UC Berkeley

States are increasingly leveraging waivers and other flexibilities in the Medicaid program to experiment with using Medicaid to fund services to address health-related social needs. This trend has created new financial incentives for cross-sector collaboration and integration of care. Better integrated social and medical care is expected to lead to more effective services, lower costs, and improved outcomes for patient populations that frequently use high-cost medical services, but is challenging to achieve. This dissertation examines care integration efforts for two populations that have been the focus of recent reforms: older people and people experiencing homelessness.

The first study uses qualitative interviews with county aging services leaders in the San Francisco Bay Area to identify the challenges and opportunities counties face in delivering services to older people and people with disabilities. The second study uses qualitative interviews to describe motivations and concerns of healthcare and social services organizations when integrating social and medical care for people experiencing homelessness in Los Angeles County. The third study uses participatory methods to explore street medicine providers’ perspectives on the impact of newly available Medicaid funding on their service model. Taken together, these studies elevate the voices of providers, payors, and county leaders to document early lessons and insights from their experiences delivering integrated services.