Greening the Medicaid Supply Chain: An ESG-Integrated Framework for Value-Based Procurement Anchored in Stakeholder Theory and the Triple Bottom Line

The growing environmental footprint of healthcare systems and persistent inequities in access and outcomes have intensified calls for procurement reform within publicly funded healthcare programs. Medicaid, as the largest public purchaser of healthcare services in the United States, occupies a strategic position to drive systemic change through its supply chain. This paper develops an ESG-integrated framework for greening the Medicaid supply chain, anchored in Stakeholder Theory and the Triple Bottom Line (TBL). Drawing extensively on contemporary literature in sustainable supply chain management, healthcare procurement, and ESG governance, the study reconceptualizes value-based procurement beyond cost containment to include environmental stewardship, social equity, and institutional accountability. The paper synthesizes theoretical foundations, operational mechanisms, and policy instruments, particularly Section 1115 waivers to propose a practical roadmap for embedding ESG principles into Medicaid procurement. International benchmarking with the UK National Health Service (NHS) Net Zero strategy further demonstrates feasibility and scalability. The framework contributes to both theory and policy by positioning Medicaid procurement as a lever for climate action, health equity, and long-term system resilience.