs
Market forces
Medicaid
Motivation
Normalization
Organizations
Performance measurement
Request for proposal
United States
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Summary: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.
ISSN:1077-5587
1552-6801
DOI:10.1177/10775587221096262