Insurance, Medicare & Medicaid

Overall, community health workers roles in Medicaid Managed Care Organizations appear to focus on supporting clinical care and making referrals for social issues, rather than addressing community-level concerns, according to these national, cross-sectional survey results.

This national study of the roles and activities of community health workers supported by Medicaid Managed Care Organizations finds that community health workers employed by Managed Care Organizations reported receiving significantly more training and benefits from their employers than community health workers who were contracted through other organizations.

Collectively, regulatory pressures, organizational strategy, and market forces influenced Medicaid Managed Care Organization’s efforts to address social determinants of health, leading to a normalization of their role in addressing members' social needs within a medical paradigm.

AcademyHealth organizational members heard from top clinical leaders in state Medicaid programs about the challenges they face after Dobbs.

This report examines Medi-Cal managed care as a tool to advance child health equity, and it looks at the extent to which managed care plans can play a central role in Medi-Cal responding to social drivers of health and health-related social needs, particularly for children’s health.

The Affordable Care Act enacted Medicaid expansion with hopes that more states would provide health insurance to low-income Americans. This ‘plain language summary’ reviews recent research published in AcademyHealth’s official journal HSR which shows that early Medicaid expansion in six states led to an increase in the total number of physician visits but did not lead to an increase in total physician participation.

New research indicates Medicare Advantage enrollment provides favorable outcomes over traditional Medicare for those with mental health issues and those at end-of-life, indicating a high efficiency of care aligning with beneficiaries’ preferences. This ‘plain language summary’ reviews recent research published in AcademyHealth's official journal, HSR, which addresses the role of Medicare Advantage in mental health care and end-of-life outcomes for older adults.

This analysis of a rural community’s efforts to address the health and social needs of its low-income residents found that Medicaid members faced resource challenges, including insufficient affordable housing and limited numbers of bilingual providers and behavioral health providers.

This Data Note examines the extent of community health center involvement in systematic efforts to screen patients for the presence of social determinants of health and concludes that targeted grant support and Medicaid performance investments for the costs associated with social risk screening and reporting are needed for universal engagement by community health centers.

This report describes parents’ experiences with their children’s Medi-Cal coverage and their recommendations for improving children’s health care, as well as how health plans can collaborate with families on systems change.