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 research article demonstrates that a commitment to equity at the organizational level contributed to greater cross-sector collaboration, perceived effective leadership, and evidence-based decision-making.
This document provides a guide for implementing a health in all policies framework based on the experiences of the California Health in All Policies Task Force and other states as well as interviews, academic and gray literature.
The article reviews efforts to measure and evaluate the impact of antiracist initiatives in Ohio.
This article, directed toward city planners, discusses the use of a racial equity lens and contains examples relevant for state agencies.
This list of resources includes the original “Everyday Discrimination Scale.”
This academic article summarizes sociological insights on racial health disparities and implications for addressing inequities.
A guide detailing each culturally and linguistically appropriate services (CLAS) standard and strategies for implementation.
This report provides recommended actions for specific communities that have been disenfranchised and face disproportionate barriers to community engagement. These actions are applicable to contexts beyond the pandemic.
This guide provides digital and nondigital strategies and methods for inclusive community engagement.
This tool for community engagement includes recommendations for advancing toward meaningful engagement.
This equity tool specific to the pandemic emergency response includes resources on community engagement that are generalizable to other public health contexts.
This article discusses findings from the development and piloting of indicators to measure the impact of health impact assessment practice on advancing equity.
This bundle of interactive data tools provides state-specific fiscal, budget, tax, economic and welfare data.
This toolkit provides various resources to embed equity within cross-sector data sharing.
This tool covers foundational practices, lessons learned and critical capabilities for organizations to consider for improving health equity.
This report focuses on literature supporting community-based solutions, policy infrastructure, multisectoral collaboration and engagement and lists multiple resources and tools to examine and promote equity.
An issue brief from the Urban Institute looks at examples, promising practices, remaining challenges and next steps to use race and ethnicity data to advance health equity. The brief draws on publicly available resources and interviews with leaders and analysts in the healthcare sector familiar with or engaged in efforts to collect and use individual or healthcare provider race and ethnicity data to reduce health inequities.
As states look to advance health equity, they need ways to measure whether their efforts result in improvements. Benchmarking can be used to identify health disparities and establish a standard for evaluating efforts to address health inequities. This issue brief summarizes the advantages and disadvantages of four common approaches to health equity benchmarking and describes the importance of acknowledging the role of societal inequity and structural racism in driving disparities.
This state spotlight highlights the investments and efforts that the Commonwealth of Massachusetts is making to promote health equity in and through the state’s Medicaid and Children’s Health Insurance Program (CHIP), otherwise known as MassHealth. With the highest coverage rate in the nation, the Commonwealth of Massachusetts has made great strides in ensuring access to healthcare for low-income residents and is now paving the way to reduce racial and ethnic disparities experienced by Medicaid and CHIP enrollees. As described in the state spotlight, MassHealth’s multi-pronged health equity strategy focuses on five cross-cutting areas: community engagement; social drivers of health; continuous enrollment; perinatal health; and provider and health plan incentives.
The Department of Medical Assistance Services recently released its 2022 Baby Steps Annual Report that highlights its accomplishments towards improving maternal health outcomes for pregnant and postpartum enrollees.
Pennie, the state’s official health insurance Marketplace, released the state’s inaugural Health Equity Data Report. The report details the impact of policies and procedures created to help reduce inequities experienced by historically marginalized communities, establishes a baseline upon which to measure future efforts to reduce inequities in enrollment, and provides a view into the uninsured rates among different communities to help identify where additional efforts are needed.
On Tuesday, August 1, State Health and Value Strategies hosted a webinar facilitated by experts from Bailit Health, showcasing how the Buying Value suite of resources can help states, employers, consumer organizations and providers implement quality measures to incentivize high-quality, high-value, equitable healthcare. The webinar highlighted two free, Excel-based tools. The Buying Value Measure Selection Tool assists stakeholders in creating and maintaining aligned quality measure sets. The Buying Value Benchmark Repository is a database of over 60 homegrown and innovative non-HEDIS measures in use by purchasers and also includes performance data when available.
On Thursday, July 27, State Health and Value Strategies (SHVS) hosted a webinar highlighting the recently published issue brief, “Medicaid Managed Care Strategies to Reduce Racial and Ethnic Health Disparities in Mental Healthcare for Adults,” which describes approaches that states can take to reduce racial and ethnic inequities in mental healthcare and improve mental health outcomes. The webinar was facilitated by experts from Bailit Health and included a discussion with experts from Health Equity Solutions and a state official on their activities to promote equity in mental healthcare.
Medicaid programs are uniquely positioned to promote greater equity in mental healthcare, as the program plays an outsized role in the financing and delivery of mental healthcare. This issue brief identifies ways in which states can leverage their Medicaid managed care (MMC) programs to advance their health equity goals.
Across the U.S. healthcare system, groups of people representing varying perspectives are coming together to advance health equity by improving unjust health outcomes and addressing the structures that perpetuate them. This complex work requires collaboration in teams that include multiple types of stakeholders in public health, healthcare, social services, and community-based organizations. A report from Advancing Health Equity: Leading Care, Payment and Systems Transformation provides recommendations for multi-stakeholder teams to advance health equity. The authors, from the Center for Health Care Strategies and the University of Chicago, draw from the work of the Emergent Strategy Ideation Institute on relationship building and creativity as modes of coming together to make change.
The Louisiana Department of Health’s Health Equity Roadmap Phase 2 is a continuation of the Department’s first Health Equity Roadmap and describes the next chapter in the state’s journey to incorporate health equity throughout its programs, policies and procedures.
The Louisiana Department of Health has created a State Health Assessment dashboard to assess the current status of health across the state to create plans that improve wellbeing.
The New Jersey Department of Health released its annual Hospital Maternity Care Report Card which shows cesarean delivery rates have continued to drop for all delivery hospitalizations. These delivery rates have steadily improved since the release of the first report card. Disparities continue to persist among Black and Latina/o parents in New Jersey.
A report from Families USA discusses how states can adopt and expand three powerful maternal health interventions to reverse recent trends: establishing or expanding coverage toward a universal doula benefit, covering all midwives, and scaling up group prenatal care. These policies are particularly impactful because they combat significant drivers of poor maternal health outcomes, namely a lack of centering patient interests and respect, growing maternity care deserts, complications from c-sections, and postpartum depression and other mental health conditions.
The New York State Department of Health released a report showing from 2016 to 2019 the number of infant deaths in the state declined by 12%. This decline exceeded the overall national decline of 5% during the same period. The data also indicate that racial and ethnic disparities in infant mortality persist. In 2019, the infant mortality rate for Non-Hispanic Black infants was 2.8 times higher than that of Non-Hispanic White infants and Hispanic infants.
The Wisconsin Department of Health Services (DHS) released two new reports on birth outcomes that continue to shed light on how to reduce and address significant disparities in infant deaths across Wisconsin. The Wisconsin Perinatal Periods of Risk reports analyze the factors that contribute to inequalities in fetal and infant mortality. Data from the DHS Maternal and Infant Mortality Prevention Unit show Wisconsin’s overall infant mortality rate, which represents the number of infant deaths per 1,000 live births, was 5.7 for 2019-2021. However, the data continue to show troubling disparities, with Black infants three times more likely to die before their first birthdays than White infants. During those same years, the infant mortality rate for American Indian or Alaska Native infants was 1.5 times the rate for White infants.
A new issue brief from The Commonwealth Fund discusses how the expansion of midwifery care could help decrease perinatal health disparities in the United States. Midwives are licensed healthcare providers who offer a wide range of essential reproductive and sexual healthcare services, from birth and newborn care to Pap tests and contraceptive care. Research consistently demonstrates that when midwives play a central role in the provision of maternal care, patients are more satisfied, clinical outcomes for parents and infants improve, and costs decrease. Use of midwives is also associated with fewer cesarean sections, lower preterm birth rates, lower episiotomy rates, higher breastfeeding rates, and a greater sense of respect and autonomy for the patient. The brief outlines policy recommendations to incorporate midwives in all U.S. maternity care systems to ease the healthcare workforce shortage.
Highlighting the importance of public transit accessibility in promoting equitable access to care, an analysis from the Urban Institute provides new evidence on transportation barriers to healthcare. Using nationally representative survey data, the analysis finds that transportation barriers to healthcare disproportionately affect Black and Latino/a adults and those with low incomes, disabilities, public health insurance coverage, residence in rural areas, and lack of household access to a vehicle. More than one in five adults without access to a vehicle who reported living in neighborhoods with fair or poor access to public transit forgo healthcare because of difficulty finding transportation.
Black birthing individuals in areas that have more access to maternal healthcare are at “disproportionately” higher risk of dying during or after childbirth than White women who live in underserved areas, according to a new study in The Lancet. The study, conducted by Surgo Health, uses a system called the U.S. Maternal Vulnerability Index, which assigns a score of 0–100 to each state and county in the country.
A brief from the Urban Institute assesses the extent of limited English proficiency (LEP) among Asian American and Native Hawaiian/Pacific Islander (AANHPI) nonelderly adults and variation in LEP across AANHPI subgroups, using the most recently available data from the American Community Survey. A lack of language accessibility for AANHPI people who are not proficient in English, in particular, could restrict their access to health insurance and healthcare, especially for those who may have to navigate complicated systems to enroll in coverage.
Superintendent of Financial Services Adrienne A. Harris issued a mandatory request for information (RFI) to health insurers to understand the scope and impact of their programs aimed at reducing health disparities. Pursuant to Section 308 of New York Insurance Law, DFS is requesting information and documentation on race/ethnicity and language data collection efforts, health equity programs, and related workforce initiatives.
A new brief from the Center for Health Care Strategies describes common barriers for addressing oral health equity for Medicaid populations and outlines recommendations to improve oral health access and quality within four key areas: (1) coverage and access; (2) workforce capacity building; (3) partnerships; and (4) payment. The brief highlights opportunities for Medicaid to partner with community-based organizations and Medicaid enrollees to reduce oral health disparities and advance oral health equity.
The Minnesota Department of Health released its first-ever Minnesota Maternal Mortality Report, which examined maternal deaths during or within one year of pregnancy from 2017 to 2018. While the report shows the state’s overall maternal mortality rate is lower than the national average, it also shows stark disparities in mortality—especially among Black and American Indian Minnesotans. Black Minnesotans represent 13% of the birthing population but made up 23% of pregnancy-associated deaths, and American Indian Minnesotans represent 2% of the birthing population, but 8% of pregnancy-associated deaths.
In a recent report funded by the Robert Wood Johnson Foundation, the Social Interventions Research and Evaluation Network at the University of California (SIREN) synthesizes existing research on social screening in US healthcare settings with the goal of informing the intensifying national dialogue about this topic. In the report, SIREN summarizes findings in five digestible sections: prevalence of screening; an update on the psychometric and pragmatic validity of existing screening tools; patients’ perspectives on screening; providers’ perspectives on screening; and screening implementation.
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 plays an important role in providing health insurance coverage to lesbian, gay, bisexual, and transgender (LGBT) adults. A new issue brief from the Medicaid and CHIP Payment and Access Commission uses data from the National Health Interview Survey (2015-2018), the National Survey on Drug Use and Health (2015-2019), and the U.S. Transgender Survey (2015) to examine two aspects of access among LGBT populations. The first set of analyses focus on the experiences of Medicaid-covered lesbian, gay, and bisexual (LGB) populations with accessing physical and behavioral health services compared to Medicaid-covered heterosexual adults. The second set of analyses compare the experiences of Medicaid-covered transgender and gender-diverse (TGD) populations to those covered by private insurance and those without insurance coverage.
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.
Large percentages of race and ethnicity data are missing from federal and state health programs. To identify the barriers and opportunities, Grantmakers In Health, in collaboration with the National Committee for Quality Assurance, interviewed a variety of stakeholders across the country, representing all levels of the health system. The second of two reports, Improving Data on Race and Ethnicity: A Roadmap to Measure and Advance Health Equity, builds on an earlier report, Federal Action Is Needed to Improve Race and Ethnicity Data in Health Programs, by providing more details about race and ethnicity data collection in federally administered health programs and an expanded list of recommendations for improving the data.
This issue brief aims to establish a conceptually nuanced, empirically informed, and practically useful framework for analyzing the racial equity implications of health policies.
Alternative payment models (APMs) present a significant opportunity to incentivize changes in delivery to help make care more accessible, drive better patient outcomes, and reduce inequities in both care and outcomes. The Health Care Payment Learning & Action Network (HCP LAN) convened the Health Equity Advisory Team to advise the HCP LAN on using APMs to advance equity, resulting in a new guidance document. The document provides stakeholders with actionable guidance on how they can leverage APMs to advance health equity in ways that are both aligned and tailored to meet their communities’ needs.
The Society for Women’s Health Research designed this roadmap to guide community program planners as they engage women and their families in meaningful conversations and initiatives to improve individual and public health through vaccinations.
To identify the barriers and opportunities, Grantmakers In Health, in collaboration with the National Committee for Quality Assurance, interviewed a variety of stakeholders across the country, representing all levels of the health system. The first of two reports, Federal Action Is Needed to Improve Race and Ethnicity Data in Health Programs, identifies tangible actions to help improve the completeness, accuracy, and usability of race and ethnicity data.
A new post on the CHIRblog, published by Georgetown’s Center on Health Insurance Reforms, examines how State-Based Marketplaces (SBMs) are planning to spend the $20 million in grant funding announced by the Centers for Medicare & Medicaid Services last month. The federal funding, allocated under the ARP, will allow SBMs to modernize their technology platforms, outreach programs, and other systems and operations to ensure compliance with federal requirements, including the ARP’s temporary subsidy expansion. The blog post highlights how, after achieving substantial enrollment through their initiatives to connect consumers to marketplace plans, the new grant funding will allow SBMs to build on their progress. As states prepare for the end of the PHE and address the ongoing hardships brought by the pandemic, investing in more equitable outreach and consumer assistance, and improved eligibility and enrollment systems will ensure that SBMs can continue to provide access to affordable, quality coverage.
Systemic racism within health care and other social institutions has led to large racial and ethnic disparities in access to health care, poor health outcomes, and high mortality rates for women and children of color. Evidence-based home visiting programs can help reduce racial and ethnic health disparities by providing mothers with screenings, case management, family support, and referrals that address a family’s physical, mental, and health-related social needs. The Center for Health Care Strategies published a new issue brief, made possible by the Robert Wood Johnson Foundation, that explores strategies used by state Medicaid and health agencies in New York, Minnesota, and Vermont to improve equitable health and well-being outcomes through their home visiting programs. Using culturally responsive, community-driven, and anti-racist approaches to support under-resourced communities can help home visiting programs increase opportunities to identify and address racial inequities and disparities, as well as improve maternal and early childhood outcomes.
Public health data should reflect the needs of everyone in America—regardless of their race, where they live, or how much money they have. The National Commission to Transform Public Health Data Systems share recommendations.
Even as the Delta variant rages through the U.S., many Americans have not received a COVID-19 vaccine. The reasons are complex, but for Black and Latino(a) communities, a long history of poor access to health care has been a tall barrier. On the first episode of the new season of the Commonwealth Fund’s The Dose podcast, host Shanoor Seervai talks to Rhea Boyd, a pediatrician and public health advocate, about what it takes to dismantle the historic racism that has long prevented people of color from getting the health care they need. Black and Latino(a) health care professionals like Dr. Boyd are answering questions about the COVID-19 vaccine online and in person. If we make it a national priority, she says, we can ensure Black and Latino(a) people get credible information about the vaccines and easy access to them.
With support from the Robert Wood Johnson Foundation, the Center for Health Care Strategies published a new brief that outlines six considerations for health systems and provider practices looking to integrate a focus on racial equity to enhance trauma-informed care approaches and promote racial justice. It draws from the experiences of two organizations participating in the Advancing Integrated Models initiative, also funded by the Robert Wood Johnson Foundation. In recent years, trauma-informed care has become a valuable tool to assist health care providers in delivering more person-centered care. Trauma-informed care seeks to both acknowledge the role trauma plays in people’s lives and the impact it has on their health and well-being, and to engage in practices that prevent re-traumatizing individuals. As the health care sector, like many industries, faces its own racial reckoning, trauma-informed approaches to care should not overlook the critical impact of racism and racialized trauma on patient health and staff well-being. The work of trauma-informed care requires a nuanced understanding of not only how trauma impacts the lives and care of patients, but the root causes behind that trauma. Health care organizations that adopt a trauma-informed approach to care should acknowledge and be held accountable for the historical and present-day trauma experienced by patients and staff from communities of color.
Pediatric health care providers and their multidisciplinary care teams are uniquely poised to affect life-long health and well-being by supporting opportunities to prevent development delays, address health-related social needs, and reduce the risk of chronic disease, trauma, and mental health difficulties. Drawing from conversations with child health care leaders nationally and a literature review, the Center for Health Care Strategies, with support from the Robert Wood Johnson Foundation, identified three key strategies, profiled in a new report, that are integral to support a more upstream, preventive, holistic pediatric delivery system model that treats all patients with dignity and respect. These strategies create the underpinnings for improving children’s health care beyond medical care, centering child and family well-being, and incorporating an upstream approach to prevention.
A new issue brief published by the Social Intervention Research & Evaluation Network (SIREN) at the University of San Francisco California examines the research on health care providers’ knowledge, attitudes and beliefs, and behaviors (KABB) about socioeconomic risk screening and referral programs. Despite growing investment from the health care sector in social care initiatives, little information has been compiled about health care providers’ perceptions of both the need for and capacity to implement screening and referral programs. In an era of increasing documentation demands, time pressures, and provider burnout, understanding the provider impacts of these activities is foundational to program implementation and sustainability.
The child health care field is embracing a shift from the traditional child-focused model of well and sick visits to a more upstream preventive, holistic, and anti-racist focus on children, their families, and the systems and communities they interact with regularly. Despite a growing desire to improve care delivery, many practices face barriers, such as time and funding resources, which prevent the scale and spread of practice transformation. The Center for Health Care Strategies, with support from the Robert Wood Johnson Foundation, is hosting a webinar on August 25 that will explore the need to transform child health care from three unique perspectives — a pediatrician, a family advocate, and a children’s health clinic director. The featured speakers serve as advisors for CHCS’ Accelerating Child Health Transformation initiative, which seeks to accelerate the adoption of key strategies necessary to advance anti-racist and family-centered pediatric practice. They will highlight key strategies for child health care transformation: (1) adopting anti-racist practices and policies to advance health equity; (2) co-creating equitable partnerships with patients, families, and medical care teams; and (3) identifying family strengths and health-related social needs to promote resilience.
The ACA includes many requirements that advance health equity in the commercial coverage market and has contributed to significant progress in narrowing racial and ethnic health disparities. While health insurers alone cannot close disparities, insurance stakeholders play a key role and have committed to doing more to address systemic racism. A new blog post by the Commonwealth Fund highlights several ACA requirements that have not been fully utilized by insurers—resulting in gaps that exacerbate disparities. Strategies include addressing provider contracting and network and benefit designs, as well as fully complying with nondiscrimination standards. Insurers and regulators can do more to turn commitment into action.
Black and Hispanic adults report experiencing discrimination when seeking health care at higher rates than white adults, which raises the question: How might these reported experiences adversely affect health care? The Urban Institute published a fact sheet on its December 2020 Well-Being and Basic Needs Survey, which asked respondents about the consequences of and actions they took in response to being treated or judged unfairly because of their race or ethnicity at a doctor’s office, clinic, or hospital in the past 12 months. Among the 3.2 percent of nonelderly adults who reported feeling treated or judged unfairly in these settings, more than three-quarters (75.9 percent) reported such treatment or judgment disrupted their receipt of health care. This includes 39.0 percent who delayed care, 34.5 percent who looked for a new health care provider, and 30.7 percent who did not get needed care. These new data highlight the need for greater attention to policies and practices that can improve health care quality and interactions with health care providers and staff for all patients, particularly for Black patients, 1 in 13 of whom reported these experiences on the Well-Being and Basic Needs Survey. This fact sheet is part of a body of work exploring perceptions of discriminatory experiences in health care and other settings. See this related publication for more information.
A new Health Affairs blog post written by CMS Administrator Chiquita Brooks La-Sure and other CMS leaders lays out a path for the next ten years of value-based care within the Center for Medicare and Medicaid Innovation. The team of leaders undertook a review of the last ten years of Innovation Center’s work and concluded the need for a shared vision of the health system that the agency is collectively striving toward; they explicitly acknowledge health equity as a central goal for this vision. This focus aligns with President Biden’s executive order charging each agency within the administration to advance racial equity and justice for underserved communities. The leaders also received feedback on what the vision for the ideal health system could look like and the role that CMS and the Innovation Center should play from various stakeholders. The result of this combined public-private dialogue is a strategy refresh that will drive the country’s delivery system toward meaningful transformation. It includes an unwavering focus on equity, paying for health care based on value instead of the volume of services provided, and delivering person-centered care that meets people where they are.
A new report released by the Funders Forum on Accountable Health and the California Accountable Communities for Health Initiative (CACHI) reveals how the Accountable Communities for Health (ACH) model is emerging as an important vehicle for improving population health and health equity. ACHs recognize that health is the result of interdependent factors at work in a community and that no single entity controls all the levers. This model brings together health care providers, public health departments, schools, social service agencies, and others, along with residents in a collective effort to make a community healthier, more equitable and resilient. The report and a companion executive summary provides an alternative framework for defining and assessing value that moves beyond the traditional “Return on Investment (ROI)” and captures the transformational nature of the ACH. It identifies three key roles that ACHs play in the community and provides in-depth case studies to demonstrate each role. This new framework will be discussed during a webinar on “Lessons Learned from the Accountable Community for Health Model.” The webinar will take place on August 24, and is part of a new webinar series that seeks to identify key lessons for scaling this model as policy makers across the country increasingly endorse multisector collaboratives focusing on equity as a way to better address social determinants of health.
The COVID-19 pandemic’s disproportionate effects on people of color and increased attention to racial justice have given rise to new or expanded efforts to address health inequities. In a new issue brief by the Urban Institute, the authors examined how governments and organizations adopt community engagement approaches to collaborate and share power with communities that experience health inequities. Drawing on interviews with representatives from national organizations and stakeholders in four states, the authors identified principles and strategies that help build trust with and engage community members, including ensuring sufficient and flexible funding and cross-sector support, dedicating time and patience and forging continuity, and fighting structural racism more broadly. The urgency of the pandemic is not only a challenge but an opportunity to elevate and operationalize community voices to better understand drivers of inequities and develop solutions with community buy-in, ultimately leading to inclusive and sustainable progress toward health equity.
A snapshot of the perception of Utah’s community health workers in considering the state’s racial and ethnic minority communities’ attitudes and hesitancy toward the COVID-19 vaccine. Analysis of local data compared with national narratives around vaccine hesitancy may inform strategic approaches to respond to barriers and improve timely vaccine uptake.
To assess Mississippians’ COVID-19 Vaccine confidence, the Mississippi Community Engagement Alliance Against COVID-19 Disparities (CEAL) Team and the Mississippi State Department of Health (MSDH) Office of Preventive Health and Health Equity (OPHHE) disseminated a statewide vaccine confidence survey beginning end of December 2020 and collecting data until March 2021. The survey is intended to be representative of Mississippians, with intentional efforts invested to reach lower income and rural Mississippi populations, as well as the state’s Black, Hispanic (Latino/ Latinx), Asian (including the Vietnamese population of the Gulf Coast), and Native American/Choctaw communities.
We encourage dissemination of these strategies to improve health outcomes for racial and ethnic minorities. Our goal is to share material included in the literature and promote effective interventions. We hope you will review the findings included in this report and consider them when you are developing programs, issuing request for proposals, and determining the types of endeavors to fund. We are committed to sharing research findings and evaluation results as it pertains to improving health and social outcomes for racial and ethnic populations and encourage dissemination of this information widely.
In the Navajo Nation, one third of residents do not have access to running water and/or electricity, and face challenges accessing broadband. These challenges, rooted in the historical impacts of colonization, directly impacted the ability of many Tribal Nations to follow COVID-19 safety protocols and access key virtual health care services. Learn more about the inequities illuminated during the pandemic and what can be done going forward.
The American Academy of Actuaries Health Practice Council created the Health Equity Work Group with a goal of contributing to efforts to reduce health disparities and improve health equity among groups that have been economically/socially marginalized. The work group is examining actuarial practices and methods in the health area to assess the extent to which they may affect health disparities and recommend changes when appropriate, educate actuaries and other stakeholders on health equity issues, and apply an equity lens to the Academy’s health policy work. Health Equity from an Actuarial Perspective: Questions to Explore introduced the first phase of the work group’s work—an identification of areas in which health actuaries are involved that may affect health equity and development of a list of questions and topics to explore further. Health Equity from an Actuarial Perspective: A Deeper Dive Into Health Plan Pricing Questions is part of a follow-up series and focuses on questions related to pricing health insurance products. Future briefs will focus on questions related to health insurance benefit design, provider contracting and network development, and population health.
A report on health disparities and social Determinants of health in Connecticut
With the possibility of a COVID-19 vaccine growing closer, increasing attention is focused on how it may be distributed, a responsibility that will largely fall to state, territorial, and local governments. Preventing racial disparities in uptake of a COVID-19 vaccine will be important for helping to mitigate the disproportionate impacts of the virus for people of color and preventing widening racial health disparities going forward. Moreover, reaching high vaccination rates across individuals and communities will be key for achieving broader population immunity through a vaccine. This brief provides an overview of barriers to vaccination that disproportionately affect people of color and discusses how current national recommendations and state vaccine allocation plans address racial equity.
The presidential transition and the incoming Biden-Harris administration’s commitment to addressing the equity issues associated withtheCOVID-19pandemicprovide an opportunity to identify programmatic and policy approaches that can ensure the kind of participation in containment and prevention strategies that will address the disproportionate disparities we see every day.
This paper identifies the services that are essential to an equity-centric approach totheCOVID-19pandemic, as well as the infrastructure and workforce needed to ensure these services are available and have an equity focus.It reviews a set of administrative and legislative steps that the new presidential administration can take to strengthen the immediate response to the pandemic and address the long-term health and social needs the pandemic has exacerbated. Finally, it offers a strategy for “building back better” in the long term.
The current public health insurance landscape for postpartum women leaves many new mothers uninsured during the first year after pregnancy, because eligibility for pregnancy-related Medicaid/Children’s Health Insurance Program (CHIP) coverage ends 60 days after pregnancy ends. In this report, we assess how many uninsured new mothers would likely benefit from a 12-month postpartum Medicaid/CHIP extension. Using 2016–18 American Community Survey data and 2020 Medicaid/CHIP eligibility rules, we find that approximately 28 percent of the nation’s estimated 440,000 women uninsured during the first year postpartum, or 123,000 new mothers annually, would likely be newly eligible for Medicaid/CHIP if pregnancy-related coverage were extended for 12 months postpartum. An additional 27 percent of uninsured new mothers are likely already eligible for Medicaid but not enrolled, and 15 percent would likely be eligible for subsidized Marketplace coverage. Postpartum extension could help ensure many new mothers’ access to needed health care during the critical postpartum period.
Concerns about maternal morbidity and mortality in the US have focused attention on uninsurance during the first year after pregnancy and fueled efforts to improve access to postpartum coverage. In this report, we assess the current public health insurance landscape for pregnant and postpartum women, including Medicaid, the Children’s Health Insurance Program (CHIP), and subsidized Marketplace coverage; recently proposed state and federal legislation to extend postpartum coverage; and how much such legislation could expand the coverage landscape for new mothers. Under current subsidized coverage options, gaps remain for many women, and extending pregnancy-related Medicaid/CHIP coverage from 60 days to 12 months postpartum could considerably expand new mothers’ coverage options in most states and promote continuous care during the postpartum period.
The current public health insurance landscape for postpartum women leaves many new mothers uninsured during the first year after pregnancy, because eligibility for pregnancy-related Medicaid/Children’s Health Insurance Program (CHIP) coverage ends 60 days after pregnancy ends. In this report, we assess how many uninsured new mothers would likely benefit from a 12-month postpartum Medicaid/CHIP extension. Using 2016–18 American Community Survey data and 2020 Medicaid/CHIP eligibility rules, we find that approximately 28 percent of the nation’s estimated 440,000 women uninsured during the first year postpartum, or 123,000 new mothers annually, would likely be newly eligible for Medicaid/CHIP if pregnancy-related coverage were extended for 12 months postpartum. An additional 27 percent of uninsured new mothers are likely already eligible for Medicaid but not enrolled, and 15 percent would likely be eligible for subsidized Marketplace coverage. Postpartum extension could help ensure many new mothers’ access to needed health care during the critical postpartum period.
The Public Health Insurance Landscape for Pregnant and Postpartum Women
This paper identifies the services that are essential to an equity-centric approach to the COVID-19 pandemic, as well as the infrastructure and workforce needed to ensure these services are available and have an equity focus. It reviews a set of administrative and legislative steps that the new presidential administration can take to strengthen the immediate response to the pandemic and address the long-term health and social needs the pandemic has exacerbated. Finally, it offers a strategy for “building back better” in the long term.
This brief provides an overview of key issues to consider for reaching noncitizen immigrants as part of COVID-19 vaccination efforts.
Today, House Ways and Means Chairman Richard E. Neal (D-MA) released a staff report, titled “Left Out: Barriers to Health Equity for Rural and Underserved Communities” that analyzes the barriers to health care in underserved communities and discusses the challenges associated with scalable and sustainable solutions. From massive geographic coverage deficiencies to structural environmental factors, the report examines the realities millions of Americans face that adversely affect their health.
A new Health Affairs blog post authored by Dr. Nathan Chomilo, Medical Director for the State of Minnesota’s Medicaid program and a practicing pediatrician and an internal medicine hospitalist with Park Nicollet Health Services/HealthPartners, highlights how racial equity can be built into research and policy and why this is important step as states and policymakers seek to dismantle structure racism in the health care system. Dr. Chomilo notes several examples of how stakeholders can assess research and policy for racial equity at the start. These examples include requiring a racial equity assessment at the start of the development of research proposals aimed at answering policy questions to help ensure investigators have, at the very least, stopped to ask how their work may or may not contribute to structural racism or advance racial justice and improving and standardizing ways to collect race, ethnicity, and language demographic data for not only public payers such as Medicare and Medicaid but all health insurers, social safety-net programs, and education systems.
This infographic explores the history of racial bias and discrimination in health care and during the pandemic, and highlights strategies to address systemic racism and improve health outcomes.
A collection of essays from various authors which is JHPPL’s first effort to make sense of the pandemic as a political, social, and comparative phenomenon that is likely to redefine public health, health policy,and health care politics for years to come.
Blog post that explores health inequities tied to lack of access to energy, water and broadband
CDC released a new study examining the disproportionate impacts of COVID-19 on American Indians and Alaska Natives (AI/AN) in 23 states between January 31 and July 3. The report found:
• The cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN was 3.5 times that of non-Hispanic whites
• Compared to whites, a higher percentage of cases among AI/AN individuals were in people under 18 years of age (12.9 percent AI/AN; 4.3 percent white)
• A smaller percentage of cases were among AI/AN individuals who are 65 years or older (12.6 percent AI/AN; 28.6 percent white)
Three reports that profile solutions from abroad.
This post will present a framework for understanding health disparities during the COVID-19 pandemic, as well as provide short-term and long-term solutions to reduce these disparities.
Policy makers can help ameliorate disparities by mandating standardized case and fatality reporting requirements and directing public health agencies to investigate why particular populations, including Asian Americans, face a seemingly heightened risk of death from COVID-19.
This memo provides a summary of policy approaches to address the disproportionate impact of COVID-19 on communities of color.
The Health Opportunity and Equity (HOPE) Initiative, funded by the Robert Wood Johnson Foundation, provides an interactive data tool to help the nation and states to move beyond measuring disparities to spur action toward health equity.
This article examines why it is important to go further and examine the root cause of racial disparities in underlying health conditions and COVID-19 outcomes.
Medicaid agencies can leverage existing and new authorities, enabled through recent COVID-19 federal regulatory flexibilities, to develop a broad plan for addressing disparities in the near-and long-term.
Recommendations developed by the Connecticut Health Foundation aimed at ensuring the state’s COVID-19 response reaches those who are most at risk.
COVID-19 has urgently demonstrated that everyone needs to live in safe and healthy communities. The people most affected by COVID-19 are communities of color, people with low income, immigrants, and other underserved groups. These groups are most vulnerable in part because of existing laws and policies that affect the fundamental drivers of health inequities. Communities and local governments that take steps to ensure health, safety, housing, food, and economic stability for all of their residents will be helping to prevent the spread of COVID-19 and laying the groundwork for health equity and prosperity for future generations. To help communities and local governments strengthen their response to COVID-19 and advance health equity, ChangeLab Solutions is publishing a blog series about policies that governments can enact right away.
Opinion piece written by Dr. Richard Besser, President and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention.
The Social Interventions Research and Evaluation Network (SIREN) at the University of California San Francisco, is a research organization focused on the intersection of medical and social services. In response to the COVID-19 crisis, SIREN has developed a resource center of sites aggregating data about health equity, policy, and social risk related to the coronavirus and related financial crisis.
Public conversations surrounding COVID-19 health outcomes in Black and Latino communities must address the role of structural racism, including how community trauma, neighborhood disinvestment, and environmental toxins can cause or further exacerbate those conditions, and how these, in turn, are driven by inequities in political power and economic opportunities. This webinar, co-hosted by Families USA and the National Urban League, highlights findings from “The Fierce Urgency of Now: Federal and State Policy Recommendations to Address Health Inequities in the Era of COVID-19”, and discusses how COVID-19 reveals legacies of disinvestment and inequities in communities of color, and how you can take action to organize for justice at the state and federal level.
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.
A report which gives some practical suggestions for public health departments wanting to become equity focused
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.
On October 1, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar, facilitated by experts at Manatt Health on the long-anticipated proposed rule released by the Department of Homeland Security (DHS) on September 22. The proposed rule seeks to change how DHS determines whether immigrants—when seeking admission to the United States, 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). Consequentially, being determined a “public charge” may put immigration status at risk. The webinar reviewed the proposed rule and its potential impacts on consumers, states and providers. Specifically, we highlighted the key ways the proposed rule departs from current guidance, with a particular focus on the implications for Medicaid and other health-related public benefits, and how the proposed rule may impact consumers’ access to certain benefits.