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Funding and Sustainability Strategies for Programs that Address Social Determinants of Health

There are several different strategies for sustaining rural programs that address social determinants of health (SDOH). The Rural Community Health Toolkit also provides information in its Sustainability Strategies and Sustainability Strategies for Specific Issues sections. Additional information about funding for rural SDOH projects can be found in the Social Determinants of Health for Rural People topic guide, Funding & Opportunities section.

Rural programs that address SDOH are using multiple strategies to fund their programs. Funding strategies include:

  • Contributions from local government and partner organizations
  • User fees from program participants (applicable in some cases, such as in transportation-focused programs)
  • Grant funding from a range of national and state agencies and organizations, as outlined on the next page of this module

Reimbursement can also be an important sustainability strategy for rural programs seeking to maintain services over the long-term. States vary in the services that can be reimbursed. Rural SDOH programs could seek reimbursement for:

  • Case management services
  • Interdisciplinary care teams
  • Home visiting services
  • Services provided through school-based health centers
  • Telehealth services
  • Transportation services, especially through Medicaid Non-Emergency Medical Transit

Alternative Payment Mechanisms

Some rural communities are addressing SDOH through provider-level and system-level changes to healthcare systems. For example, several federal and state programs are focusing on providing patients with supportive services to address social, physical, and emotional needs. These programs fund investments in SDOH with the overall goal of improving health outcomes and decreasing costly medical services, such as preventable hospitalizations.

In particular, the Centers for Medicare & Medicaid Services (CMS) funds demonstrations of different payment and care models in an effort to improve the quality of care for all populations, including Medicaid managed care plans that address social needs. One new model being tested by CMS with representation in rural areas is the Accountable Health Communities Model (AHCM), which aims to connect Medicare and Medicaid patients to various forms of social services and support. Western Colorado is one of several places testing out the AHCM model to better understand whether addressing certain patient social needs can improve healthcare delivery and outcomes.

States are also using federal funding to transform their own state Medicaid programs, often focusing on addressing SDOH and promoting health equity. Oregon is one among several states that are testing out these new models. In Oregon, Coordinated Care Organizations (CCOs) receive a global budget to provide all integrated physical and behavioral health services to regional patients. As part of the global budget, CCOs can fund flex services that address SDOH, ranging from housing and transportation to food access and educational opportunities. For example, the Eastern Oregon Coordinated Care Organization, which serves 12 of Oregon's rural counties, is funding the Frontier Veggie Rx Program to provide eligible patients with prescriptions to buy healthy fruits and vegetables.

Uniting Funding Streams for SDOH

Rural programs addressing SDOH may struggle to manage multiple funding streams with different eligibility requirements. For example, a rural program seeking to connect community members to health insurance, housing assistance, childcare support, and transportation access could be managing 4 different federal and state funding sources. Rural communities could explore the option of blending or braiding siloed funding sources in order to streamline payment and reimbursement of services. The Rural Services Integration Toolkit provides examples of one-stop shop rural programs that are seeking to blend or braid different programs and funding streams.

Resources to Learn More

Braiding and Blending Funds to Promote Social Determinants of Health
Video/Multimedia
Describes challenges to and strategies for combining different funds to support community health and economic development.
Organization(s): Brookings Institution
Date: 5/2019

Federal Funding Streams and Strategies to Improve Conditions for Learning: A Resource Guide for States
Document
Describes federal funding streams that can be combined to address key SDOH to improve education outcomes. Includes information about federal programs that offer improved food access, access to physical and behavioral health services, and resources to address homelessness.
Organization(s): Council of Chief State School Officers (CCSSO)
Date: 4/2019

Medicaid's Role in Addressing Social Determinants of Health
Document
Describes ways that Medicaid programs are addressing SDOH and includes key considerations for state policymakers. Lists additional resources related to Medicaid funding for SDOH.
Organization(s): Robert Wood Johnson Foundation
Date: 2/2019

State Payment and Financing Models to Promote Health and Social Service Integration
Document
Describes financing models that facilitate integration of various funding streams, with a particular focus on Medicaid.
Author(s): Crawford, M. & Houston, R.
Organization(s): Center for Health Care Strategies
Date: 2/2015