Facilitators and Barriers to Addressing Health-Related Social Needs: A Qualitative Study of Medicaid Waiver Implementation

• In Event: Medicaid Policy Levers in Maternal and Child Health: Enrollment, Services, and Access

Abstract

Background: The New York Medicaid 1115 Waiver expands enhanced social services to address food, housing, and transportation needs during pregnancy and the first year after birth. Effective implementation of the Waiver depends on the integration of health and social care stakeholders such as healthcare teams and regional social care organizations. Yet, there is limited primary evidence on how these stakeholders experience implementation of the Waiver to best address patient needs. 

Purpose: We use primary qualitative data collection to explore system stakeholder experiences and query for key facilitators and barriers to Waiver implementation in large urban safety-net systems that serve individuals with a high level of social needs, representing the frontline of Medicaid policy implementation for vulnerable populations. 

Methods: Guided by the Consolidated Framework for Implementation Research, we are conducting 50 primary, in-depth semi-structured interviews with: (1) pediatric health system staff (pediatricians, nutritionists, social workers, community health workers), (2) social care network stakeholders (patient navigators, food, housing, and other assistance providers), and (3) health system policy administrators. Interviews began in March 2026 (4 have been completed) and will complete this summer. Participants will be purposively sampled to maximize variation in implementation roles and experiences. Data will be collected directly from participants in English or Spanish, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis with functional reflexivity and iterative, team-based codebook development until thematic saturation.  

Results: We will present preliminary findings on facilitators and barriers to policy implementation to integrate health and social care for patients with health-related social needs. We anticipate emerging themes around challenges in health and social care system integration, reflections around access challenges, such as language barriers, complex eligibility criteria, and fragmented referral pathways. For example, one participant has noted: “The care really needed to be at the point of contact for people, which is generally at their doctor's office but typical doctor’s practices can't do it. But the more layers you add…you lose them, and then they're gone. You don't know what happens to that person. Maybe they ran out of minutes. They lost their cell phone. They got scared and got a different number. Like, you just can't get them afterwards.” 

Conclusion/Implications: This primary data collection study seeks to highlight modifiable levers and concrete friction points described by system stakeholders intimately involved in integrating health and social care systems to address health-related social needs. This work is time-sensitive, as the current Waiver is set to expire in March 2027, creating an urgent, strategic window to inform policy renewal and refinement. We aim to provide policymakers with actionable insights to apply system stakeholder-grounded principles to increase service uptake, strengthen future Waiver iterations (6 states are currently pending social needs-related Waivers), and improve maternal-child health.  [HR1]since this is complete yet, do you want to give some sense of the timing (and how much you anticipate having by the conference?)

Author

• Carol Duh-Leong, New York University
  Presenting Author