Money Moves the Mare: The Response of Community‐Based Organizations to Health Care’s Embrace of Social Determinants

Lauren Taylor
Elena Byhoff
Peer-Reviewed Article
January 2021


This article suggests that community-based organizations (CBOs) are responding to Medicaid redesign efforts that prioritize social determinants of health by adopting practices similar to health care organizations.


Partnerships between health care providers and CBOs continue to grow in both size and scale due to the increasing demand for interventions that address patient health-related social needs. Little is known about how CBO partnerships with health care organizations affect CBO operations. This article explores findings from a qualitative study of Massachusetts CBO leaders that sought to understand how CBOs are responding to new SDOH-focused polices amid recent state Medicaid redesign efforts.


Despite CBOs wanting to remain distinct from health care and avoid medicalization, interviewed CBOs shared that they are undergoing organizational changes to signal their legitimacy to health care organizations. Some examples of these changes include adopting new measures, using medical language to describe their work, and hiring more clinical staff to management and board positions. CBOs expressed that they want to become appealing partners for more well-resourced health care organizations, due to their own historically limited funding.


Recent Medicaid redesign efforts have amplified the pressure on CBOs to professionalize in order to enter into partnerships with health care organizations. CBOs need to ensure future access to financial resources, but may risk straying from their missions.

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