Social factors are primary impediments to managing care for high-cost Medicaid beneficiaries. These factors create barriers that impede beneficiary participation in care management services, creating challenges for states trying to improve outcomes and reduce costs for high-expenditure Medicaid beneficiaries. The biggest barriers include lack of transportation to medical appointments, lack of stable housing, and inconsistent access to food and other basic resources. Additional barriers to effective care management include staff shortages in rural areas and state or Medicaid managed care organization (MCO) difficulties contacting beneficiaries due to outdated contact information or limited beneficiary mobile phone minutes. A review . . .