# Care Integration, Supportive Housing, and Outcomes for Medicaid Accountable Care Organization Enrollees with Behavioral Health Conditions

> **NIH AHRQ R36** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2024 · $46,475

## Abstract

PROJECT SUMMARY
Close to 65 million US adults have a behavioral health condition (BHC), including mental health and substance
use disorders.2 Persons with BHCs have a greater burden of complex health conditions, unmet health-related
social needs (HRSNs) such as nutrition insufficiency and housing insecurity, use more healthcare, and are
more likely to die prematurely.2 Access to mental health, addiction treatment, primary care services, and
connection to social services in the same location is uncommon, even though physical illness, unmet HRSNs,
mental health disorders, and substance use disorders often co-occur.6 Fragmented care is associated with
increased hospital and emergency department visits, higher complication rates, and higher episode costs.30,31
Medicaid is the primary health insurance program for underserved populations in the United States. The main
objectives of many recent Medicaid behavioral health-related policy reforms have been to integrate behavioral
health treatment with primary care and to connect Medicaid members with social services in primary care
settings.2,4,5 6,7,8 In 2018, Massachusetts’ Medicaid program, MassHealth, launched a new Accountable Care
Organization (ACO) delivery and payment system to deliver integrated person-centered care to meet
members’ social, behavioral, and physical health needs by integrating care within and between healthcare and
social service sectors. MassHealth’s shift to this integrated ACO model attempts to provoke improved
healthcare outcomes and decreases in acute and emergency healthcare utilization for Medicaid members,
typically who have a higher prevalence of complex BHCs and HRSNs than the privately insured.2,4,5 13 In this
study, we will examine the effects of healthcare and social service integration on the experiences and
outcomes of MassHealth members with BHCs. We will first analyze data collected from qualitative interviews
among a sample of 36 MassHealth members with BHCs to identify barriers and facilitators to good health,
access to care, and effective care delivery, and to characterize their experiences with the integration of social,
behavioral, and physical health supports.15,16,17-21 We will then conduct a cross-sectional analysis, using survey
and MassHealth administrative data from 2022, to examine the relationship between primary care providers’
perceptions of clinical and social services integration, as measured on the Provider and Staff Perceptions of
Integrated Care survey, and rates of acute and emergency healthcare utilization among MassHealth members
with BHCs from the same clinics.22 Finally, we will use MassHealth administrative data collected between 2020
and 2022 to quantify the effect of receiving integrated housing supports through MassHealth’s Flexible
Services Program on healthcare utilization among MassHealth members with BHCs experiencing housing
insecurity or homelessness.14

## Key facts

- **NIH application ID:** 10896589
- **Project number:** 1R36HS030039-01
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Meagan J Sabatino
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $46,475
- **Award type:** 1
- **Project period:** 2024-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10896589

## Citation

> US National Institutes of Health, RePORTER application 10896589, Care Integration, Supportive Housing, and Outcomes for Medicaid Accountable Care Organization Enrollees with Behavioral Health Conditions (1R36HS030039-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10896589. Licensed CC0.

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