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Review of Social Determinants of Health Terms in 2019-2020 State Medicaid Managed Care Contracts

At this early stage of social determinant of health incorporation, many states are targeting their programming, particularly screening and care management/coordination, towards high-risk populations, such as beneficiaries in substance use disorder treatment or those with significant behavioral health needs, children with complex care needs, beneficiaries living with HIV, and individuals with multiple comorbidities.

In recent years, states increasingly have sought to use Medicaid managed care to promote health care as an entry point into access to services aimed at addressing underlying social determinants of health. State Medicaid programs primarily rely on managed care to provide efficient, comprehensive, quality care. Today, approximately seven in ten Medicaid beneficiaries are enrolled in managed care. As research continues to establish the importance of addressing social determinants of health, the ongoing pandemic highlights significant needs to address and incorporate social determinants of health into services for low-income and racial/ethnic minority beneficiaries. This blog describes findings from the first phase of the study. George Washington University researchers conducted a contract review of Medicaid managed care organization contracts from 39 states and the District of Columbia. The contract review was based on the 40 MCO model or executed contracts that were publicly available as of October 1, 2019 and the contract review process was completed in June 2020.

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Peter Shin, Ph.D., M.P.H.

Associate Professor of Health Policy and Management - George Washington University

Peter Shin, Ph.D., M.P.H. is an Associate Professor of Health Policy and Management at the George Washington U... Read Bio