Identify a proposed state and federal policy that aligns with your advocacy priorities for your vulnerable population. Clearly describe and provide evidence to support this policy. If the policy needs to change, describe and provide evidence to support the proposed change.
Universal Medicaid Expansion: Eliminate the state option to not expand Medicaid, thereby closing the coverage gap for low-income adults in all remaining states.
Mandate HRSN Integration via Medicaid: Require states to use Medicaid funds, under the Centers for Medicare & Medicaid Services (CMS) authority (e.g., Section 1115 waivers or state plan amendments), to screen all enrollees for key SDOH (like housing and food insecurity) and to reimburse for non-clinical interventions such as:
Housing assistance (e.g., short-term subsidies for transitionally homeless patients).
Nutritional assistance (e.g., "medically tailored meals" for patients with chronic diseases).
Non-emergency medical transportation (NEMT).
Evidence for Medicaid Expansion: States that have adopted Medicaid expansion have experienced the largest reductions in the number of uninsured persons. For low-income, non-elderly adults, the uninsured rate is about half the rate of non-expansion states. Increased access to care is associated with reduced mortality and improved health outcomes, particularly for racial and ethnic minorities who are disproportionately uninsured (Result 4.4, 4.2).
Evidence for SDOH Integration: Using Medicaid to address SDOH is an evidence-based strategy. Permanent Supportive Housing (PSH) models for individuals with chronic health conditions, for instance, have shown improved health outcomes and reduced healthcare costs (Result 2.2). Furthermore, new CMS guidance encourages states to leverage Medicaid managed care to address HRSN, with most managed care states already requiring MCOs to screen enrollees for social needs and provide referrals to social services (Result 2.3). Expanding this into a mandate ensures nationwide equity and a systemic, preventive approach to care.
A key advocacy priority for nurses working with vulnerable populations is the integration of healthcare with social services to address the Social Determinants of Health (SDOH). Based on this priority, the following federal and state policy proposals are highly relevant.
The federal policy proposal aligns with the goal of improving access to high-quality healthcare services and economic stability for vulnerable populations.
The proposal is to finalize and universally enforce Medicaid Expansion across all US states as originally intended by the Affordable Care Act (ACA), and to enhance the use of Section 1115 Waivers to mandate coverage and reimbursement for Health-Related Social Needs (HRSN) services.