By: Demri Henderson, MHA, Grants and Program Manager, Civitas Networks for Health
Across the United States, health care leaders are grappling with how to better address social determinants of health (SDOH) while ensuring providers are properly reimbursed for the work involved. During a recent multi-state discussion among health information exchange (HIE) leaders, policymakers, and health care organizations at the February 2026 Civitas Networks for Health® (Civitas) SDOH and Interoperability Workgroup, several key themes emerged around reimbursement models, data sharing, and the evolving role of health care infrastructure.
The Reimbursement Gap for SDOH
Providers widely recognize the importance of screening patients for social needs such as housing instability, food insecurity, and transportation barriers. However, many states report that reimbursement models have not kept pace with this work. In Arkansas, providers are willing to conduct screenings, but limitations in reimbursement discourage widespread adoption. Medicaid programs still rely heavily on fee-for-service structures, where SDOH screening is often treated as a non-essential service rather than a reimbursable service. Although tools like Z- and G-codes allow providers to document social factors, utilization remains low because financial incentives are minimal. Other states reported similar challenges. In Louisiana, reimbursement rates for SDOH services are often so low that organizations choose to fund care coordination through community health workers rather than billing insurers.
Emerging Policy Changes
Despite SDOH reimbursement barriers, there are several promising policy shifts that are underway. Some states are beginning to reimburse community health workers (CHWs), recognizing their role in addressing social needs and improving maternal and community health outcomes. Arkansas and Pennsylvania are among those exploring or implementing these models, though there is still a struggle with complicated billing requirements. Arizona has taken another approach by expanding programs that link SDOH data—particularly housing insecurity—to reimbursable services through Medicaid initiatives.These changes reflect a broader national trend of moving toward value-based care, where providers are rewarded for improving outcomes rather than simply delivering services.
The Role of Health Information Exchanges
Notably, HIEs are becoming critical infrastructure in this transition. By integrating clinical data with social care data, HIEs can help health care systems see a more complete picture of patient needs. During the February SDOH and Interoperability Workgroup, several organizations described how they are using tools like Master Patient Indexes (MPI) to match clinical records with social determinant information and share that data with payers, care teams, and community-based organizations (CBOs).Closed-loop referral platforms are also emerging, allowing health care providers to refer patients to social services and track whether those services were delivered. Despite technological progress, data sharing remains a major hurdle, particularly for behavioral health and substance use disorder (SUD) data. Legal concerns, compliance interpretations, and outdated systems continue to limit information exchange.
Advancing Social Care Data Exchange in New York: Progress Under the NYHER 1115 Waiver
The February SDOH and Interoperability Workgroup discussion highlighted the importance of the work being done in New York state to advance health and social care data integration. Since 2024, New York eHealth Collaborative (NYeC) in partnership with Gravity Project (Gravity) and Civitas, has been working to implement standardized social care data exchange across the state. This effort supports the state’s Medicaid transformation under the NYHER 1115 Medicaid Waiver Amendment, which runs through March 2027, aiming to better integrate health care and social care services for Medicaid beneficiaries. At the center of this initiative is the Statewide Health Information Network for New York (SHIN-NY), the state’s health information exchange infrastructure that connects six regional HIEs, known as Qualified Entities (QEs). To support the waiver’s goals, NYeC developed a SHIN-NY FHIR Implementation Guide (IG) designed to enable consistent exchange of social care data using Gravity standards.
In late 2024, the six New York QEs began piloting and testing the new framework to ensure that high-quality, standardized data could flow from community organizations and healthcare providers through the SHIN-NY Data Lake to Medicaid systems. By mid-year 2025, feedback from these pilots informed updates to the implementation guidance, including new advancements in reimbursement models for social needs within Medicaid. As this work continues, New York’s approach offers a valuable model for how states can operationalize social care data standards to strengthen the integration and reimbursement of health and social services at the state level.
The Bigger Picture: Whole-Person Care
SDOH efforts will only succeed if health care systems move toward whole-person care models and support them with reimbursement. However, simply collecting more data is not enough. Health care organizations must focus on how the data will be used—to drive care coordination, improve outcomes, and reduce costs. It is not enough to just gather information, but how to turn it into meaningful action for patients and communities.
