The relationship between social needs and primary care use after enrollment in Virginia’s Medicaid expansion: The influence of sociocultural and built environments

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Project Abstract. Medicaid expansion is a critical antipoverty tool that protects individuals from health care costs and reduces food and housing insecurity, significant contributors to poor health and health disparities. Medicaid expansion increases access to primary care, a hypothesized mechanism by which this public insurance coverage for low-income individuals reduces social needs. However, social needs and access to primary care are influenced by the sociocultural and built environments as well as health care system supply. This study applies the NIMHD’s Research Framework to understand how these domains of influence differentially shape access to primary care across those with or without social needs and in turn explores a possible mechanism in which Medicaid expansion reduces food and housing insecurity, primary care use. This work will leverage a well-established state-university partnership and unique data set consisting of the experiences of newly enrolled Medicaid expansion members in Virginia. The following existing data will be linked for this study by Medicaid member identification number: 1) pre-enrollment surveys asking members about their experiences in the year prior to Medicaid expansion enrollment (n=1,255), 2) a follow-up survey asking members about experiences in the year after enrollment (n=580), 3) all encounter and pharmacy claims data for these same Virginia Medicaid members, and 4) publicly-available measures of sociocultural, built environment, and health care system domains of influence linked to members’ census tracts or counties. The proposed research is supported by Virginia Medicaid as it aligns with the agency’s commitment to advance health equity through increasing primary care and reducing social needs. This proposed work aims to: 1) Assess how sociocultural environment, built environment, and health care system domains modify the effect of food and housing insecurity in the year prior to Medicaid expansion enrollment on primary care utilization in the year after enrollment, and 2) Explore whether primary care utilization reduces food and housing insecurity after the first year of enrollment in Medicaid expansion. Ultimately this work will provide much needed evidence to policymakers about the disparities in access to primary care across sociocultural and built environment factors as well as provide insight into how Medicaid expansion is reducing social needs. Addressing social needs through health care policies and primary care system design will improve population health and is necessary to achieve health equity. This application describes an excellent research and training environment for the proposed work, supported by a collaborative mentorship team that includes both faculty members and Virginia Medicaid’s Chief Medical Officer. This proposal will provide integrated, robust clinical and research training in health disparities, health policy, and geospatial statistics to a physician-scientist dedicated to practicing family medicine and pursuing a faculty position focused on advancing health equity through health policy.