Alumni Impact Award Winner: Designing a Smarter Social Safety Net

Brown armed him with the tools needed to analyze and improve health policy, but Chima Ndumele’s passion for righting injustice keeps him looking forward, focused on improving the lives of low-income Americans.

For his work redefining health care policy and delivery for America’s low-income populations, Chima Ndumele MPH, Ph.D.’13, associate professor of health policy at the Yale School of Public Health, is the recipient of the Brown University School of Public Health’s 2024 Alumni Impact Award. A distinguished alumnus of Brown’s doctoral program in health services research, Ndumele’s insights into health insurance and health care systems have positioned him as a leading figure in the field, influencing state and federal policy and working to streamline the administration of safety-net programs.

Ndumele’s research focuses on the organization and delivery of services under Medicaid, health insurer for over 90 million Americans, and the extended social safety net. Amid concerns that the federal expansion of Medicaid would increase demand for services without a parallel increase in the number of physicians, Ndumele was the first researcher to calculate that expansion was unlikely to compromise access or reroute care to emergency rooms.

His contributions include groundbreaking studies examining “ghost providers” in Medicaid networks (which claim to take Medicaid coverage but deliver little to no care to recipients); the relationship between social services availability and utilization and health outcomes; and inefficiencies and persistent disparities within the U.S. health care system. Recognized as an Emerging Scholar by the National Academies of Medicine in 2023, he has been cited over 2500 times in peer-reviewed literature.

Currently, Ndumele is leading a multi-state initiative aimed at designing a smarter, more integrated safety-net for low-income households, while also embedding a data science team from Yale within the Connecticut Department of Social Services to cultivate evidence-based policy improvements. 

We spoke with Professor Ndumele about his contributions, his ongoing projects and how the mentorship he received at Brown expanded his approach to building a more equitable and efficient health care system.

You’ve achieved remarkable success early in your career, particularly in health policy research related to low-income Americans. What initially drew you to this area of study?

The inequity in health outcomes among low-income Americans resonated with me deeply. Growing up in East Orange, New Jersey, it was common to see preventable health challenges severely impacting lives, and that felt wrong on a personal level.

As a child, I lived next door to an elderly woman who would routinely say, “If something happens to me, make sure they take me to Mountainside Hospital.” But Mountainside was four towns and six hospitals away. She viscerally and intuitively understood that the care she would get in her community wasn’t the best. I wanted to figure out why that was the case and what I could do to help solve that challenge.

“ I think there is a growing consensus that social determinants matter, but the administration of our social safety net hasn’t caught up with that understanding. ”

Chima Ndumele MPH, Ph.D. ’13 Associate Professor of Health Policy, Yale School of Public Health

Over time, my understanding of health inequities and potential solutions evolved, but my core motivation remains the same: to remedy what feels fundamentally unjust and dedicate my career to making a difference.

Considering the complex issues you've tackled, like ghost providers in Medicaid networks and the impact of social service availability on health outcomes, what do you see as today’s most pressing health care policy challenge for low-income families?

The fragmentation of services stands out as a critical issue. For example, 90% of SNAP recipients are also on Medicaid; 45% of individuals on Medicaid are also on two more assistance programs. Yet the way we craft policy and administer services ignores the whole person who engages with these programs. The disconnect between various assistance programs and the actual needs of people, leads to inefficiencies and missed opportunities for improving health outcomes.

I think there is a growing consensus that social determinants matter, but the administration of our social safety net hasn’t caught up with that understanding. So our team has built a series of initiatives called “Building a Smarter Safety Net” that recognized that people have multiple touch points within the system and thus seeks to integrate services more effectively.

What emerging trends or innovations in health policy and management do you believe will impact efforts to address health disparities and improve health care delivery for vulnerable populations?

First, we need to confront a fundamental question: What is the purpose of our health care safety net? Currently, evidence shows that over half of Medicaid recipients will still be in the program ten years from now. Simply being on Medicaid doesn't automatically provide a pathway out of it. This reality challenges the common perception of Medicaid as a temporary solution. So, do we continue to treat Medicaid as a short-term fix, or do we commit to transforming it into a long-term support system designed to genuinely improve lives? This means not only providing consistent coverage as we do with Medicare, but also addressing the social factors that contribute to the need for Medicaid in the first place.

Second, I’ve spent a lot of time recently examining the role of private partners in caring for the most vulnerable populations. Medicaid consumes about 30% of state budgets, potentially diverting funds from other critical areas like education and public health. So many states have turned to private insurance companies to manage Medicaid, a move that carries the risk of prioritizing profit over patient care if not carefully regulated. It’s essential to establish strong guardrails to ensure that when the drive for efficiency and the profit motive collide, patient care remains the top priority.

“ Mentorship has been the key to any success I’ve experienced. I’ve been lucky to have incredible mentors. It’s the daily, incremental effort that truly helps people grow. ”

Chima Ndumele MPH, Ph.D. ’13 Associate Professor of Health Policy, Yale School of Public Health

We're all aware there are limitations and tough choices to be made. Our research essentially focuses on this dilemma: Given our finite resources, how can we best allocate them? Wishing or hoping isn’t enough. These decisions are crucial and often have clear best choices. Our goal is to tackle these issues with humility, acknowledging what we don’t know while leveraging what we do—our tools, data and passion. We’re in a position to design programs that are both effective and efficient, proving that improving lives and being cost-effective don’t have to be at odds.

How do you approach mentorship, and why is it so vital in academia and research?

Mentorship has been the key to any success I’ve experienced. I’ve been lucky to have incredible mentors. A friend and colleague once joked, "no one writes country love songs about taking incremental steps forward,” but that’s exactly what mentorship is all about. It’s the daily, incremental effort that truly helps people grow. The big moments might be getting into a Ph.D. program or winning awards, but the real work of mentorship is in the day-to-day development.

Some of the best mentorship I’ve received has been at Brown. Vincent Mor, for example, completely expanded my sense of what’s possible. He showed me that we can reinvent the way we see the world and fundamentally change our approach to improving lives. Amal Trivedi taught me about execution. It’s easy to think leadership is all about being loud and demanding, but Amal showed me the power of patience and meticulous guidance—not just correcting a student’s work but explaining the reasoning behind those corrections. Fox Wetle taught me as much about professionalism as anyone I’ve ever known. She always does what she says she’s going to do. 

They not only had an effect on the way I see the world, but they also shaped how I guide my students and mentor others.

Alumni Impact Award

This competitive award recognizes one exceptional master’s or doctoral alumnus or alumna making a significant impact on their community and/or in their field.