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.
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.
NC Medicaid is introducing an enhanced payment to Carolina Access primary care practices serving beneficiaries from areas of the state with high poverty rates.
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.