Health Equity in Motion: Addressing Social Drivers of Health in Our Communities

How We’re Driving Change

CareFirst has invested in a variety of initiatives aimed at addressing SDOH in the communities we serve:

• Fueling Maternal Health Through Nutrition: The Centers for Disease Control and Prevention identifies food and nutrition security as a key SDOH. As such, CareFirst Community Health Plan Maryland (CareFirst CHPMD), our Medicaid managed care organization, has partnered with NourishedRx to launch Mommy Meals, a maternal health benefit available for pregnant CareFirst CHPMD members. Mommy Meals participants receive six months of nutritious home-delivered meals, guidance and support from a NourishedRx nutrition coach and education to promote a healthy pregnancy. The program is grounded in Food is Medicine principles, recognizing the nourishing power of food and the relationship between nutrition and health outcomes.
• Fighting Food Insecurity: Through a partnership with CFG Bank Arena and Goodr, CareFirst is addressing food insecurity in Baltimore. Goodr’s Surplus Food Recovery solution manages the logistics of donating quality, unused food from events to local nonprofits, food banks and schools. To date, this initiative has delivered thousands of pounds of food to community-based organizations (CBOs) in the Baltimore region. This partnership not only provides sustenance but also reduces food waste while supporting vulnerable populations.
• Empowering Community Efforts Against Diabetes: CareFirst has committed $6 million to provide multi-year funding for our Place-Based Diabetes Grant Program. Initiatives supported through this program enhance nutritional security for diet-related chronic conditions, utilize Food is Medicine interventions to reduce the incidence and prevalence of diet-related chronic conditions, and promote nutrition education. By investing in community-led programs, we aim to address diet-related chronic conditions and improve outcomes for populations at risk of diabetes.
• Creating Economic Opportunities in West Baltimore: In partnership with Coppin State University and the Center for Urban Families, CareFirst developed our West Baltimore Workforce Development Program, focused on creating economic opportunities in West Baltimore. As part of the initiative, we collaborate with local employers to infuse West Baltimore with sustainable wage jobs and have committed to hiring 100 employees from zip codes 21215, 21216 and 21217 directly to our organization. Individuals enrolled in the program receive training that equips them for careers in community health, customer service and more. The program also offers a suite of wraparound supports such as transportation, childcare, healthcare navigation and financial literacy.
• Social Risk Intelligence Strategy with Socially Determined: CareFirst’s collaboration with Socially Determined leverages their SocialScape platform to better understand SDOH risk factors among our members. SocialScape helps us identify key factors that influence health outcomes, allowing us to create more effective strategies that optimize our investments, improve care and support health equity.

Advocating for Policy Change

Although partnerships and programs are critical, achieving health equity requires bold action from policymakers. CareFirst urges leaders at all levels to implement policies that address SDOH, eliminate barriers to care and promote equity. Some of our specific recommendations include:

• Strengthen Nutrition Assistance Programs: The Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) play vital roles in helping families access nutritious food. Research shows these programs improve food security and contribute to better health outcomes.^{2 3} To maximize their impact, policymakers should look to the data, which clearly supports increasing funding, expanding eligibility and simplifying enrollment processes to ensure these programs continue to meet the needs of vulnerable families effectively. Learn more about our recommendations to enhance access to WIC here.
• Permanently Extend the Enhanced Advance Premium Tax Credits: Without congressional action, the enhanced Advance Premium Tax Credits will expire at the end of 2025. Extending them is essential to ensuring sustained access to care. These credits make health insurance coverage more affordable for millions of Americans and have been critical for increasing enrollment, particularly among minority populations.⁴ Availability of affordable coverage facilitates timely access to preventive care, chronic disease management and other essential healthcare services. Without coverage, many individuals forgo needed care due to cost, leading to untreated health issues that can limit one’s ability to work, care for their families and fully enjoy their personal lives. This creates a cascading cycle of poor health outcomes and economic instability, perpetrating the exact drivers of disparities the tax credits help address.
• Expand and Diversify the Provider Pipeline: Congress should establish grants and scholarships for accredited education programs aimed at increasing diversity among primary care and behavioral health clinicians. Congress and state governments should also support and invest in university programs that increase the diversity of faculty, mentors and preceptors through recruitment and retention-focused initiatives.
• Increased Investment in Community-Based Organizations: Policymakers should establish dedicated grant programs and increase reimbursement mechanisms that directly fund CBOs actively addressing SDOH. CBOs are deeply embedded in the communities they serve, often possessing the cultural competency, trust and local knowledge needed to tailor programs effectively. Increased investment in CBOs will enable policymakers to better support initiatives that meet the unique needs of various communities.

Advancing Health Equity Together

Health equity is a shared responsibility. It requires the combined efforts of healthcare organizations, policymakers, community leaders and individuals. To ensure progress, we must continue adequately investing in initiatives that address SDOH and advance health equity. Without these efforts, the economic and societal costs of deepening health disparities will limit opportunities for individuals and communities to thrive.

At CareFirst, we remain steadfast in our commitment to this work. Together, we can create a resilient, healthier, and more equitable society—now and for generations to come.