State Health and Value Strategies (SHVS), in partnership with Manatt Health, Health Equity Solutions, Georgetown’s Center on Health Insurance Reforms (CHIR), the State Health Access Data Assistance Center (SHADAC), Bailit Health, and GMMB, developed this resource page to serve as an accessible “one-stop” source of health equity information for states. This resource is designed to support states seeking to make coverage and essential services available to all of their residents, regardless of where they live, how much money they make, or discrimination they face. SHVS will update this page frequently with new resources as they become available.
This issue brief documents how REL data are collected by the Medicaid programs in the 50 U.S. states, the District of Columbia, and five U.S. territories. This serves as an update to SHADAC’s previous brief, providing up-to-date information on Medicaid REL data collection among the states and extending the analysis to include the District of Columbia and the five territories.
Given the outsized role of Medicaid in maternal health—accounting for 75% of all public expenditures for family planning services and covering close to half of all births nationally—state policymakers have both a moral imperative and major opportunity to improve and protect the health and well-being of their pregnant/postpartum residents, their infants and families. This compendium provides information on strategies to improve maternal health outcomes and synthesizes research about the national state-of-play, including state examples, across four domains: maternal health models, quality improvement, workforce and benefits, and eligibility and enrollment/coverage expansion. This resource builds on a September 2022 maternal health roundtable convened by State Health and Value Strategies (SHVS) and Manatt Health with California, Louisiana, Maryland, Minnesota, and Tennessee.
On September 8, the Department of Homeland Security (DHS) issued a final rule on the “Public Charge Ground of Inadmissibility,” regarding DHS’ authority to refuse a noncitizen’s application for admission or application for visa adjustment (including receipt of a green card) on grounds that they are “likely at any time to become a public charge.” This expert perspective provides an overview of the final rule.
This expert perspective reviews the focus on health equity in California’s final Medi-Cal Managed Care Plans Request for Proposals (RFP) which the state issued in February 2022. This expert perspective is a companion to the latest version of State Health and Value Strategies’ Medicaid Managed Care Contract Language: Health Disparities and Health Equity which has been updated to incorporate new details from California’s RFP.
This document provides excerpts of health disparities and health equity language from Medicaid managed care (MMC) contracts and requests for proposals (RFPs) from 17 states and the District of Columbia. The criteria for inclusion in this compendium are contracts and RFPs that explicitly address health disparities and/or health equity. Website links to the full contracts are included where available. The latest update to this publication adds language from California’s final Medi-Cal Managed Care Plans Request for Proposals (RFP) which the state issued in February 2022. This is the sixth update to this State Health and Value Strategies resource since its original publication in June 2020.
State Health and Value Strategies published findings from a series of interviews with state Medicaid leaders about how to monitor the implementation of “social care.” State Medicaid agencies are increasingly exploring opportunities to incorporate “social care” into strategies for improving health, decreasing healthcare costs, and achieving equity. The findings are derived from a two-part research project conducted by the Social Interventions Research and Evaluation Network at the University of California, San Francisco (SIREN) for SHVS that explored ways to scale and sustain social care across the healthcare sector.
Medicaid estate recovery has important health equity implications. While estate recovery is intended to recoup funds to support the Medicaid program and ensure that enrollees and their families who are able to pay for long-term services and supports do so, the burden falls disproportionately on families of color and exacerbates existing inequities in the distribution of wealth tied to the historical and contemporary realities of structural discrimination and racism. This toolkit is intended to assist state officials in evaluating their current estate recovery policies and understanding where they may have flexibility to make the policies less burdensome for affected low-income families.
On February 17, the Department of Homeland Security (DHS) released its 2022 notice of proposed rulemaking (NPRM) which would largely codify longstanding federal guidance regarding DHS’ authority to refuse a noncitizen’s application for admission or application for visa adjustment (including receipt of a green card) on grounds that they are “likely at any time to become a public charge.”
This issue brief provides an overview of key provisions of the 2022 NPRM and includes commentary to describe how the proposed rule differs from the 1999 Field Guidance, as well as how the proposed rule seeks to promote clarity and address the chilling effects caused by elements of the now-repealed 2019 Rule. Comments on the 2022 NPRM are due on April 25.
Many immigrants and their families are concerned that enrolling in Medicaid/CHIP, Marketplace, and other public health insurance programs will run afoul of public charge rules and jeopardize their immigration status. These fears remain despite the fact that the administration has reinstated longstanding public charge guidance that does not consider the use of Medicaid/CHIP benefits (other than government-funded institutionalization for long-term care) or Marketplace coverage in a public charge determination. This issue brief, the third in a series, Supporting Health Equity and Affordable Health Coverage for Immigrant Populations, provides an overview of the status of the public charge rule and presents strategies to help connect eligible individuals to affordable coverage.
Under federal regulations, states may provide pregnancy-related care through the Children’s Health Insurance Program (CHIP) state plan to targeted low-income children from conception to birth (the so called “unborn child” option). This option–referred to in this brief as the CHIP coverage option for pregnant immigrants and their children–enables states to provide prenatal, labor and delivery, and postpartum services to pregnant individuals, regardless of immigration status. This issue brief–the second in a series, “Supporting Health Equity and Affordable Health Coverage for Immigrant Populations”–offers considerations for policymakers around the CHIP coverage option for pregnant immigrants and their children, regardless of immigration status.
On Tuesday, February 15, State Health and Value Strategies is hosting a webinar, Centering Health Equity in Medicaid Section 1115 Demonstrations from 12:00 p.m. to 1:00 p.m. ET. Many states are looking to Medicaid as a critical lever for advancing health equity, and states have multiple tools and authorities in Medicaid to advance health equity through coverage and benefit policy, delivery system and payment reform, and innovations that impact social drivers of health. State Health and Value Strategies is hosting a webinar during which experts from Manatt Health will provide an overview of Medicaid’s role in promoting health equity and ways states can advance health equity and address structural racism throughout the Section 1115 demonstration lifecycle, from planning to implementation to monitoring, and evaluation.
To support state efforts, State Health and Value Strategies continues to update the resource Medicaid Managed Care Contract Language: Health Disparities and Health Equity. This compendium provides Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality initiatives, and procurement processes, to promote health equity and address health disparities. This expert perspective highlights trends in state Medicaid managed care procurements and model contracts from Michigan, North Carolina, Ohio, Oregon, Virginia, and Washington, as well as new excerpts of relevant language from Pennsylvania and Rhode Island.
This document provides excerpts of health disparities and health equity language from Medicaid managed care (MMC) contracts and requests for proposals (RFPs) from 17 states and the District of Columbia. The criteria for inclusion in this compendium were contracts and RFPs that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available. This is the fifth revision of this publication since its original release in June 2020. This latest iteration includes updated language from Medicaid programs in Michigan, North Carolina, Ohio, Oregon, Virginia, and Washington, as well as new language from Pennsylvania and Rhode Island.
Ensuring affordable health coverage and healthcare for immigrant populations in the United States is critical to advancing health equity. In a new series, State Health and Value Strategies (SHVS), with support from the Robert Wood Johnson Foundation, highlights strategies for states to expand affordable health coverage to immigrant populations in the United States. This expert perspective provides an overview of the products included in the series.
With authorization of the first COVID-19 vaccine for children ages five and older, most kids in the United States are now eligible to be immunized. Recent experience with other vaccines shows the country is capable of vaccinating kids widely and equitably, but the challenges in vaccinating adults against COVID-19 and experiences with other immunizations in children, like the vaccine against the human papillomavirus (HPV), also demonstrate that success is not inevitable. To meet their COVID-19 vaccination goals to vaccinate kids against COVID-19, states can borrow strategies that have historically proved effective in immunizing kids against diseases such as measles and resulted in dramatic reductions in certain vaccination rate disparities. This issue brief highlights state strategies that have led to high childhood vaccination rates—and dramatic strides toward health equity—and identifies how those strategies could be applied in the context of the current COVID-19 crisis.
On Monday, November 1 State Health and Value Strategies is hosting a webinar that will review steps states can take to integrate health equity into their Medicaid managed care programs. Medicaid’s role in providing healthcare coverage to individuals who experience economic and social disadvantage is leading many states to integrate health equity into their population health management strategies, focusing specific attention on reducing health disparities and addressing conditions that create health inequities. The webinar will profile the recently published Promoting Health Equity in Medicaid Managed Care: A Guide for States, a practical guide that offers a series of concrete actions state Medicaid agencies can implement internally and with their contracted health plans in pursuit of health equity. During the webinar, experts from Bailit Health will review the three sections of the Guide and facilitate a discussion with state officials.
Population groups covered by Medicaid are often among the most economically and socially marginalized. Medicaid’s role in providing health care coverage to individuals who experience economic and social disadvantage is leading many states to integrate health equity into their population health management strategies, focusing specific attention on reducing health disparities and addressing conditions that create health inequities. This guide describes recommended process steps for states to integrate a focus on health equity in their Medicaid managed care programs. It offers a series of concrete steps to be more intentional about advancing health equity in Medicaid, and specifically through Medicaid managed care programs. The guide focuses on the internal agency commitments and changes that are necessary to address systemic barriers to accessing high quality health care and improving health outcomes, particularly among populations that experience persistent health inequities. It is organized into three primary sections, each containing specific actions for Medicaid agencies.
The crisis in immigrant health coverage has been both highlighted and exacerbated by the recent pandemic. Access to affordable health coverage and healthcare for immigrant populations in the U.S. is critical to advancing health equity and reducing health disparities. This issue brief—the first in a series “Supporting Health Equity and Affordable Health Coverage for Immigrant Populations”—provides an overview of the national immigrant health coverage landscape and offers considerations for policymakers related to state-funded affordable coverage programs for low-income individuals who do not qualify for subsidized health insurance under the ACA or other public programs due to immigration status.
Thirteen million people identify as part of a sexual or gender minority (SGM) in the United States, and an estimated 1.17 million of those SGM adults (age 18-64 old) have Medicaid as their primary source of health insurance. Although there has been increasing recognition over the last decade that sexual orientation and gender identity (SOGI) are important determinants of health, the recent coronavirus (COVID-19) crisis has amplified the stark health disparities that many vulnerable populations face. Despite gaps and inconsistencies in state and federal reporting on COVID-19, data continues to show that Black, Indigenous, and other people of color (BIPOC) have been disproportionately impacted by both higher risks of infection and poorer health outcomes. However, health-related data about SGM populations is particularly scarce. This brief documents how information describing SGM populations is currently collected at the federal level and in Medicaid. The brief also spotlights Oregon’s recent efforts to improve the collection of SOGI data, and present several issues that states should consider as they look to improve their collection of SOGI data in Medicaid.
On Wednesday, October 6 State Health and Value Strategies hosted a webinar that provided an overview of eligibility standards for evacuees and strategies that states can deploy to expeditiously enroll people into health coverage in order to access care. Tens of thousands of Afghans who fled the Taliban are awaiting resettlement, with many having already arrived in the U.S. living on military bases and being processed in several states. Evacuees are in need of access to medical care, as measles and other infections spread and newcomers grapple with the trauma associated with fleeing their home country. States are evaluating the tools available to them to ensure their new residents have access to health coverage as they settle in the U.S.
During the webinar, experts from Manatt Health reviewed new CMS guidance released on September 27, 2021 to help states understand what health coverage options are available to Afghan evacuees. The webinar included a question and answer session.
Promoting Health Equity in Medicaid Managed Care: A Guide for States describes recommended process steps for states to integrate a focus on health equity in their Medicaid managed care programs. It offers a series of concrete steps to be more intentional about advancing health equity in Medicaid, and specifically through Medicaid managed care programs. The guide focuses on the internal agency commitments and changes that are necessary to address systemic barriers to accessing high quality health care and improving health outcomes, particularly among populations that experience persistent health inequities. It is organized into three primary sections, each containing specific actions for Medicaid agencies.
Many states are looking to fill gaps in race and ethnicity data for Medicaid and related agencies. Working with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, with support from the State Health and Value Strategies (SHVS) program, New York tested multiple strategies aimed at encouraging applicants to answer the optional race and ethnicity questions. This expert perspective highlights an effort by New York’s official state-based marketplace, NY State of Health, to improve the completeness of race and ethnicity data that applicants share when applying for Medicaid; Child Health Plus, the state’s Children’s Health Insurance Program (CHIP); the Essential Plan, New York’s Basic Health Program (BHP); or Qualified Health Plan (QHP) coverage through its Marketplace.
To support state efforts, SHVS continues to sponsor ongoing updates to Medicaid Managed Care Contract Language: Health Disparities and Health Equity compendium. The compendium provides Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality programs, and procurement processes, to promote health equity and address health disparities. This expert perspective highlights the latest update to the SHVS compendium which incorporates excerpts from Medicaid managed care procurements and model contracts in California, Indiana, Louisiana, and Nevada.
This document provides excerpts of health disparities and health equity language from Medicaid managed care (MMC) contracts and requests for proposals (RFPs) from 15 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California. The criteria for inclusion in this compendium were contracts and RFPs that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available.
This is the fourth revision of this publication since its original release in June 2020. This latest iteration includes new language from Medicaid programs in California, Indiana, Louisiana, and Nevada and the expert perspective States Are Leveraging Medicaid Managed Care to Further Health Equity highlights the new additions to the compendium.
State Health and Value Strategies, in partnership with Health Equity Solutions, created the Health Equity Language Guide for State Officials which is comprised of three tools to help state officials with the language they use to discuss and write about race and health equity. The Guide includes definitions and explanations of words and phrases, how to think about their usage, and examples of how they might be applied.
Rates of COVID-19 vaccination vary widely, with Black, Indigenous and people of color (BIPOC) receiving smaller shares of COVID-19 vaccinations compared with their shares of the total population, despite experiencing disproportionately higher rates of COVID-19 cases, hospitalizations, and deaths. These disparities in vaccination rates among BIPOC as compared to white Americans highlight the longstanding inequities and structural racism that underpin the United States health care delivery system and that contributed to disparities in health outcomes before and during the COVID-19 pandemic. This expert perspective shares highlights from a new issue brief, Strategies for States to Drive Equitable Vaccine Distribution and Administration, which outlines the key barriers states face in their efforts to increase vaccination rates among BIPOC and highlights strategies states are pursuing in partnership with community-based organizations (CBOs) to address these challenges.
On Thursday, August 12, State Health and Value Strategies hosted a webinar during which experts from Manatt Health and Health Equity Solutions provided an overview of the strategies states can pursue in partnership with community-based organizations to reduce disparities in COVID-19 vaccine uptake, and in the longer term, to build a more equitable and sustainable public health system. While more than 20 states and the District of Columbia reached the Biden administration’s goal of administering one or more COVID-19 vaccine doses to at least 70 percent of adults by early July, wide variation in vaccination rates persists across communities within these states and among the 30 states still working to reach this goal. This variation in vaccination rates at the community level translates to disparities across racial and ethnic groups, as most states continue to have disparities in vaccination rates between Black, Indigenous and people of color (BIPOC) and white populations. States and their community partners are implementing a broad range of distribution and outreach strategies to improve vaccine equity and are looking to build sustainable infrastructure and capacity to advance health equity within state and local public health and health care delivery systems.
Since March 2020, many states have rapidly leveraged federal and state flexibilities under the public health emergency to expand telehealth capabilities and reimbursement through both public and private payers. Now, some states are extending telehealth for the long term or expanding their existing telehealth programs. Increased uptake of telehealth could reduce administrative costs, transportation costs, and wait times. It also could exacerbate existing disparities if barriers to care for populations experiencing these disparities are not addressed. To realize telehealth’s potential for increasing equity in access, states must analyze the impact of these services. This expert perspective highlights considerations for states to maximize the potential of telehealth care to improve equity.
The rollout of vaccines designed to end the coronavirus (COVID-19) crisis has begun in earnest across the United States. Currently, each state is responsible for determining how to allocate, distribute, track, and report its vaccine allotment from the federal government, although the federal government is expected to take on a larger role under a new Biden administration. Since the beginning of the pandemic, Black, Indigenous, and other people of color have been disproportionately impacted by both higher risks of infection and poorer health outcomes, and many are concerned that an inequitable or inefficient distribution of the COVID-19 vaccine may further widen health inequities among these populations. One way to help ensure the equitable administration of COVID-19 vaccine is to track vaccine administration disaggregated for key subpopulations, such as gender, race and ethnicity, and geography (e.g., urban vs. rural). This expert perspective reviews the data states are currently publicly reporting related to vaccine administration and provides an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography. The expert perspective also discusses what current data sources states are using to provide this information and provides an overview of options states can consider to collect information about the administration of COVID-19 vaccine in populations via survey data.
The recently enacted American Rescue Plan Act of 2021 (ARP), provides an exciting opportunity for states and localities to invest in a more equitable, comprehensive, and integrated crisis system that connects individuals in behavioral health crisis with specialized and appropriate behavioral health treatment. The new mobile crisis provision can help states address rising behavioral health needs worsened by COVID-19. States that take up the new option to provide community mobile crisis intervention services for a five-year period beginning in April 2022 will receive an 85 percent enhanced federal matching rate for qualifying services for the first three years of state coverage. To further encourage states, ARP includes $15 million in planning grants to support state efforts to develop a state plan amendment (SPA) or waiver request. State Health and Value Strategies hosted a webinar during which experts from Manatt Health provided an overview and considerations on the state option to provide community mobile crisis interventions services included in ARP. Presenters walked through key questions on the new option, reviewed promising models for crisis mobile intervention services, and shared strategies for equitable design and implementation. The webinar included a question and answer session during which webinar participants posed their questions to the experts on the line. In case you missed it, the corresponding expert perspective, American Rescue Plan Provides a New Opportunity for States to Invest in Equitable, Comprehensive and Integrated Crisis Services, is posted on our website.
With the passage of the American Rescue Plan (ARP), more people than ever before are eligible for financial help to pay for a health insurance plan. Estimates are that on average, 4 out of 5 customers can now find a health plan for less than $10 a month—a remarkable step to provide more affordable coverage, for more Americans. To promote these significant savings, Marketplaces are launching integrated and innovative outreach campaigns—including tapping into existing public health and COVID-19 vaccination efforts—to reach residents with this important information and get them enrolled. As vaccine distribution is increasingly going local, state marketplaces are tapping into trusted partners like local community centers, faith groups, and small businesses as well as coordinating with state and federal agencies to combine education and outreach to drive enrollment. As Marketplaces look for ways to ensure equitable outreach and enrollment, especially as our nation recovers from COVID-19, this expert perspective highlights a range of communications and outreach strategies to align with vaccine education and distribution.
This issue brief documents how states are collecting information about race, ethnicity, and language on their Medicaid applications. The information presented here draws from the State Health Access Data Assistance Center’s (SHADAC’s) review of 50 states’ paper Medicaid applications and 33 states’ online Medicaid applications. For this resource, the authors provide an overview of REL data collection standards and examine state Medicaid application’s question structure, answer options, and instructional language. They also provide an overview of the frequency of different iterations of questions and responses and provide state examples to illustrate common and unique data collection practices.
The American Rescue Plan (ARP) Act enacted on March 11, 2021 establishes a state option to provide community mobile crisis intervention services for a five-year period beginning in April 2022. As an incentive to state adoption, the law provides for an 85 percent enhanced federal matching rate for qualifying services for the first three years of state coverage. To further encourage states, ARP also includes $15 million in state planning grants to support their efforts to develop a state plan amendment or waiver request to take up the option. The new mobile crisis provision arrives just as many states and localities are exploring strategies to address the worsening behavioral health as well as preparing for implementation of 998, the new, national hotline for behavioral health crises. For states and localities reviewing their policing procedures, the new option also could be used to support state efforts to refine the role of law enforcement in responding to behavioral health crisis, offering more resources to the police on such calls or, in some instances, even entirely avoiding the need for law enforcement. This expert perspective provides an overview and state considerations on the state option to provide community mobile crisis interventions services included in the American Rescue Plan.
The rollout of vaccines designed to end the coronavirus (COVID-19) crisis has begun in earnest across the United States. Currently, each state is responsible for determining how to allocate, distribute, track, and report its vaccine allotment from the federal government, although the federal government is expected to take on a larger role under a new Biden administration. Since the beginning of the pandemic, Black, Indigenous, and other people of color have been disproportionately impacted by both higher risks of infection and poorer health outcomes, and many are concerned that an inequitable or inefficient distribution of the COVID-19 vaccine may further widen health inequities among these populations. One way to help ensure the equitable administration of COVID-19 vaccine is to track vaccine administration disaggregated for key subpopulations, such as gender, race and ethnicity, and geography (e.g., urban vs. rural). This expert perspective reviews the data states are currently publicly reporting related to vaccine administration and provides an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography. The expert perspective also discusses what current data sources states are using to provide this information and provides an overview of options states can consider to collect information about the administration of COVID-19 vaccine in populations via survey data.
State Health and Value Strategies recently released the third update to the Medicaid Managed Care Contract Language: Health Disparities and Health Equity, which includes excerpts from managed care contracts, procurement questions, and other policy documents from twelve states and the District of Columbia. This expert perspective share highlights from the recent updated version of the compendium.
State Health and Value Strategies recently released the third update to the Medicaid Managed Care Contract Language: Health Disparities and Health Equity, which includes excerpts from managed care contracts, procurement questions, and other policy documents from twelve states and the District of Columbia. This expert perspective share highlights from the recent updated version of the compendium.
This document provides excerpts of health disparities and health equity contract language from Medicaid managed care (MMC) contracts and requests for proposals from 12 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California. The criteria for inclusion in this compendium were contracts that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available. This is the third revision of this publication since its original release in June 2020. It has been updated to incorporate language from requests for proposals in Hawaii, Oklahoma, and North Carolina (for the state’s managed behavioral health care program) and excerpts from Ohio’s request for applications for managed care and managed behavioral health care. In addition, this version includes language from New York’s Value-Based Payment Roadmap.
On Wednesday, February 24, State Health and Value Strategies hosted a webinar on analyzing health disparities in Medicaid managed care. Health disparities are a key indicator of health equity and understanding health care disparities is a critical component of informing systems changes to improve health care outcomes. Stratifying performance data by race, ethnicity, disability, gender identity, or sexual orientation can inform targeted interventions to reduce health care disparities; yet many states lack complete and reliable data to do so. During the webinar, experts from Bailit Health discussed how states can use performance rates and disparities analyses from Medicaid managed care programs in other states to determine where disparities are likely to exist in their own state and develop interventions. Attendees also heard from Dr. Lisa Albers at the California Department of Health Care Services about California’s experience analyzing Medi-CAL HEDIS data to identify health care disparities and establish performance improvement expectations for Medi-CAL plans.
The rollout of vaccines designed to end the coronavirus (COVID-19) crisis has begun in earnest across the United States. Currently, each state is responsible for determining how to allocate, distribute, track, and report its vaccine allotment from the federal government, although the federal government is expected to take on a larger role under a new Biden administration. Since the beginning of the pandemic, Black, Indigenous, and other people of color have been disproportionately impacted by both higher risks of infection and poorer health outcomes, and many are concerned that an inequitable or inefficient distribution of the COVID-19 vaccine may further widen health inequities among these populations. One way to help ensure the equitable administration of COVID-19 vaccine is to track vaccine administration disaggregated for key subpopulations, such as gender, race and ethnicity, and geography (e.g., urban vs. rural). This expert perspective reviews the data states are currently publically reporting related to vaccine administration and provides an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography. The expert perspective also discusses what current data sources states are using to provide this information and provides an overview of options states can consider to collect information about the administration of COVID-19 vaccine in populations via survey data.
As the country struggles to respond to and recover from the devastating fallout of the COVID-19 pandemic, the case for Medicaid expansion has never been stronger. The public health crisis has focused a spotlight on both the benefits of stable health coverage and the gaps in the nation’s system of coverage and care. This expert perspective reviews what Medicaid expansion would mean in the 12 states that have not yet expanded.
As health inequities continue to be exacerbated by the COVID-19 pandemic, there is concerted energy to address this topic across states. Oregon has had a longstanding focus on health equity and employed two foundational strategies that can serve as examples for other states seeking to further their health equity efforts. Oregon first developed a common language and defined what “health equity” meant in the state. The state also engaged community partners to ensure that the community voice was apparent in policy decisions on the state level. When combined, these strategies have helped Oregon develop a foundation to build and implement subsequent health equity efforts in the state.
The COVID-19 pandemic has highlighted longstanding health inequities which have resulted in an increased risk of sickness and death for people of color. The crisis has also propelled a nationwide focus on understanding and addressing health inequities. While COVID-19 and the reckoning on racial justice have mobilized some state officials working in Medicaid, public health, insurance departments, and Marketplaces, alike, states are at different places on their journeys to confront systemic racism and inequities in health care, and each faces unique and challenging barriers. This issue brief explores impediments and accelerants to advancing health equity as states are increasingly being called upon to drive change.
This document provides excerpts of health disparities and health equity contract language from Medicaid Managed Care (MMC) contracts from five states—Michigan, Minnesota, North Carolina, Ohio, Oregon—and Washington, D.C. as well as the contract for California’s Health Exchange, Covered California. The criteria for inclusion in this compendium were contracts that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available. Excerpts from the MMC contract language are organized into specific categories and measures identified by the state as equity or disparities measures. This document will be updated as we identify other contracts to include.
A new open enrollment landscape created by the continued health and economic impacts of the COVID-19 pandemic, a national movement calling for racial justice, and the concurrent timing of a presidential election year is raising new challenges for states as they plan outreach and enrollment campaigns. Marketplaces are reimagining their campaign strategies to meet this moment, with plans to operationalize virtual activities, communicate with new and existing audiences, and reflect changing consumer behaviors in their outreach tactics. This expert perspective highlights strategies from SHVS’ 2-part webinar series on preparing for OEP 2021 and features several strategies states can pursue to help ensure a successful open enrollment period this year.
In light of recent postal delays and housing displacements caused by the COVID-19 pandemic and related economic crisis, and a wave of natural disasters across the country, state Medicaid and Children’s Health Insurance Program (CHIP) agencies face new challenges communicating with their enrollees about their health coverage. Acting now to mitigate these challenges is essential as states are preparing for the end of the public health emergency (PHE) and “catching up” on coverage renewals for a large portion of their enrollees. This expert perspective reviews strategies that state Medicaid and CHIP agencies may consider to help mitigate coverage losses.
As states seek to address the social determinants of health and advance health equity, they face longstanding and persistent challenges in collecting complete, accurate, and consistent race, ethnicity and language (REL) data. This expert perspective provides an overview of current REL data collection standards; ideas for increasing completeness in data by engaging the enrollee and enrollment assisters, and modifying enrollment and renewal interface; and provides suggestions for how states could leverage alternative sources of data in order to improve REL data completeness.
This expert perspective provides a survey of actions that state and local governments have taken to intentionally incorporate equity into their recovery and reopening policies.
On Wednesday, July 22, State Health and Value Strategies hosted part II of the Preparing for OEP 2021 webinar series that provided a deep dive into effective strategies to consider as states design their outreach and education campaigns for OEP 2021 in a shifting health care environment. Presenters from GMMB explored how the impacts of COVID-19 should inform the marketplace’s tactical campaign approaches for virtual outreach and partnership engagement, digital and social platform usage, and paid advertising and earned media. Participants also heard insights from several state officials from state-based marketplaces along the way. Topics for discussion included coordinating with state agencies, engaging micro-influencers, leveraging social media live streams, hosting virtual enrollment events, developing advertising buys, and considering new earned media hooks. This webinar included a question and answer session during which webinar participants can pose their questions to the experts on the line.
This expert perspective highlights examples employed by DC Health Link, the Oregon Health Authority, and beWellnm and the community-centered outreach they are using to actively enroll and connect consumers to care. The expert perspective also includes best practices surfaced for marketplaces and agencies to adapt their COVID-19 communications and outreach—and beyond—to ensure those with inequitable access to health coverage are prioritized and supported.
This expert perspective provides an update on states’ reporting of health equity data and a summary of CARES Act reporting requirements.
Many people in America face segregation, social exclusion, encounters with prejudice, and unequal access and treatment by the health care system, all of which can impact health. Medicaid programs serve a disproportionate share of populations that are negatively impacted by health disparities. This new State Health and Value Strategies (SHVS) issue brief provides examples from a handful of states that have begun the work of identifying, evaluating, and reducing health disparities within their Medicaid managed care programs. Additionally, it offers an approach for other states interested in measuring disparities in health care quality in Medicaid managed care as a step towards achieving health equity, such that all Medicaid managed care enrollees have a fair and just opportunity to be as healthy as possible.
On Friday, June 12 at 12:00 p.m. ET, State Health & Value Strategies hosted a webinar during which experts from Manatt Health and Georgetown reviewed the current telehealth policy landscape and considerations for states as they design their post-apex telehealth policies. This webinar included a question and answer session during which webinar participants posed their questions to the experts on the line.
This expert perspective looks in more depth at which states are regularly reporting data that helps shed light on the health equity issues of this crisis. Specifically, the post includes interactive maps that explore the extent to which all 50 states and the District of Columbia are reporting (as of May 28) data breakdowns by age, gender, race, ethnicity, and health care workers for both cases of and deaths from COVID-19.
On Thursday, May 7, State Health and Value Strategies hosted a webinar that reported on how states are tracking the disproportionate impact of COVID-19 on vulnerable populations and provided a framework for states to examine their COVID-19 response efforts to yield better outcomes for such populations. As the COVID-19 crisis evolves, it has become increasingly clear that vulnerable populations are disproportionately impacted. Unsurprisingly, these disparately affected groups are the same ones that have long experienced stark health disparities, such as communities of color, low income populations, and those that reside in congregate living facilities (nursing homes, jails, shelters, etc.). During the webinar, technical experts from Health Equity Solutions and SHADAC shared findings from recent SHVS publications.
Early evidence suggests there are health disparities based on race, gender, and geography in both the contraction of COVID-19 and deaths related to the virus. People of color and those who live in urban centers are faring worse from this pandemic. These higher rates of illness and death are rooted in longstanding, structural inequities in our country. While these inequities cannot be fixed overnight, states can begin to foster a more equitable and just COVID-19 response, relief, and recovery effort by employing a few key guidelines. This expert perspective poses a series of questions states can use to inform immediate actions to strengthen their initial responses and lay the foundation for broader reforms to advance health equity.
This expert perspective reviews the key indicators currently being tracked by states via their COVID-19 dashboards and also provides an overview of “best practices” states can consider when developing or modifying these same COVID-19 dashboards.
On August 14, 2019, the Department of Homeland Security (DHS) published a final rule, Inadmissibility on Public Charge Grounds. The rule makes significant changes to the standards DHS will use to determine whether an immigrant is likely to become a “public charge”—a person dependent on the government for support—which will have consequences for certain immigrants’ legal status. This document provides answers to frequently asked questions about whom the rule will impact, what benefits are implicated by the rule, and how the rule might be administered.
In this Expert Perspective, our colleagues at Manatt Health review the Supreme Court’s decisions granting the Administration’s requests to stay preliminary injunctions that had blocked the Department of Homeland Security public charge final rule from taking effect in October 2019.
State Medicaid programs are increasingly seeking to understand and address social factors that contribute to poor health—such as food insecurity, unstable housing, and a lack of access to social supports—in order to lower costs, improve outcomes for their members, and advance health equity. To inform this work of addressing the social determinants of health (SDOH) and advancing health equity, states and Medicaid officials need data in order to identify priority areas of unmet social and economic needs, execute SDOH initiatives, and monitor and evaluate the impacts of these programs. Increasingly, states are leveraging a broad array of data sources to support efforts to address health equity. While those sources closest to the Medicaid program are the most widely used, each has advantages and disadvantages. This brief focuses on how Medicaid programs can use data from one federal survey, the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity. This brief also highlights relevant examples from states that use SDOH and health equity measures from the ACS, including which measures and what they are used for.
The first webinar in the SHVS Health Equity Through Managed Care Series series reviewed the foundational principles of health equity, barriers to its realization and the impact of health disparities.
The fifth webinar in the SHVS Health Equity Through Managed Care Webinar Series profiled the work of one MCO, HealthPartners, in addressing equity issues within its Medicaid line of business. We heard from Brian Lloyd, who manages Health Partners’ organization-wide equity initiative, which includes collecting data to eliminate disparities in care, supporting language access, partnering with communities, and building an organizational understanding of equity, diversity, inclusion, and bias.
The fourth webinar in the SHVS Health Equity Through Managed Care Webinar Series reviewed approaches employed by states to incorporate contract requirements and performance incentives in Medicaid managed care contracts to reduce health disparities among covered populations.
The third webinar in the SHVS Health Equity Through Managed Care Webinar Series identified evidence-based interventions that states can use to address disparities in their Medicaid managed care programs.
The second webinar in the SHVS Health Equity Through Managed Care Webinar Series explored how states can use data collection and measurement to support their efforts to advance health equity in Medicaid managed care.
On October 4, the President issued a proclamation that requires immigrants to show that they have health insurance or can pay medical expenses out of pocket in order to receive a visa. The proclamation will impact individuals applying for a visa with the Department of State (DOS) through consular offices abroad. In this expert perspective, Manatt Health reviews this latest policy regarding uninsured noncitizens and provides their take on implications for states.
On August 12, 2019 the Department of Homeland Security (DHS) issued a final version of its public charge rule which was to go into effect on October 15. The public charge rule will change how DHS determines whether immigrants—when seeking admission to the U.S., an extension of their stay, or status change to become a legal permanent resident—are “likely at any time to become a public charge” (i.e., dependent on the government for financial support). The webinar reviewed the final rule, highlighted changes from the proposed rule, and explored the rule’s potential impacts on consumers, states and providers.
Medicaid programs are increasingly considering how best to address social factors, such as housing, healthy food, and economic security, that can affect health and medical expenditures. Often referred to as social determinants of health (SDOH), these factors are significant drivers of population health outcomes. While states historically have had some experience tackling such issues for specialized, high-need populations, they are now confronting whether, and how, Medicaid should address SDOH for a broader population of Medicaid enrollees in order to achieve better health outcomes. This issue brief explores the “next generation” practices that states are deploying to address social factors using Medicaid 1115 waivers and managed care contracts, as well as the specific steps states can take to implement these practices.