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 section. 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
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
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.
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
and Blending Funds to Promote Social Determinants of Health
Describes challenges to and strategies for combining different funds to support community health and economic
Organization(s): Brookings Institution
Funding Streams and Strategies to Improve Conditions for Learning: A Resource Guide for States
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)
Role in Addressing Social Determinants of Health
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
State Payment and
Financing Models to Promote Health and Social Service Integration
Describes financing models that facilitate integration of various funding streams, with a particular focus on
Author(s): Crawford, M. & Houston, R.
Organization(s): Center for Health Care Strategies