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 expert perspective summarizes CMS’ new Informational Bulletin and accompanying framework which together detail Medicaid coverage options for services that address the health-related social needs (HRSN) of Medicaid enrollees. The new guidance reiterates the importance of addressing HRSNs to improve access to care and health outcomes, and summarizes (and in some cases updates) multiple previous sources of CMS guidance on how HRSN services may be covered in Medicaid, including guidance on in lieu of services authority and on HRSN coverage in section 1115 waivers.
CMS released an informational bulletin on adding sexual orientation and gender identity (SOGI) questions to state Medicaid and CHIP applications. The guidance follows a recent announcement that starting November 1, individuals applying for coverage through HealthCare.gov will be asked three new optional SOGI questions. States that elect to include these questions on their Medicaid and CHIP applications exactly as they are worded will not be required to seek CMS approval, while states using alternative language are asked to work with CMS and may need to seek formal approval. Irrespective of which wording states choose, these questions must be optional.
Medicaid is an important source of coverage for LGBTQI+ populations, but few states collect data that can be used to understand and improve health for these individuals. This issue brief documents how information describing sexual orientation and gender identity (SOGI) data is currently collected at the federal level and in state Medicaid applications, summarizes the recent consensus recommendations for how to ask questions that measure SOGI data, and highlights recent federal action on this topic. The issue brief also spotlights Oregon’s ongoing efforts to improve the collection of SOGI data.
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.
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.
The Oregon Health Authority announced that starting July 1, Oregon Health Plan (OHP) coverage is available to all children and adults who meet income and other eligibility criteria, regardless of immigration status. The change initially applies to approximately 40,000 members ages 26 to 54 who moved automatically from emergency coverage to full OHP benefits July 1. But, beginning July 1, all people who meet income and other eligibility criteria, regardless of immigration status, can enroll.
The Maryland Department of Health announced non-citizen pregnant Marylanders with income up to 250% of the federal poverty level will have access to Medicaid coverage, effective July 1. The Department estimates approximately 6,000 non-citizen pregnant Marylanders will be eligible in the first year. The benefit will provide coverage during the pregnancy and four months of comprehensive coverage during the postpartum period.
Governor Joe Lombardo signed SB 163, which requires certain public and private policies of health insurance and healthcare plans, including Medicaid, to cover the treatment of conditions relating to gender dysphoria. The legislation also prohibits an insurer from engaging in discrimination on the basis of gender identity or expression.
The Maine Department of Health and Human Services released a progress update on efforts to advance health equity in communities at higher risk of COVID-19 and address systemic health inequities revealed during the pandemic. Efforts, which were funded by a COVID-19 Health Disparities grant of over $32 million from the U.S. Centers for Disease Control and Prevention, included: investment in tribal communities and community-based organizations; addressing the end of the Medicaid continuous coverage requirement; and expanding COVID testing.
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.
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.
Governor Kathy Hochul announced actions as part of the 2024 budget to strengthen abortion protections and access. The budget increases Medicaid reimbursement rates to boost New York abortion access, enacts data protections for patients seeking reproductive healthcare, requires private insurers to cover medication abortion when prescribed off-label for abortion, and allocates $100.7 million in new funding to support abortion providers and reproductive healthcare.
Governor Wes Moore signed legislation that solidifies protections for reproductive rights and protects the rights of transgender Marylanders. The legislation includes a bill that establishes the fundamental right to reproductive freedom and a bill that requires Maryland’s Medicaid program to provide gender-affirming treatment in a nondiscriminatory manner.
This expert perspective reviews the proposed rule, which would add DACA recipients to the list of “lawfully present” immigrants who can receive three types of federally supported health coverage.
HHS published a proposed rule aimed at expanding health coverage options for certain recipients of Deferred Action for Childhood Arrivals (DACA) status. The proposed rule would add DACA recipients to the list of “lawfully present” immigrants who can receive three types of federally supported health coverage.
President Biden announced the administration’s plan to expand health coverage options for recipients of Deferred Action for Childhood Arrivals (DACA) status—undocumented individuals who were brought to the United States as children and who meet certain other eligibility criteria. Per President Biden’s announcement, HHS will propose an amendment to the regulatory definition of “lawful presence” that will permit the 800,000 DACA recipients to “apply for coverage through the Health Insurance Marketplace, where they may qualify for financial assistance based on income, and through their state Medicaid agency.”
This expert perspective highlights the latest updates to the Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity which describes approaches states are taking within Medicaid managed care to promote health equity.
The Compendium identifies approaches states are taking within their Medicaid managed care (MMC) programs to promote health equity. It has been updated seven times since its original publication in June 2020 and this latest update describes approaches 21 states are taking within MMC to promote health equity, features state examples for further illustration, and includes excerpts from state contract and procurement documents.
A new Commonwealth Fund report, Inequities in Health Insurance Coverage and Access for Black and Hispanic Adults: The Impact of Medicaid Expansion and the Pandemic, examines how adults’ healthcare coverage and access for Black, Hispanic, and White Americans changed during the 2019-2021 period and analyzes earlier healthcare trend data for these groups since 2013, before the ACA’s major coverage expansions went into effect. Between 2013-2021, uninsured rates fell 15.7 percentage points for Hispanic adults, 10.9 points for Black adults, and 6.3 points for White adults. Key findings show coverage disparities narrowed considerably, uninsured rates for adults across racial and ethnic groups improved and in states that expanded Medicaid, uninsured rates were lower and racial and ethnic disparities were smaller.
Individual-level data on race and ethnicity collected within the Medicaid program and in other state agencies is greatly influenced by federal guidance. This expert perspective summarizes the proposed revisions to the federal standards for collecting race and ethnicity that are currently out for comment, and provides considerations for states interested in submitting comments.
On Thursday, March 23, State Health and Value Strategies will host a webinar that will review the recent adoption of statewide health equity data standards for the collection of self-reported patient demographic information by provider organizations, Medicaid and commercial insurers in Massachusetts. During the webinar, experts from MassHealth (Massachusetts Medicaid) and Bailit Health will review the adopted standards as well as a complementary framework for introducing accountability for advancing health equity into value-based contracting. Panelists will also describe how Massachusetts engaged a wide array of stakeholders in the development process and the plan for dissemination and adoption. The webinar will include a question and answer session for participants.
This issue brief highlights community engagement work in Virginia and Colorado. Each state has invested in coordinated community engagement strategies that amplify the voices of those directly impacted by Medicaid and leverage their input to drive improvements. This pioneering work offers practical examples of how to structure community engagement to foster participation and improve program outcomes.
New York’s Acting Medicaid Director, Amir Bassiri, joined the Rockefeller Institute of Government’s latest podcast episode of Policy Outsider to examine how New York is using a Section 1115 waiver to address health equity issues. Discussion included how the waiver works, the goals the waiver seeks to accomplish, strategies for achieving those goals, and a vision for the future of Medicaid.
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.
Medicaid agencies make daily decisions about how to spend program dollars and use this opportunity to guide payment strategies to advance health equity. State agencies can involve a variety of stakeholders, including people served by Medicaid, to develop a comprehensive approach to guide spending and payment decisions focused on health equity. A new issue brief provides a checklist of eight key questions that can help state purchasers and other payers develop a robust payment and spending strategy focused on advancing health equity. Each question includes concrete state examples for adopting health equity-focused payment models. The brief, authored by the Center for Health Care Strategies (CHCS), is a product of Advancing Health Equity, a national initiative supported by the Robert Wood Johnson Foundation that is working with states to pursue payment innovations that support health equity. The initiative is led by the University of Chicago in partnership with CHCS and the Institute for Medicaid Innovation
The CMS Office of Minority Health published The Path Forward: Improving Data to Advance Health Equity Solutions, a blog post which outlines a plan to tackle health equity data efforts across CMS programs to achieve health equity by underlining the importance of health equity data collection and chart the next steps for CMS to improve data collection efforts.
From its humble beginnings in 1965 as a supplement to Medicare designed to provide health insurance for individuals living in poverty, Medicaid has evolved to become a primary strategy to expand coverage and a critical part of the national social safety net. In recent years, with the expansion enabled by the Affordable Care Act (ACA) and the maintenance of coverage required by the Families First Coronavirus Response Act, Medicaid has significantly eclipsed Medicare in the number of individuals covered and arguably rivals it in importance. California has developed an ambitious agenda to fully realize the potential of Medicaid as a driver of health equity.
Governor Gavin Newsom and the Department of Health Care Services announced that roughly 286,000 older adult Californians are receiving full scope Medi-Cal as a result of the expansion of comprehensive preventive care and other services to all income-eligible adults 50 years of age and older, regardless of immigration status.
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.
Over the past decade, there have been alarming increases in behavioral health disparities and overdose data, with Black men and Native American/Alaska Native women now experiencing the highest rates of fatal overdose. The National Association of Medicaid Directors recently published a Federal Policy Brief highlighting actions federal stakeholders can take to enhance behavioral health equity.
CMS approved a new section 1115 demonstration that will allow the state to address inadequate food, housing and other root-cause issues that lead to poor health. As part of the agreement, the federal government also approved expanded Oregon Health Plan (OHP) coverage for young children, as well as extended eligibility for youth and adults. Children determined eligible for Medicaid will stay continuously enrolled until they turn six years old, without their families needing to renew their coverage.
The Baker-Polito administration received federal approval to expand and extend its Medicaid section 1115 waiver through December 2027. The demonstration approved by CMS supports integrated, outcomes-based care for MassHealth’s two million members and brings a new focus on advancing health equity by closing disparities in quality and access. The demonstration also focuses on investing in primary, behavioral and pediatric healthcare.
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.
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.
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.
Data Across Sectors for Health (DASH), together with the Center for Health Care Strategies (CHCS) and with support from the Robert Wood Johnson Foundation, is leading a national initiative, Learning and Action in Policies and Partnerships, to test new ways to support community-based data-sharing efforts. The first cohort included six communities—in Arizona, Connecticut, Rhode Island, South Carolina, Washington, D.C., and Washington—that sought to strengthen relationships between communities and state agencies to address health equity priorities via data-sharing efforts. A recently published issue brief shares lessons from these six pilot sites to help guide additional states and community-based organizations (CBOs) in enhancing community data-sharing capabilities and fostering relationships between state governments, CBOs, and community members with lived expertise.
The Oregon Health Authority released an annual progress report for Healthier Together Oregon (HTO), the State Health Improvement Plan. HTO is a strategic plan to advance health equity. The strategies in the plan are organized into eight implementation areas: equity and justice, healthy communities, housing and food, healthy families, healthy youth, workforce development, behavioral health and technology and health.
The Department of Health Care Policy and Financing published its Fiscal Year 2022-23 Department Health Equity Plan. The report identifies four initial Health First Colorado (Colorado’s Medicaid program) health disparity areas of focus, including: COVID-19 vaccination rates, maternal care, behavioral health and prevention.
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.
Medicaid programs collectively are the largest insurer of births in the U.S., covering 42 percent of all births. California’s Medicaid program, Medi-Cal, pays for more than 50 percent of births in the state. That’s nearly five percent of all births in the U.S., and over 11 percent of all Medicaid births nationally. With new budget initiatives, a California Momnibus Act, and a new Medicaid transformation initiative called California Advancing and Innovating Medi-Cal, California is seeking to advance more whole-person care for pregnant and birthing people, and to ensure and expand access to reproductive healthcare. This Center for Health Care Strategies Policy Cheat Sheet explores what these new initiatives mean for maternity and reproductive healthcare in California, and why other states may want to pay attention.
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.
CMS released the Health Coverage Options for Certain Ukrainian Nationals fact sheet. The publication outlines pathways to health coverage eligibility through Medicaid, CHIP, the Marketplace, or Refugee Medical Assistance based on the legal pathways through which Ukrainians may enter or reside in the United States under current law, including parole, temporary protected status, and refugee.
The Department of Health and Human Services announced that it has established MaineCare eligibility for children under 21 years of age who would be otherwise eligible for federal Medicaid benefits but are not eligible due to their immigration status and for pregnant people who are not eligible for federal Medicaid benefits due to their immigration status, but are able to receive coverage under the federal Children’s Health Insurance Program.
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.
The Biden administration released a Blueprint for Addressing the Maternal Health Crisis which provides a whole-of-government approach to combatting maternal mortality and morbidity. The Blueprint outlines five priorities to improve maternal health outcomes in the United States.
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.
Pregnant undocumented immigrants and their children will be eligible for Medicaid starting in 2025 under a bill signed by Governor Jared Polis. Under the law, pregnant undocumented people who would otherwise qualify for Medicaid and the Children’s Basic Health Plan, or CHIP, would be provided full health insurance coverage for up to a year following a child’s birth. Undocumented children will be eligible until they turn 18.
Governor DeSantis signed into law HB 855 which establishes reporting requirements for managed care plans to begin stratifying data by age, sex, race and ethnicity. The new data reporting requirements will take effect in 2025.
Governor Ned Lamont signed into law the fiscal year 2023 budget adjustment bill, which expands HUSKY Health (Connecticut’s Medicaid and CHIP program) eligibility to children age 12 and under with a household income up to 323 percent of the federal poverty level, regardless of immigration status.
As of May 1, Medi-Cal, the state’s Medicaid program, is extending eligibility for full coverage to more than 185,000 individuals who are 50 years of age or older, regardless of immigration status.
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.
CMS outlined an action plan to advance health equity. As part of the plan, CMS Administrator Chiquita Brooks-LaSure charged each CMS Center and Office to build health equity into their core work and aim to better identify and respond to inequities in health outcomes, barriers to coverage, and access to care.
The New York State Department of Health filed an amendment to its Medicaid 1115 waiver seeking authority to spend $13.5 billion in Medicaid funds over five years for a demonstration project aimed at addressing health disparities and delivery system problems magnified by COVID-19. The state will conduct two virtual hearings on the waiver amendment. The public comment period is open until May 13.
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.
The California Department of Health Care Services released Medi-Cal’s Strategy to Support Health and Opportunity for Children and Families, a policy agenda aimed at advancing health equity, stressing whole health and preventive care, providing family and community-based care, promoting integrated care, and improving accountability and oversight for children enrolled in Medicaid.
The United States is facing a maternal health crisis, as maternal mortality rates continue to rise with significant racial, ethnic, and socioeconomic disparities in birth outcomes. Nationally, there has been a growing interest in expanding the maternal health workforce with an investment in doulas–trained professionals who provide continuous physical, emotional, and informational support to pregnant people before, during, and shortly after childbirth. In January 2022, Virginia became the latest state to cover doula services through its Medicaid program. The National Academy for State Health Policy released a new blog post detailing Virginia’s doula benefits, including their reimbursement structure. Community doulas can begin enrolling in the state’s Medicaid program this spring.
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.
CMS released a request for information (RFI) seeking feedback on topics related to healthcare access. The RFI will aid in CMS’ understanding of enrollees’ barriers to enrolling in and maintaining coverage and accessing needed healthcare services and support through Medicaid and CHIP.
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.
This issue brief aims to offer guidance to state Medicaid offices on the steps needed to advance equity in maternal health, particularly as it relates to people of color. In addition to recommending key agency strategies, the brief offers state and federal models that leaders can look to when taking each approach.
This report aims to continue the evolution of how policy within the Minnesota Department of Human Services (DHS) is designed, proposed and considered by intentionally striving for community co-creation. At the outset of drafting this report, staff met with individuals from the U.S.-born Black community, leaders of organizations that are a part of the community and those working to advance racial equity in health care for Black Minnesotans.
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.
This issue brief aims to establish a conceptually nuanced, empirically informed, and practically useful framework for analyzing the racial equity implications of health policies.
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.
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.
Under federal and state law, insurers must cover gender-affirming care — including medically necessary mental health care, hormone therapy, and surgical treatments — for transgender people. But many transgender people continue to face discriminatory barriers accessing this care. In Colorado, state officials requested — and the U.S. Department of Health and Human Services (HHS) approved — a change to the state’s essential health benefits (EHB) benchmark marketplace plan to affirm and clarify insurer coverage of gender-affirming care. Plans must comply beginning in 2023. This blog post reviews the status of insurer coverage for gender-affirming care, improvements made in transgender health under the Affordable Care Act (ACA), and Colorado’s announcement.
The last ten years of testing and learning have laid a strong foundation for the CMS Innovation Center to lead the way towards broad and equitable health system transformation. This white paper describes the Innovation Center’s refreshed vision and strategy and provides examples of approaches and efforts under consideration to achieve the goals of each strategic objective. The Innovation Center’s overarching goal will continue to be expansion of successful models that reduce program costs and improve quality and outcomes for Medicare and Medicaid beneficiaries. In addition, the paper emphasizes how measuring progress toward broader health system transformation is also critical to achieving these goals and vision.
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.
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.
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.
The COVID-19 pandemic, ensuing recession, and amplification of issues related to health equity have forced state Medicaid agencies to evaluate their budgets and investments to better serve Medicaid enrollees. In the latest episode of the Medicaid Leadership Exchange podcast, Tracy Johnson, Medicaid director at the Colorado Department of Health Care Policy and Financing, and Caprice Knapp, director of the medical services division at the North Dakota Department of Human Services, share strategies on how to have discussions with budget staff and legislators about investing in infrastructure that supports long-term health equity goals. They also explore how Medicaid services and budgets are affected by factors that impact access to equitable care, including criminal justice, childcare, broadband access, and more.
Throughout the pandemic, the nation’s children have suffered in myriad ways during some of the most critical ages for healthy development. Children of color, children with greater existing health care needs and children dealing with the impacts of poverty have been the hardest hit. The National Association of State Medicaid Directors has released a report, Medicaid Forward: Children’s Health, that provides a close look at the realities the country is facing to aid the recovery of its children, as well as the innovations Medicaid programs across the country have made and are continuing to make to help millions of kids. Medicaid and the Children’s Health Insurance Programs, which cover about 2 in 5 American children and nearly half of all births, will be essential in the nation’s efforts to help children and their families recover from these impacts and build additional resilience for the future. NAMD is also hosting a webinar on Thursday, June 17 from 12:00 to 1:00 p.m. ET about the Medicaid Forward series and this second report focused on children’s health.
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.
Medicaid is the primary source of health care coverage for over 77 million Americans, with Black and Latino communities making up approximately 46 percent of enrollees and as such, Medicaid programs are a significant player in reducing health disparities and advancing health equity. The Center for Health Care Strategies hosted a question and answer session with internist and pediatrician Nathan Chomilo, MD, Medical Director of Minnesota Medicaid and MinnesotaCare to get his perspectives on priority opportunities for addressing health equity for people served by the state’s Medicaid program. Medicaid medical directors have a unique leadership opportunity to address equity through their oversight of services covered by Medicaid and their connections with providers delivering those services. From their vantage point, medical directors have insight into provider and patient experiences, as well as the barriers that can hinder access and treatment.
State Medicaid agencies are increasingly pursuing opportunities to address health-related social needs (HRSN) to improve health outcomes, reduce health care spending, and advance health equity. A new tool, produced by the Center for Health Care Strategies with support from the Episcopal Health Foundation, can guide state Medicaid agencies in developing a cohesive strategy to address HRSN supported by Medicaid managed care and value-based payment initiatives. A robust HRSN strategy can help states achieve high-priority Medicaid goals and can support broader state goals to improve community-level social determinants of health. A companion environmental scan highlights available evidence on specific approaches, tools, and resources related to addressing HRSN.
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.
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.
Value-based payment, which many payers are already using to improve health outcomes and support more efficient care, can be an effective tool in designing equity-focused payment and contracting models. The development of equity-focused VBP approaches to support care delivery transformation is an important lever that can help payers advance health equity and eliminate disparities in health care. A new report, authored by the Center for Health Care Strategies and the Institute for Medicaid Innovation, identifies six connected strategies to guide payers, including Medicaid agencies and managed care organizations, in developing equity-focused VBP approaches to mitigate health disparities at the state and local level. These strategies include: (1) articulating an equity goal; (2) assessing the payment and care delivery environment; (3) selecting performance measures; (4) setting performance targets; (5) designing the payment approach; and (6) addressing operational challenges.
An analysis of structural racism within the Medicaid program, and how Medicaid policies have failed to resolve racial health disparities throughout the program’s history.
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.
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 analysis includes several key considerations intended to help state policymakers identify and overcome common barriers associated with integrating and operationalizing CHWs in Medicaid and other state health programs
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.
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.
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.
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.