States across the country increasingly recognize the value of addressing social determinants of health — such as housing, transportation, food, and employment — as a means to improve population health, advance health equity, and reduce health care spending. In early 2018, Indiana’s Family and Social Services Administration (FSSA) created the Office of Healthy Opportunities. Dedicated to ensuring “equitable access to the social and physical supports needed to promote health from birth through end-of-life,” the office has three goals: (1) identify the specific health care related social needs of Hoosiers; (2) connect those in need with state and community organizations; and (3) create new policies and programs to provide services where they do not currently exist.

This case study explores how FSSA is working to meet the goals set forth by the new office through engagement with consumers and collaboration with multiple peer agencies — including public and private stakeholders — to rethink how to optimize the integration and delivery of health and social services for Medicaid beneficiaries.

The case study is a product of the Medicaid Leadership Institute (MLI), an initiative of the Robert Wood Johnson Foundation directed by the Center for Health Care Strategies (CHCS) that helps Medicaid directors develop the skills and expertise necessary to successfully lead their state programs in an ever-changing policy environment. Allison Taylor, Indiana’s Medicaid Director, brought this emerging effort to CHCS’ attention during her MLI Fellowship because of its consonance with the Foundation’s focus on social determinants of health and the need to support a ‘Culture of Health’ across communities.