At the crossroads: Initial findings and lessons learned from a Medicaid housing benefit pilot

Background/Rationale: While health-related social needs (HRSN) screening is foundational to identifying and addressing patient unmet HRSN, the collection of this new type of dataespecially when documented in medical records-may expose patients and their families to certain risks.Existing research highlights, for example, potential negative impacts on patients, providers, and the patient-provider relationship from asking sensitive questions without meaningful follow-up (e.g., providing support for identified needs).Policy and practice considerations that take the potential for unintended consequences into account are critical to minimizing harm.Unsafe or otherwise unwanted uses and disclosures of social risk information outside of the patient-provider relationship is one particular area of concern.Objectives: Researchers set out (1) to identify and explore the bounds of potentially high-risk scenarios involving unsafe or otherwise unwanted uses and disclosures of social risk information and (2) to review and discuss strategies to minimize harm from both "Big P" policy (i.e., governmental) and "small p" policy (i.e., institutional) perspectives.Methods: Researchers combined legal research with discussion with interdisciplinary stakeholders such as health system staff, legal experts, and academics.Results/Conclusion: Permitted disclosures under patient privacy law are such that safety and privacy concerns relating to third-party disclosures are real.Disclosures in pediatric settings and in the context of interpersonal violence may be especially sensitive.This assessment does not mean that HRSN screening is, overall, a less valuable pursuit, nor does it necessarily negate potential benefits of HRSN screening; rather, amid the positive developments in the integration of HRSN screening, services, and supports into health care, it is important to acknowledge the potential for unintended consequences and adapt interventions to minimize risk of harm.The topic of safe, equitable screening is especially timely as HRSN screening is increasingly integrated into health care delivery, including as a result of evolving federal and state regulations.