Experimentation in the Medicaid program creates an opportunity for states to modify their Medicaid programs to better meet enrollees’ health and social needs. Projects under the Research in Transforming Health and Healthcare Systems program examine Medicaid innovation, through Section 1115 Waivers or managed care organizations.
Experimentation in the Medicaid program creates an opportunity for states to modify their Medicaid programs to test new operating approaches and to better meet enrollees health and social needs. States have used Section 1115 waivers to advance many different types of Medicaid provisions as well as to experiment with innovative approaches to addressing social determinants of health, such as housing and nutrition. Further, for many state Medicaid programs, identifying and addressing enrollees’ social needs is a growing priority. While Medicaid programs may pursue this in numerous ways, one approach utilizes the payment and contracting strategies that states employ with Medicaid managed care organizations (MCOs), which provide services to a large and growing share of Medicaid enrollees nationwide. From 2018-2020, the Robert Wood Johnson Foundation has awarded 15 grants, managed by AcademyHealth, to provide new insights into states’ use of Section 1115 Medicaid demonstration waivers and to examine how states and managed care organizations are working to identify and respond to Medicaid enrollees’ social needs.