How Medicaid Managed Care Contracts Can Impact Community Health Centers’ Services that Address Social Determinants of Health

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. The goal of the project is to provide insights into how different contracting approaches play out over different types of plans, health center network providers, and on-the-ground community conditions (i.e., COVID-19 pandemic and recession) and to help states build purchasing arrangements more attuned to the evolving conditions that patients and communities face. In the first phase of the study, the researchers will review Medicaid managed care organization (MCO) contracts to identify and catalog key characteristics and attributes related to social determinants of health, care coordination and management, and enabling services. The researchers will also survey Primary Care Associations (PCAs) on the impact of the pandemic on health center financing and operations. The researchers will then conduct case studies in five states whose contract terms vary in their strategies for addressing social determinants of health, focusing on the experiences of state officials, MCO leaders, PCA leaders, health center board members and leaders, and the service provider partners that health centers engage to address social determinants of health. In the final phase of the study, the researchers will identify key elements and considerations involved in drafting social determinants-related provisions in order to help states build purchasing arrangements more attuned to evolving public health and economic conditions that patients and communities face. Deliverables will include a project work plan and 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.