What is Medicaid?
Compared to Medicare, Medicaid covers populations of more diverse demographics, such as children, pregnant women, childless adults, parents, and seniors/people with disabilities. Federal Law mandates that states cover certain groups of people, for example, low-income families, individuals receiving Supplemental Security Income (SSI), and qualified pregnant women and children.2
Together with CHIP, Medicaid is a joint program administered by federal and state governments. In 2017, Medicaid/CHIP provided needed care to more than 70 million Americans, almost a quarter of the country’s total population, making it the largest single source of healthcare in the United States. Nationwide, Medicaid pays for 1 in 6 dollars in the healthcare system, and 1 in 2 dollars on long-term care services and supports.3
Addressing Social Determinants of Health Using Medicaid Data
As the COVID-19 pandemic evolves, we have seen certain populations are disproportionately affected by the disease. The need to understand the sociodemographic factors of these high impact populations has become more critical than ever.
Medicaid caters to low-income and vulnerable populations whose health is often conversely impacted by their lack of access to healthy food, stable and safe housing, and transportation. An increasing amount of research has shown that social determinants of health (SDOH), such as age, gender, race, ethnicity, language, educational level, and income can profoundly impact care access, utilization, and outcomes.
As early as 2003, a report by the Institute of Medicine (IOM) has addressed the roots of racial and ethnic health inequalities in the U.S. and recommends developing comprehensive strategies to tackle these challenges.4 A recent study claims that community economic distressed levels are associated with increased stroke severity.5 In a partnered research with Microsoft Health Next using Medicare Fee-for-Service (FFS) data, CareJourney finds that beneficiaries living in communities with higher levels of economic deprivation receive significantly less preventive care than those living in affluent neighborhoods.6
Thus, in order to deliver and advance value-based care, stakeholders must understand the socio-economic context of the community they are serving and address the social determinants of health that are associated with high costs and adverse health outcomes.7