New York and Massachusetts 1115 Medicaid demonstration waivers aimed to prioritize social determinants of health and engage community-based organizations to improve health outcomes. This is an evaluation of community-based organizations' public comments regarding their participation in social services delivery within the 1115 waivers. Both states solicited public comments on waiver implementation to date and potential improvements. The research team extracted all publicly available comments (n = 359) made by direct service providers between November 2016 and April 2019. The sample was then limited to only comments that discussed social service provision and health care-social service partnerships (n = 58). Findings are presented in 2 stages: (1) concerns regarding delivery system reform incentive payments funding levels, timing, and flow and (2) perspectives on how states and Medicaid administrators could improve health care-community organization relationships. Resource-dependent, community-based organizations protested insufficient funding. Additional comments identified specific design, structure, and implementation aspects of the 1115 waiver that could improve partnerships. Despite 1115 waivers prioritizing social service integration, community-based organizations still feel underfunded and disenfranchised. Aligning with health care standards requires significant time and effort. Given resource constraints, the state must facilitate these investments. Community organizations' feedback can also offer guidance on waiver strategies in other states.
Keywords: 1115 waiver; ACO; Medicaid; accountable care; community organization; delivery systems transformation; public health partnerships; social determinants.
To address Medicaid enrollees’ social needs, New York and Massachusetts have led the way in aiming to integrate community-based organizations into Medicaid policy and financing. In an evaluation examining public comments submitted by community-based organizations to state Medicaid offices, perspectives on participating in 1115 Medicaid demonstration waivers revealed 2 themes (1) financial concerns about funding, timing, and flow of payments and (2) nonfinancial suggestions for enhancing health care and community-based organization partnerships through standardized partnership standards, enhanced governance, and tailored metrics to better address social determinants of health.
© The Author(s) 2023. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.