Social Needs and Health-Related Outcomes Among Medicaid Beneficiaries

Abstract

Unmet social needs—including food, housing, and utilities—have been associated with negative health outcomes, but most prior research has examined the health associations with a single unmet need or analyzed samples that were homogeneous along one or more dimensions (e.g., older adults or patients with chronic health conditions). We examined the association between unmet social needs and psychosocial and health-related outcomes in a sample of Medicaid beneficiaries from 35 U.S. states. In 2016-2017, 1,214 people completed an online survey about social needs, demographics, and health-related and psychosocial outcomes. Seven items assessing social needs formed an index in which higher scores indicated higher levels of unmet needs. Participants were eligible if they were ≥18 years and had Medicaid. The sample was predominantly female (87%). Most (71%) lived with at least one child ≤18 years, and 49% were White and 33% were African American. Average age was 36 years (SD = 13). The most common unmet needs were not enough money for unexpected expenses (54%) and not enough space in the home (25%). Analyses controlling for recruitment method and demographics showed that increasing levels of unmet social needs were positively associated with stress, smoking, and number of chronic conditions, and negatively associated with future orientation, attitudes toward prevention, days of exercise/week, servings of fruits or vegetables/day, and self-rated health (all p < .01). Results add to the evidence about the relationship between unmet social needs and health. Interventions to help meet social needs may help low-income people improve both their economic situations and their health.

Predictors of hepatitis C treatment outcomes in a harm reduction-focused primary care program in New York City

“…Medicaid itself serves as a proxy for other social determinants of health, as research has demonstrated that most medicaid beneficiaries lack in at least one social need-i.e., adequate income, food, housing, utilities, etc. [53]. These unmet needs have been associated with an increased number of chronic conditions as well as decreased physical functioning and higher mortality [53][54][55].…”

“…[53]. These unmet needs have been associated with an increased number of chronic conditions as well as decreased physical functioning and higher mortality [53][54][55]. Recognizing this, the Centers for Medicare and Medicaid Services modernized its operations in 2016 to promote practices that look beyond clinical care and to address patients' social needs [56].…”

Social Risks Among Primary Care Patients in a Large Urban Health System

“…Directly comparing the overall results to other studies is challenging because of differences in the populations being screened 21,23,27-31 and, more importantly, differences in the screening tools, either based on the number or types of risks being screened for 23,30,[32][33][34] or the wording of the instrument. [35][36][37][38] Among more comparable studies, Berkowitz et al 20 screened 5,125 adult primary care patients in Boston, finding that 34.6% of the population had at least 1 risk.…”

Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT

“…11 However, long-term maintenance of diabetes control is still an issue for some individuals even after DSME courses are completed. 12 Inequities found in the social determinants of health add to the struggles of diabetes management including low-income, 13 inadequate housing, 14 behavioral health needs, 15 and lack of health insurance. 16 In addition, lack of resources/support for medications and doctor visits, 17 transportation, 4 day labor jobs/choice between work and doctor visits, 18 culture and language capabilities 19 are other barriers to diabetes self-management found among Mexican American populations.…”