The human services sector is critical to helping individuals, families, and communities thrive and optimizing health, well-being, and equity. Yet there is no consensus around which programs and services should be considered human services, and the sector is often misunderstood, underfunded, and underappreciated. Human services can include, for example, cash and in-kind benefits; aging and senior services; child, family, and community services; disability and independent living services; and workforce development and financial well-being services.

Growing evidence on the importance of the social determinants of health is also shining a light on the critical need to strengthen the human services sector.

States play a central role in the organization, management, and delivery of human services. How states structure their human services systems can have important implications for the flow of funding, pace of innovation, and satisfaction of customers. This report describes the human services landscape within state governments and uses case studies to show the range of approaches state governments take in structuring their human services systems. It also explores some implications of these structures for alignment and coordination within human services and with the health care sector.

HOW STATES STRUCTURE THEIR HUMAN SERVICES SYSTEMS

State governance of human services can be multifaceted and complex. State agency structures—which programs and services are administered by which agencies—vary across states and often reflect a state’s attempt to balance tension between specializing in a particular population or policy area and spanning multiple populations or policy areas. State structures differ with respect to the roles played by counties, nongovernmental and community-based organizations, and the state’s executive and legislative branches.

HOW ALIGNMENT OCCURS WITHIN HUMAN SERVICES AND WITH HEALTH CARE

Agency structure can create the conditions for alignment and coordination among human services and with the health care sector, but it doesn’t guarantee it. States align and coordinate their human services functions through agency structures, other formal structures, technology, and budget processes. Through our case studies, we discovered nuanced factors that can facilitate or impede human services alignment and coordination with health care.