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.
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.