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Food and Housing Insecurity, Stress, and Health Care Use After Medicaid Expanded Services Program.

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Massachusetts Flexible Services program (FSP) did not show short-term improvements in food insecurity, housing insecurity, diet, or stress for Medicaid beneficiaries. Participant experiences varied, highlighting both benefits and challenges of social needs interventions.

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Area of Science:

  • Public Health
  • Health Services Research
  • Social Determinants of Health

Background:

  • Medicaid Section 1115 waivers enable states to test innovative healthcare delivery models.
  • Addressing food and housing insecurity is crucial for vulnerable populations.
  • The impact of social needs interventions on health outcomes requires further investigation.

Purpose of the Study:

  • To evaluate the 1-year impact of the Massachusetts Flexible Services program (FSP) on food and housing insecurity.
  • To assess changes in diet quality, stress levels, and acute healthcare utilization among FSP participants.
  • To compare outcomes between FSP participants and a matched cohort of eligible non-participants.

Main Methods:

  • Prospective cohort study design involving adult Medicaid beneficiaries in Massachusetts.
  • Comparison between FSP participants and propensity score-weighted non-FSP participants.
  • Measurement of food insecurity, housing insecurity, diet quality (HEI-2020), stress (PSS), and acute healthcare use over 1 year.

Main Results:

  • No significant differences were observed in the changes of food insecurity or housing insecurity between FSP and non-FSP groups.
  • No significant differences were found in diet quality, stress levels, or acute healthcare use between the two groups.
  • Qualitative interviews revealed mixed participant experiences, noting both benefits and persistent challenges.

Conclusions:

  • The Massachusetts Flexible Services program (FSP) did not demonstrate short-term effectiveness in improving food security, housing security, diet, or stress.
  • Participant feedback indicates that while FSP offers benefits, challenges related to cost and availability persist.
  • Further research is needed to understand the long-term effects and optimize social needs interventions within healthcare systems.