Poverty and racism make people sick, Medicaid can help
By Emma Schubert
The Ohio Department of Medicaid’s asked for ideas and information to improve the state’s Medicaid Managed Care Program. We provided some, summarized in this blog post.
Because Medicaid patients are, by definition, low-income, they struggle to afford basics like food, transportation, and shelter. In 2017, almost 1.6 million Ohioans lived in poverty. More than 700,000 lived in deep poverty, with incomes less than half the federal poverty level. Poverty is stressful, and prolonged, concentrated poverty can be toxic. Access to health care through Medicaid, alone, cannot dismantle health barriers. We must also address conditions caused by poverty and racism - like pollution, unsafe housing, lack of green space, unreliable transportation, and lack of access to healthy food. If Ohio’s Medicaid program took a “whole person” approach to health care provision, that addresses these health-related social needs as well as medical ones, fewer people would be made sick by these structural factors.
States have flexibility to address the “whole person” through Medicaid’s “optional benefit” State Amendment Plans. This approach helps people live in healthier environments so they’ll be less likely to get sick and need treatment. That’s better for everyone.
We could achieve a healthier Ohio with enhanced case management at MCOs, creating a statewide 2-1-1- Benefit Bank system staffed by Community Resource Navigators, and improving transportation.
Robust Managed Care Organizations
MCOs are health care or medical service organizations that offer managed care health plans, preventive medicine and patient education. They connect patients and communities to health care providers. The Ohio Department of Medicaid can push MCOs to build stronger bridges between communities and medical institutions and address patients’ social and medical needs.
Ohio can improve its MCO’s services in three main ways. First, MCOs can require enhanced case management through mandatory screening. Case managers could determine whether patients have health-related needs for food, lead abatement, employment training or drug rehabilitation. They could also help patients enroll in public benefits. MCOs should also track health indicators like obesity, asthma, diabetes, and heart disease, by race, income, age, and zip code. This will help determine the structural root causes of poor health. California has taken this approach when collecting data for their Let’s Get Healthy program.
Second, the Department of Medicaid can require MCOs to invest some profits in local communities -- like Arizona does – to address needs like housing instability, lead poisoning, food insecurity, or childhood asthma.
Lastly, Ohio can incentivize MCOs to provide wrap-around services to address social needs. MCOs whose patients improve could receive bonus payments and the state could withhold funds from low-performing MCOs.
Ohio could improve care coordination by establishing health homes which assist with social, emotional, and physical needs. Preventive and rehabilitative programs can be expanded to include wrap-around services provided by community-based partners. Rehabilitative services can also be offered outside of health care settings, in the home or community.
A Benefit Bank
The United Way’s 2-1-1 Help Center model provides free, 24-hour help for social services. A similar system could serve all Ohio Medicaid patients. The Benefit Bank centers, staffed by trained Community Resource Navigators, would help patients access benefits, meet social needs, and find community health organizations.
Medicaid patients need a “one-stop shop” where they can call, go online, or have face-to-face appointments. Navigators can provide case management, including for high-need patients with chronic health conditions, disabilities, or limited English. A medical-legal partnership could integrate civil attorneys and social workers into the clinical setting to assist with legal and social problems. Navigators should be from the community they serve to increase effectiveness, establish trust, and ensure culturally specific care. Michigan has pioneered this approach.
The now-shuttered Ohio Benefit Bank provides a great model. By connecting patients’ health indicators to poverty and structural racism, the Benefit Bank can point toward strategies to treat the whole person.
Increased Transportation Access
Many Ohioans rely on cars to get to work, school, and the doctor. However, cars are costly. The state’s underfunded public transit system makes it difficult for people with low incomes to access things they need to be healthy like good jobs, healthy groceries, and clinics. This is particularly true for Ohioans with chronic health conditions who often receive less timely care, suffer worse health outcomes and have higher transportation costs.
While Medicaid allows state support for non-emergency medical transportation, these funds are implemented differently across counties. 2-1-1 outlets and MCOs can help by connecting patients to public benefits including transportation dispatch services.
Ohioans who can’t drive may use specialized transportation services from non-profit, for-profit and government agencies. State-level coordination could streamline services, improve communication between providers, reduce duplication and increase efficiencies and access. Like other states , Ohio should create a coordinating council, with ample and consistent funding and robust reporting requirements.
Medicaid is a vital program that helps ensure the health, safety, and happiness of many Ohioans. But without addressing social needs, health disparities tied to poverty and racism will persist. Ohio can take concrete steps today to improve Medicaid’s managed care system by investing in MCOS, creating a Benefit Bank System, and improving transportation access. Together we can treat the whole person, and improve the health of all Ohioans.