The Role of Economic Evidence in Shaping Medicaid-supported Health and Social Care Integration Policies in the United States: A Review of Policy Evaluation Frameworks
Justine Exonam Amekoe
University of North Carolina Charlotte, Charlotte, NC, USA.
Daniel Ohene-Djan *
University of Professional Studies, Accra, Ghana.
*Author to whom correspondence should be addressed.
Abstract
Health and social care integration has become an important policy strategy within U.S. Medicaid as states and health systems respond to fragmented care, persistent health-related social needs, and pressure to demonstrate value from public spending. This narrative review examines how economic evidence has informed Medicaid-supported health and social care integration in the United States from January 2020 through May 2026. A structured search of PubMed, Scopus, Web of Science, Google Scholar, and JSTOR was used to identify peer-reviewed literature on Medicaid, integrated care, health-related social needs, economic evaluation, implementation, value-based financing, and health equity; authoritative policy documents and selected foundational studies were used only for context. The evidence indicates that Medicaid-supported integration can improve social-needs identification, referral processes, care coordination, and access to community resources, but effects on health care utilisation and costs are heterogeneous. Empirical Medicaid studies show both favourable utilisation shifts and null short-term effects, while implementation studies consistently identify administrative burden, workforce capacity, data interoperability, referral completion, and the stability of community partnerships as major determinants of program performance. Economic evaluation remains limited by short time horizons, inconsistent costing methods, narrow health-system perspectives, and incomplete treatment of equity and implementation costs. The March 2025 rescission of prior federal guidance on health-related social needs also illustrates that policy pathways can change while the underlying evidence base continues to evolve. Future evaluations should combine conventional cost and utilisation measures with implementation costs, longer-term outcomes, explicit uncertainty analysis, and equity-sensitive measures. Economic evidence is therefore most useful when interpreted as one component of a broader policy decision framework rather than as a simple test of short-term cost savings.
Keywords: Medicaid, integrated care, economic evaluation, health-related social needs, social determinants of health, health equity, value-based care