Social care can boost health, but how we approach it matters
How can someone with diabetes avoid complications if they lack nutritious food? How can someone with anxiety manage symptoms if they worry about paying rent? And how can someone with cancer get treatment if they cannot afford transportation to the hospital?
Such questions animate the movement towards addressing social needs such as food, housing and transportation insecurity in health care. Initiatives to address social needs and promote value-based payment models — which incentivize health care providers to keep populations healthy — will soon become more integrated into New York’s health care sector. The federal Centers for Medicare & Medicaid Services recently approved the state Medicaid program’s plan to reimburse partnerships of community organizations and health care providers to address the social needs of people with Medicaid.
But how will people with Medicaid respond to this scaling-up of social care? A research review by the SIREN Center found that patients who have experienced discrimination in health care may be less likely to accept social needs screenings. Since twothirds of New York’s Medicaid recipients are people of color, most of the people eligible for further social care may be at least somewhat apprehensive about the potential side effects of increased social needs screenings and services.
Public Agenda, in focus groups supported by United Hospital Fund, asked lowincome parents in New York City what they thought about pediatricians screening for social needs. These parents understood that social care could benefit their children, but they were reluctant to share sensitive information with pediatricians because they feared the information could be used against them in child welfare investigations.
These fears echo the claims of a class-action lawsuit filed in February by the Family Justice Law Center against New York City alleging that investigators for the city’s Administration for Children’s Services “deceive and bully their way into people’s homes, where they riffle through families’ most private
spaces, strip-search children and humiliate parents.” These claims are consistent with a report in which ACS’S own staff cited pervasive negative stereotypes “about the abilities of Black and Brown parents to provide for their children.”
People in New York who are covered by Medicaid stand to benefit from social care. A similar model in Massachusetts has already led to improvements in some
health outcomes. And the state’s social service sector stands to benefit from more sustained investment and partnerships with health care providers. But providers and community organizations need to contend with worries about child welfare investigators and the impacts of experiences of racism. Taking these concerns and traumas seriously can make social care investments more likely to succeed.