There are new growth opportunities for high-performing Medicaid plans with some states expanding Medicaid, more business being shifted to plans that can manage costs, and potential public option plans. While these growth opportunities keep Medicaid managed care a promising business, policy restrictions threaten to decrease Medicaid enrollment and therefore MCO sustainability.

In fact, with new initiatives such as work requirements, immigration rules, and block grants that might affect Medicaid enrollment, MCOs are likely to lose healthy members, rather than gain sicker members.

Consequently, more and more Medicaid plans are investing in efforts to address social determinants of health (SDOH) as their principal strategy to bend the cost growth curve. The biggest plan challenge within SDOH is that there are too many possibilities—both in terms of the array of determinants to address first and in the types of roles plans can play.

Plans have long since been viewed as the funder but their role can grow beyond the funder to cover convener, expert, advocate, and creator roles.

Primary roles for organizations to become an effective SDOH community partner

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