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 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.