This project is funded as part of the Robert Wood Johnson Foundation’s “Research in Transforming Health and Health Care Systems” program, which seeks to build the evidence base on the potential effects of policies or policy changes intended to transform health and health care systems. The goal of the project is to comparatively assess the social determinants of health (SDOH)-focused activities of managed care organizations (MCOs) and their impact in states with and without either a contractual mandate or incentives to align contractual requirements and payment mechanisms with such efforts. The project is a cross-sectional study that will address its research questions in two phases, using a combination of primary and secondary data and a mixed methods research approach. To assess the motivation, operations and sustainability of SDOH activities, including the impact of contractual mandates, incentives, or other state-specific requirements in programming decisions, the researchers will conduct qualitative telephone interviews with leadership or subject matter experts from MCOs in eight states (IL, HI, NJ, NY, FL, GA, KY, SC). In phase two, in order to assess the impact of SDOH programming and any moderating effect of state-specific variations in SDOH programming expectations, the researchers will partner with WellCare’s Community Connections program to evaluate the program’s impact on health care utilization, cost, satisfaction and health equity in these eight states using a differences-in-differences quantitative study design. Program utilization data will be linked to Medicaid claims data for all study states. Deliverables will include a project work plan, annual narrative, and financial reports. The grantee will also produce paper(s) suitable for publication and present findings at national research meetings and to other stakeholder audiences as appropriate, including policymakers at the federal, state, and local levels, as part of the deliverables for this grant.