HJNO Mar/Apr 2025

48 MAR / APR 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS MEDICAID COLUMN MEDICAID DESPITE a return to “normalcy” after the ravages of the COVID-19 pandemic, social isolation and loneliness continue plaguing public health. Social isolation is defined as a lack of meaningful social connections, while loneliness is characterized by per- ceived isolation or inadequate meaningful connections and represents a gap between one’s preferred experience and their actu- al. 1 These conditions have been linked to adverse physical and mental health out- comes and include an increased risk of cardiovascular disease, depression, cog- nitive decline, and mortality among all age groups. The pandemic amplified the devastating impacts of both social isolation and loneli- ness when people could no longer gather at their favorite restaurant, shopping mall, church, or school, not to mention main- taining social distance and wearing masks, furthering separation between friends and loved ones. But while the masks, face shields, and other creative barriers are now long gone, many individuals still suf- fer from the effects of social isolation and loneliness. According to the Healthy Minds Poll, 30% of adults reported feelings of loneliness at least once a week over the past year, while 10% reported feeling lone- ly every day. 2 And among Medicaid popu- lations, social isolation and loneliness are further compounded by factors such as poverty, disability, chronic illness, and lim- ited access to community resources, mak- ing it a critical issue for healthcare provid- ers and policymakers to address. Our Medicaid population: the dis- proportionately impacted Within the Medicaid system, certain populations are uniquely impacted by so- cial isolation and loneliness. Older adults, individuals with disabilities, those with chronic mental health conditions, un- housed individuals, and youth are at par- ticularly high risk. The research on the effects of social isolation and loneliness in older adults is particularly eye-opening. In a 2024 poll, 29% of adults aged 50-80 years reported feeling isolated in the past year and 33% of this same cohort report- ed feeling a lack of companionship. 3 Now, imagine the added burden of living alone, struggling with mobility issues, lacking fa- milial support, suffering from the effects of chronic illness, and other factors that many older adults on Medicaid cope with and you can see how social isolation and loneliness are more pronounced and det- rimental to their health outcomes. Accord- ing toAARP, social isolation and loneliness cost Medicare $6.7 billion/year due to increased emergency room visits, longer hospital stays, and enhanced home-based support. 4 The costliness of these condi- tions on older adults should warrant more proactive solutions to address them. Those with chronic mental health con- ditions, including depression and anxiety, may struggle with maintaining social con- nections due to stigma, withdrawal, or dif- ficulty accessing appropriate support sys- tems. Medicaid recipients who experience homelessness face extreme social isola- tion due to instability, lack of community belonging, and limited access to consistent healthcare and social services. 5 Youth are another group impacted by social isolation and loneliness. Because social relationships are central to their identity, adolescents are especially af- fected during this critical period of their physical and emotional development. Since teens are highly attuned to the so- cial dynamics around them, they compare their status to that of their peers and any perceived lack may be negatively internal- ized, which fuels feelings of inadequacy that lead to isolation and loneliness. 1 Other factors that set the stage for this sequence of events include inadequate support sys- tems, bullying, social media, limited access to social activities, and peer exclusion. As these perceptions — which are a reality for most adolescents — fester, they can lead to depression, anxiety, suicidal ideation, sub- stance use, and the development of risky behaviors. How can we address this? Screening for social isolation is essen- tial for addressing its impact on Medicaid populations. Healthcare providers, social workers, and case managers must incor- porate validated screening tools to assess social isolation risk and intervene ear- ly. Instruments such as the UCLA Lone- liness Scale, the Berkman-Syme Social Network Index, and the Patient-Report- ed Outcomes Measurement Information The Epidemic of Social Isolation and Loneliness HOW THOSE WITH THE LEAST SUFFER THE MOST