Cross-sector partnerships as a strategy to address social needs of low-income Black children and adolescents with mental health concerns in Philadelphia

In Pennsylvania, the State Medicaid agency was approved for a new Section 1115 demonstration by the Centers for Medicare and Medicaid Services to address health-related social needs (HRSNs) in target populations. Within the Pennsylvania Medicaid program, Behavioral Health Managed Care Organizations (BH-MCOs) play a crucial role in addressing the HRSNs of low-income Black youth covered by their health plan. As BH-MCOs tackle member HRSNs, developing cross-sector partnerships with community-based organizations (CBOs) is a promising integration and intervention strategy to address unmet HRSNs under Medicaid. It is important to focus on social needs interventions in low-income Black youth because unmet social needs are more prevalent among minoritized racial and ethnic populations due to historical and ongoing structural racism (Cene et al., 2023) and prior studies have shown that low-income people often have multiple unmet needs (Thompson et al., 2019). Black children are disproportionately represented in Medicaid, as shown by a 2018 analysis that Black children made up 14 percent of the child population but represented 20.8 percent of children with Medicaid (Brooks & Gardner, 2020). This dissertation project aimed to identify barriers and facilitators in forming and sustaining effective culturally responsive partnerships between BH-MCOs and CBOs to address unmet HRSNs for low-income Black youth. I employed a rapid literature review to identify best practices related to facilitators and barriers to partnerships between managed care organizations (MCOs) and CBOs for addressing HRSNs in Medicaid populations from New York, North Carolina, California, and Massachusetts. I synthesized these best practices and used insights to identify recommendations for Pennsylvania. Next, I focused specifically on Philadelphia by exploring partnerships between Community Behavioral Health -- a Philadelphia-based BH-MCO -- and CBOs located in the Greater Philadelphia area. I conducted in-depth, semi-structured, key informant interviews with 12 healthcare non-profit leaders of organizations in Philadelphia between February and March 2025. These interviews helped me to assess barriers and facilitators to financing, data sharing, integrating workflows, building trusting partnerships, and evaluating knowledge and attitudes related to BH-MCOs and CBOs working together to develop and sustain partnerships in Philadelphia that are scalable to other parts of Pennsylvania. This information will be useful because community-payer partnerships can potentially lower healthcare costs and utilization, help with Community Behavioral Health's overall mission to provide access to quality care to its members, and inform the next steps related to the Pennsylvania Section 1115 demonstration. I developed a toolkit to allow other MCOs and CBOs to understand how to start developing and sustaining these cross-sector partnerships.