Medicaid serves vulnerable populations that experience deep health inequities and significant health-related social needs. In recent years, reforms to Medicaid have sought to respond to those needs, with mixed results. Value based payment methods, which in theory link payment to outcome metrics, are emerging in commercial insurance markets and can be adapted to the needs of Medicaid programs and their beneficiaries. These methods seek to tie payment for services to the forging of connections between medical and social care including housing supports and nutrition services for vulnerable populations. This paper describes the merits and some pitfalls of the attempt to turn Medicaid from its roots as a medical insurance program to a broader health insurance program. It describes the benefits of employing community care hubs – intermediaries between community-based organizations and large payers and hospital systems – as a way to spur the move to social care in Medicaid. It also addresses some of the barriers to this move, including the perceived danger of “medicalizing” society’s failures and the apparent turn by the current federal administration away from commitment to health equity.