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 guide focuses on equity in the accountable community for health model and can be applied to other cross-sector partnerships.
A guide dedicated to advancing workforce equity in governmental organizations.
This resource guide summarizes recommendations to advance equity through governmental contracting processes.
This report presents current practices and case studies from nine states currently implementing a health in all policies framework.
This document provides a guide for implementing a health in all policies framework based on the experiences of the California Health in All Policies Task Force and other states as well as interviews, academic and gray literature.
The article reviews efforts to measure and evaluate the impact of antiracist initiatives in Ohio.
This report provides recommended actions for specific communities that have been disenfranchised and face disproportionate barriers to community engagement. These actions are applicable to contexts beyond the pandemic.
This guide provides digital and nondigital strategies and methods for inclusive community engagement.
This equity tool specific to the pandemic emergency response includes resources on community engagement that are generalizable to other public health contexts.
This state case study examines Minnesota’s actions related to social determinants of health and structural racism to address health equity at multiple levels, including reports and a health equity data analytics resource guide.
This state case study examines Colorado’s incorporation of equity metrics in evaluation and development and use of standard equity language in publications including a boilerplate template and tools.
This resource was created to help government agencies, communities, and organizations begin increasing racial consciousness.
This state implementation guide from Oregon contains REALD categories, data collection and community engagement resources, workplans, trainings, and tools.
This report focuses on literature supporting community-based solutions, policy infrastructure, multisectoral collaboration and engagement and lists multiple resources and tools to examine and promote equity.
This journal article summarizes examples of instituting racial equity practices in school settings and can be applied to a state agency setting.
This resource guide details a strategic approach to institutional change for equity.
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 announced that starting November 1, individuals applying for coverage through HealthCare.gov will be asked three new optional SOGI questions.
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.
An issue brief from the Urban Institute looks at examples, promising practices, remaining challenges and next steps to use race and ethnicity data to advance health equity. The brief draws on publicly available resources and interviews with leaders and analysts in the healthcare sector familiar with or engaged in efforts to collect and use individual or healthcare provider race and ethnicity data to reduce health inequities.
Governor Phil Murphy signed a bill to launch a new website—the Reproductive Health Information Hub—providing information on reproductive rights, access and healthcare coverage across New Jersey. The Hub will serve as a one-stop shop for anyone seeking information on reproductive healthcare in the state including information on an individual’s rights under state law.
The California Department of Public Health is awarding nearly $2.4 million in grants through the Transgender, Gender Nonconforming, and Intersex Wellness and Equity Fund to provide and support clinical services for gender-affirming healthcare across the state. The grants are designed to ensure these populations have access to lifesaving care.
Governor Phil Murphy announced the state’s progress in expanding access to hormonal contraceptives by enabling pharmacists to provide self-administered hormonal contraceptives to patients without a prescription. A joint rule proposal advanced by the state Board of Medical Examiners and the Board of Pharmacy implements legislation that Governor Murphy signed in January. These new services will be available in 2024.
Governor Gavin Newsom signed several bills into law to protect people from legal retaliation and prohibit law enforcement and corporations from cooperating with out-of-state entities regarding lawful abortions in California, while also expanding access to contraception and abortion providers in California. The package of bills also includes expanded birth control access regardless of gender or insurance coverage status by requiring health plans to cover certain over-the-counter birth control without cost-sharing and prohibits employment-related discrimination based on reproductive health decisions.
The New Jersey Department of Banking and Insurance announced the adoption of rules to require comprehensive abortion coverage as part of all health benefit plans regulated by the department. This requirement, which was in place of January 1, 2023 in the individual and small employer health insurance markets, will now be in effect for the fully-insured large employer health insurance market upon plan issuance or renewal.
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.
CMS unveiled a transformative step to test a state’s ability to improve the overall healthcare management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“AHEAD Model”) aims to better address chronic disease, behavioral health and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set healthcare expenditures on a more sustainable trajectory and lower healthcare costs for patients.
The Department of Medical Assistance Services recently released its 2022 Baby Steps Annual Report that highlights its accomplishments towards improving maternal health outcomes for pregnant and postpartum enrollees.
Pennie, the state’s official health insurance Marketplace, released the state’s inaugural Health Equity Data Report. The report details the impact of policies and procedures created to help reduce inequities experienced by historically marginalized communities, establishes a baseline upon which to measure future efforts to reduce inequities in enrollment, and provides a view into the uninsured rates among different communities to help identify where additional efforts are needed.
MNsure, the state’s official health insurance Marketplace, announced that help is available for undocumented Minnesotans struggling to pay for insulin. Minnesotans can now use an Individual Taxpayer Identification Number (ITIN) as an accepted form of identification for the Minnesota Insulin Safety Net Program. This change provides a pathway to access the program for those who do not have a valid Minnesota identification card, driver’s license or permit, or tribal-issued identification. For minors under the age of 18 who need help affording insulin, a parent or legal guardian can use an ITIN as an accepted form of identification.
On Thursday, July 27, State Health and Value Strategies (SHVS) hosted a webinar highlighting the recently published issue brief, “Medicaid Managed Care Strategies to Reduce Racial and Ethnic Health Disparities in Mental Healthcare for Adults,” which describes approaches that states can take to reduce racial and ethnic inequities in mental healthcare and improve mental health outcomes. The webinar was facilitated by experts from Bailit Health and included a discussion with experts from Health Equity Solutions and a state official on their activities to promote equity in mental healthcare.
Governor Ned Lamont has signed a series of bills to protect reproductive rights in Connecticut. The laws protect medical providers from adverse actions taken by another state; allow pharmacists to prescribe birth control; increase access to reproductive care for college students at public institutions of higher education; and protect the privacy of patient health data online.
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.
Governor Katie Hobbs announced the expansion of access to over-the-counter contraception to Arizonans 18 years and older without a doctor’s prescription. The standing order goes into effect immediately and patients seeking contraceptives will be required to complete a screening and blood pressure test.
Department of Banking and Insurance Acting Commissioner Justin Zimmerman issued a bulletin providing guidance to insurance carriers concerning health coverage for transgender individuals to ensure all New Jersey residents have equal access to health coverage and healthcare. The bulletin provides guidance regarding the prohibitions against unfair discrimination in the issuance and administration of health benefit plans in the state.
The Louisiana Department of Health’s Health Equity Roadmap Phase 2 is a continuation of the Department’s first Health Equity Roadmap and describes the next chapter in the state’s journey to incorporate health equity throughout its programs, policies and procedures.
The Louisiana Department of Health has created a State Health Assessment dashboard to assess the current status of health across the state to create plans that improve wellbeing.
The 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 Katie Hobbs signed two executive orders to ensure the state employee healthcare plan covers medically-necessary gender-affirming surgery and bars state agencies from funding, promoting, or supporting conversion therapy treatment for minors.
Governor Wes Moore signed an executive order to protect gender affirming healthcare In Maryland. The order will protect those seeking, receiving, or providing gender affirming care in Maryland from attempts at legal punishment by other states.
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.
Governor Dan McKee signed into law the Equality in Abortion Coverage Act which requires the coverage of abortion procedures for individuals enrolled in state employee health plans and Medicaid.
Governor Tim Walz signed the state’s new budget, which will allow for the expansion of MinnesotaCare, the state’s Basic Health Program, to undocumented residents using state funding. This will expand access to more than 40,000 people who are undocumented.
Governor JB Pritzker, the Illinois Department of Public Health (IDPH) and the Illinois Department of Financial and Professional Regulation announced a new process to expand access to self-administered hormonal contraceptives, making them more available to Illinois residents. The IDPH standing order authorizes Illinois pharmacists to dispense hormonal contraception following training.
Governor Phil Scott signed abortion and gender-affirming shield bills into law that protect access to medication used in abortions, even if the U.S. Food and Drug Administration withdraws approval of the pill, Mifepristone. The bills also protect providers from discipline for providing legally protected reproductive and gender-affirming healthcare services.
Governor Hochul signed legislation to allow pharmacists to dispense hormonal contraception over the counter and legislation to ensure that every student enrolled within the State University of New York and the City University of New York public university systems has access to medication abortion on campus.
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.
Governor Gavin Newsom announced that California has secured a stockpile of Misoprostol, an abortion medication that can be taken on its own to induce a safe and effective abortion. More than 250,000 pills have already arrived in California, and the state has negotiated the ability to purchase up to 2 million Misoprostol pills as needed through CalRx.
Governor Maura Healey issued an executive order confirming protections for medication abortion under existing state law.
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.
Governor Lujan Grisham signed into law House Bill 7, the Reproductive and Gender-Affirming Healthcare Act, which prohibits public bodies, including local municipalities, from denying, restricting, or discriminating against an individual’s right to use or refuse reproductive healthcare or healthcare related to gender.
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.
Governor JB Pritzker signed into law a bill authorizing an easier process for individuals seeking to change the gender listed on their birth certificate. The updated law allows changes to the birth certificate providing the petitioner signs a statement affirming their gender identity, opening an easier path to legal recognition for transgender Illinoisans.
The Michigan Department of Health and Human Services has issued a request for proposals (RFP) to fund resources supporting implementing the social determinants of health strategy and the development of the next iteration of the Michigan Health Equity Roadmap.
President Biden signed an Executive Order to strengthen the federal government’s ability to address the barriers that under-resourced communities face. It includes an array of strategies designed to increase the federal government’s capacity to advance equity and builds on Executive Order 13985, which instructed federal agencies to conduct equity assessments, by requiring agencies to produce an annual public Equity Action Plan. The Order also directs agencies to increase engagement with under-resourced communities through culturally and linguistically appropriate listening sessions, outreach events or requests for information, during the development and implementation of the agencies’ Equity Action Plans, annual budget submissions, and grants and funding opportunities.
United States of Care, in partnership with Waxman Strategies, released a report showcasing cutting-edge, actionable policies that states across the country have implemented to drive improvements in health equity through insurance coverage. The report is a comprehensive look at approaches states can take to reduce disparities and advance health equity through Affordable Care Act marketplaces, public options, and insurance plans more broadly. The report includes policy options to broaden people’s access to diverse providers, improve providers’ cultural responsiveness, expand access to safety net providers, improve data collection, and address bias throughout the system, among many other issues that affect health equity for enrollees. Paired with the report is a companion piece, A State Checklist for Advancing Equity Through Health Coverage, which summarizes the report’s findings and presents recommendations for states to consider to ensure disparities are being addressed.
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
A new toolkit produced by the NORC Walsh Center for Rural Health Analysis in collaboration with the Rural Health Information Hub (RHIhub) compiles evidence-based frameworks and promising strategies and resources to support organizations working toward health equity in rural communities across the United States. The modules in the toolkit contain information and resources focused on developing, implementing, evaluating, and sustaining rural programs that focus on health equity.
The Wisconsin Department of Health Services received CMS approval to provide housing supports for low-income Wisconsin families in need. Those who are eligible include families with children 18 and younger and individuals who are pregnant who have low income (below 200% of the federal poverty level) and do not have housing. Wisconsin is the first state to implement this type of housing benefit through a Children’s Health Insurance Program (CHIP) Health Services Initiative (HSI). The HSI option allows states to use a portion of CHIP funding to implement initiatives that improve the health of children.
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.
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 Office of Management and Budget (OMB) announced a formal review to revise OMB’s Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. This Directive provides minimum standards that ensure the federal government’s ability to compare race and ethnicity information and data across federal agencies, and also helps to understand how well federal programs serve a diverse America. Earlier this year, Dr. Karin Orvis, Chief Statistician of the United States, convened an Interagency Technical Working Group of federal government career staff representing over 20 agencies across the federal government, including almost every CFO Act agency and recognized statistical agency that collect or use race and ethnicity data, as well as the Equal Employment Opportunity Commission. The Working Group has begun developing a set of recommendations for improving the quality and usefulness of federal race and ethnicity data and now invites public input through virtual, bi-monthly listening sessions. These listening sessions will begin Thursday, September 15, 2022.
The North Carolina Department of Health and Human Services released the 2022 North Carolina State Health Improvement Plan (NC SHIP), which includes key strategies for health equity, education and economic stability for all North Carolinians. A major focus of NC SHIP is advancing health equity by reducing disparities in opportunity and outcomes for historically marginalized populations across the state.
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.
Colorado has been gearing up for its official launch of the Colorado Option (HB21-1232), designed to expand affordable, high-quality, dependable, and equitable healthcare access to all Coloradans. This groundbreaking legislation is set to launch in January 2023 and specifically aims to make coverage more affordable with a focus on addressing health disparities and advancing health equity, including with the establishment of culturally responsive provider networks. In a new fact sheet, United States of Care outlines these and other provisions of the Colorado Option that aim to advance health equity and highlights opportunities for other states to build on this work.
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.
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.
A new commentary from the National Academy of Medicine discusses an emerging emphasis on building community power and why it is essential to achieving health and racial equity, highlighting a set of values and principles to guide practitioners, researchers, and leaders in transforming how they work with communities to build their power.
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.
State health officials are recognizing that marketplaces and participating insurers can help reduce health inequities. A first step is for marketplaces to improve data collection of enrollees’ race and ethnicity. A new blog post from the Commonwealth Fund authored by researchers at Georgetown University reviews current data collection of race and ethnicity among state-based marketplaces. In the post, the researchers highlight how changes to the application process and working with insurers to fill gaps, state-based insurance marketplaces can improve their collection of information on race and ethnicity.
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.
Researchers and policymakers are increasingly acknowledging the importance of addressing racial and ethnic inequities in mental health. While attention has been directed toward increasing diversity in the mental health workforce to improve quality of care for Black, Indigenous, and people of color, more immediate solutions are needed. In a new Milbank Memorial Fund blog post, researchers detail alternative, immediate-term policy approaches to improve quality of care, such as cultural humility training for mental health providers and required assessments of the influence of race and culture on a client’s mental health.
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.
The Wisconsin Governor’s Health Equity Council (GHEC) released the executive summary and prelude to their full report of final recommendations. Established under Governor Tony Evers’ Executive Order #17, the GHEC was charged with creating a comprehensive plan to achieve long-lasting and equitable health outcomes for all Wisconsinites. The council’s leadership is drafting the full report, to be published in early summer 2022, and is working with council members to finalize recommendations.
OHA announced the launch of a new program to fund community-based organizations to support their focus on local priorities while meeting their health equity goals. This grant opportunity supports community-based organizations working toward equity in: communities of color; federally recognized tribes and tribal communities; people with disabilities; immigrant and refugee communities; undocumented communities; migrant and seasonal farmworkers; LGBTQIA+ communities; faith communities; older adults; houseless communities; and others. OHA is awarding 147 community-based organizations a total of about $31 million.
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.
In a new blog post by the Milbank Memorial Fund, Grace Flaherty and Deepti Kanneganti of Bailit Health explore where in the cost growth target implementation process states can consider or incorporate health equity. States may also deploy complementary policies to promote health equity, such as quality and health equity targets. An increasing number of states work with health insurers, providers, consumers, and other stakeholders to set annual targets for statewide healthcare cost growth. As they engage in this work, states can ensure that their efforts to slow cost growth do not exacerbate the deep and well-documented inequities in the health care system but, instead, help address them.
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.
In January, CMS issued its proposed annual Notice of Benefits and Payment Parameters (NBPP), which updates regulations governing the ACA marketplaces. CMS requested and received public comments on the proposed rule, and researchers at CHIR reviewed and summarized a sample of those comments from consumer advocates, insurers and brokers, and state insurance departments and marketplaces. The notice of proposed rulemaking also requested feedback from stakeholders on ways for CMS to advance health equity. Georgetown’s Center on Health Insurance Reforms reviewed comments from states, insurers, and consumer advocates to see how they responded and summarized the findings in a new blog post.
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.
As many states seek to improve pregnancy and childbirth outcomes among people of color, strategies to expand the maternity care workforce and implement an accessible doula network are increasingly a priority. For example, New Jersey began providing Medicaid coverage of doula services in January 2021. California is seeking to implement coverage for doulas as part of a broad set of activities to improve maternity care implemented under the SB-65 California Momnibus Act and recent state budget provisions. On March 29, the Center for Health Care Strategies will host a webinar, made possible by the California Health Care Foundation, which will explore challenges and opportunities to expanding the maternity care workforce and highlight California and New Jersey’s experiences in implementing the doula benefit. National and state experts will share key considerations for developing a doula workforce.
This article in Health Affairs summarizes the efforts DC’s state-based marketplace has made to address health equity and racism in healthcare.
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 state’s official health insurance marketplace, Massachusetts Health Connector, announced new health equity initiatives in its 2023 Seal of Approval plan certification process. Starting in 2023, Health Connector coverage will include new benefits, protections, and reduced cost-sharing to advance health equity objectives.
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.
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 blueprint provides resources, tools, and a plan for federal agency leaders to implement President Biden’s historic executive order on advancing racial equity. Geared toward staff working within federal agencies, the blueprint also includes tools that are applicable for equity advocates across the nation working inside and outside of government, including: the transformative potential equity presents for key socioeconomic outcomes; a starter tool for conducting and refining an initial equity assessment; and a tool for agencies to develop a strategic vision and action plan to advance equity, and guidance on how to launch this journey.
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.
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.
Covered California’s Strategies to Address Health Equity and Disparities
To identify the barriers and opportunities, Grantmakers In Health, in collaboration with the National Committee for Quality Assurance, interviewed a variety of stakeholders across the country, representing all levels of the health system. The first of two reports, Federal Action Is Needed to Improve Race and Ethnicity Data in Health Programs, identifies tangible actions to help improve the completeness, accuracy, and usability of race and ethnicity data.
This bulletin explains that Afghan immigrants who are Special Immigrant Visa holders, Special Immigrant Conditional Residents, Special Immigrant Parolees, or Humanitarian Parolees in the United States are eligible for public programs to the same extent as refugees.
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.
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.
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.
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.
State Health and Value Strategies, in partnership with Health Equity Solutions, created the Health Equity Language Guide for State Officials which is comprised of three tools to help state officials with the language they use to discuss and write about race and health equity. The Guide includes definitions and explanations of words and phrases, how to think about their usage, and examples of how they might be applied.
Rates of COVID-19 vaccination vary widely, with Black, Indigenous and people of color (BIPOC) receiving smaller shares of COVID-19 vaccinations compared with their shares of the total population, despite experiencing disproportionately higher rates of COVID-19 cases, hospitalizations, and deaths. These disparities in vaccination rates among BIPOC as compared to white Americans highlight the longstanding inequities and structural racism that underpin the United States health care delivery system and that contributed to disparities in health outcomes before and during the COVID-19 pandemic. This expert perspective shares highlights from a new issue brief, Strategies for States to Drive Equitable Vaccine Distribution and Administration, which outlines the key barriers states face in their efforts to increase vaccination rates among BIPOC and highlights strategies states are pursuing in partnership with community-based organizations (CBOs) to address these challenges.
Since March 2020, many states have rapidly leveraged federal and state flexibilities under the public health emergency to expand telehealth capabilities and reimbursement through both public and private payers. Now, some states are extending telehealth for the long term or expanding their existing telehealth programs. Increased uptake of telehealth could reduce administrative costs, transportation costs, and wait times. It also could exacerbate existing disparities if barriers to care for populations experiencing these disparities are not addressed. To realize telehealth’s potential for increasing equity in access, states must analyze the impact of these services. This expert perspective highlights considerations for states to maximize the potential of telehealth care to improve equity.
The DC Health Benefit Exchange Authority (DCHBX) Executive Board voted to adopt recommendations from its Social Justice and Health Disparities Working Group, in an effort to stop racism in health care. These recommendations are focused on three crucial areas in order to establish practices, structures, and policies that can be implemented by DCHBX and DC Health Link health plans to (1) expand access to providers and health systems for communities of color, (2) eliminate health outcome disparities for communities of color, and (3) ensure equitable treatment for patients of color in health care settings and in the delivery of health care services.
The AzHIP provides a structure and a venue bringing together a networked system of partners to improve the health of communities and individuals across Arizona. Driven by data and community participation, the AzHIP includes input from individuals and organizations who comprise the public health system. The plan aligns the state on common goals by enhancing non-traditional partnerships, focusing work on priority areas, breaking silos, and leveraging community health improvement plans (CHIPs) statewide. By identifying priorities specific to Arizona’s needs, the plan can make the greatest impact on health promotion and disease prevention.
The rollout of vaccines designed to end the coronavirus (COVID-19) crisis has begun in earnest across the United States. Currently, each state is responsible for determining how to allocate, distribute, track, and report its vaccine allotment from the federal government, although the federal government is expected to take on a larger role under a new Biden administration. Since the beginning of the pandemic, Black, Indigenous, and other people of color have been disproportionately impacted by both higher risks of infection and poorer health outcomes, and many are concerned that an inequitable or inefficient distribution of the COVID-19 vaccine may further widen health inequities among these populations. One way to help ensure the equitable administration of COVID-19 vaccine is to track vaccine administration disaggregated for key subpopulations, such as gender, race and ethnicity, and geography (e.g., urban vs. rural). This expert perspective reviews the data states are currently publicly reporting related to vaccine administration and provides an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography. The expert perspective also discusses what current data sources states are using to provide this information and provides an overview of options states can consider to collect information about the administration of COVID-19 vaccine in populations via survey data.
The recently enacted American Rescue Plan Act of 2021 (ARP), provides an exciting opportunity for states and localities to invest in a more equitable, comprehensive, and integrated crisis system that connects individuals in behavioral health crisis with specialized and appropriate behavioral health treatment. The new mobile crisis provision can help states address rising behavioral health needs worsened by COVID-19. States that take up the new option to provide community mobile crisis intervention services for a five-year period beginning in April 2022 will receive an 85 percent enhanced federal matching rate for qualifying services for the first three years of state coverage. To further encourage states, ARP includes $15 million in planning grants to support state efforts to develop a state plan amendment (SPA) or waiver request. State Health and Value Strategies hosted a webinar during which experts from Manatt Health provided an overview and considerations on the state option to provide community mobile crisis interventions services included in ARP. Presenters walked through key questions on the new option, reviewed promising models for crisis mobile intervention services, and shared strategies for equitable design and implementation. The webinar included a question and answer session during which webinar participants posed their questions to the experts on the line. In case you missed it, the corresponding expert perspective, American Rescue Plan Provides a New Opportunity for States to Invest in Equitable, Comprehensive and Integrated Crisis Services, is posted on our website.
As of March 2021, the United States is administering more than 3 million COVID-19 vaccines a day.1 From the day vaccines were on the horizon, Congress, governors, and the Biden administration committed to equitably distributing them, pointing to disproportionately high rates of COVID-19-related illness and death among Black, Indigenous, and people of color (BIPOC). These disparate outcomes from COVID-19 are linked to longstanding inequities in health care and systemic racism within society.
The state House gave final passage Tuesday to a sweeping measure that declares racism a public health crisis in Connecticut and would trigger a deeper exploration of the effects racism has on public health.
Developed in partnership with community leaders, chief equity officers, policymakers, economic development practitioners, research and policy organizations, and philanthropic partners, 10 Priorities for Advancing Racial Equity Through the American Rescue Plan: A Guide for City and County Policymakers suggests municipal strategies for deploying ARP funds equitably, efficiently, and strategically. Additionally, the guide lays out a framework for equitable decision-making around ARP spending and investments with prompts that local leaders can use to not only ask hard questions around racial equity, but also seek to address them.
DELTA (Developing Equity Leadership through Training & Action) is a health equity and inclusion leadership program that includes training, capacity building, and networking to health, community, and policy leaders in Oregon. The purpose of this program is to build and strengthen the capacity of Oregon’s public health and health systems, and community based leaders to promote equity and diversity. This nine-month program trains 25 members committed to advancing health equity and diversity throughout Oregon.
The American Rescue Plan (ARP) Act enacted on March 11, 2021 establishes a state option to provide community mobile crisis intervention services for a five-year period beginning in April 2022. As an incentive to state adoption, the law provides for an 85 percent enhanced federal matching rate for qualifying services for the first three years of state coverage. To further encourage states, ARP also includes $15 million in state planning grants to support their efforts to develop a state plan amendment or waiver request to take up the option. The new mobile crisis provision arrives just as many states and localities are exploring strategies to address the worsening behavioral health as well as preparing for implementation of 998, the new, national hotline for behavioral health crises. For states and localities reviewing their policing procedures, the new option also could be used to support state efforts to refine the role of law enforcement in responding to behavioral health crisis, offering more resources to the police on such calls or, in some instances, even entirely avoiding the need for law enforcement. This expert perspective provides an overview and state considerations on the state option to provide community mobile crisis interventions services included in the American Rescue Plan.
The National Governors Association released a case study highlighting Nurture NJ, an initiative of First Lady Tammy Murphy to address significant disparities and curb the rate of preventable maternal deaths in the state. Nurture NJ is an umbrella that breaks down silos between stakeholders, bringing them together to tackle issues related to maternal and child health (MCH). Seated in the First Lady’s office, the program facilitates collaborative partnerships with the Governor’s office, 18 state agencies and national MCH organizations. The initiative has also partnered with state legislative caucuses to brief legislators on issues affecting the MCH population. Direct funding is earmarked for the Nurture NJ campaign, including much of their community outreach work; however, the initiative also works with partners to obtain support for various programs under the larger umbrella. For example, state budget dollars in 2020 were allocated to increase Medicaid reimbursement for midwifes and fund implicit bias training at labor and delivery hospitals, as well as Federally Qualified Health Centers, as a part of advancing Nurture NJ’s mission. Overall, the initiative has assisted in procuring around $19 million for various MCH-related programs in the state thus far.
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.
COVID-19’s effects have underscored the ways the nation’s history of racism, bias, and discrimination are embedded in the health, social, and economic systems. A new report by the Center for Budget and Policy Priorities highlights three principles state policymakers can consider to enact antiracist, equitable, and inclusive policies that build an economic recovery that extends to all people. Adhering to these three equity principles would help states take advantage of this moment. States can make transformative policy changes to drastically reduce the severe hardships that millions of people will otherwise experience in the months and years ahead, sharply reduce long-standing inequities rooted in historical racism and other forms of oppression, and build revenue systems capable of sustaining a future in which people no longer go hungry and get the housing, health care, and other supports they require.
NC Medicaid is introducing an enhanced payment to Carolina Access primary care practices serving beneficiaries from areas of the state with high poverty rates.
The Biden-Harris Administration is announcing a series of actions to expand access to COVID-19 vaccines to the hardest-hit and highest-risk communities across the country.
The Centers for Disease Control and Prevention (CDC) today announced a plan to invest $2.25 billion over two years to address Coronavirus Disease 2019 (COVID-19)-related health disparities and advance health equity among populations that are at high-risk and underserved, including racial and ethnic minority groups and people living in rural areas.
The plan provides officials with the tools to create, implement, and support a vaccination campaign that works with BIPOC communities to remedy COVID-19 impacts
The rollout of vaccines designed to end the coronavirus (COVID-19) crisis has begun in earnest across the United States. Currently, each state is responsible for determining how to allocate, distribute, track, and report its vaccine allotment from the federal government, although the federal government is expected to take on a larger role under a new Biden administration. Since the beginning of the pandemic, Black, Indigenous, and other people of color have been disproportionately impacted by both higher risks of infection and poorer health outcomes, and many are concerned that an inequitable or inefficient distribution of the COVID-19 vaccine may further widen health inequities among these populations. One way to help ensure the equitable administration of COVID-19 vaccine is to track vaccine administration disaggregated for key subpopulations, such as gender, race and ethnicity, and geography (e.g., urban vs. rural). This expert perspective reviews the data states are currently publically reporting related to vaccine administration and provides an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography. The expert perspective also discusses what current data sources states are using to provide this information and provides an overview of options states can consider to collect information about the administration of COVID-19 vaccine in populations via survey data.
The presidential transition and the incoming Biden-Harris administration’s commitment to addressing the equity issues associated withtheCOVID-19pandemicprovide an opportunity to identify programmatic and policy approaches that can ensure the kind of participation in containment and prevention strategies that will address the disproportionate disparities we see every day.
This paper identifies the services that are essential to an equity-centric approach totheCOVID-19pandemic, as well as the infrastructure and workforce needed to ensure these services are available and have an equity focus.It reviews a set of administrative and legislative steps that the new presidential administration can take to strengthen the immediate response to the pandemic and address the long-term health and social needs the pandemic has exacerbated. Finally, it offers a strategy for “building back better” in the long term.
Executive Order on Restoring Faith in Our Legal Immigration Systems and Strengthening Integration and Inclusion Efforts for New Americans
CORE creates training, tools, and processes for local officials, staff, and the community to intentionally identify and disrupt implicit biases and systemic inequities in policymaking.
First Lady Tammy Murphy and national public health expert Dr. Vijaya Hogan released the Nurture NJ 2021 Strategic Plan, a strategy to reduce New Jersey’s high rates of maternal and infant mortality and eliminate the racial disparities responsible for these deaths. The Plan includes over 70 specific, actionable recommendations for maternal health stakeholders across all sectors.
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.
This paper identifies the services that are essential to an equity-centric approach to the COVID-19 pandemic, as well as the infrastructure and workforce needed to ensure these services are available and have an equity focus. It reviews a set of administrative and legislative steps that the new presidential administration can take to strengthen the immediate response to the pandemic and address the long-term health and social needs the pandemic has exacerbated. Finally, it offers a strategy for “building back better” in the long term.
Today, House Ways and Means Chairman Richard E. Neal (D-MA) released a staff report, titled “Left Out: Barriers to Health Equity for Rural and Underserved Communities” that analyzes the barriers to health care in underserved communities and discusses the challenges associated with scalable and sustainable solutions. From massive geographic coverage deficiencies to structural environmental factors, the report examines the realities millions of Americans face that adversely affect their health.
As health inequities continue to be exacerbated by the COVID-19 pandemic, there is concerted energy to address this topic across states. Oregon has had a longstanding focus on health equity and employed two foundational strategies that can serve as examples for other states seeking to further their health equity efforts. Oregon first developed a common language and defined what “health equity” meant in the state. The state also engaged community partners to ensure that the community voice was apparent in policy decisions on the state level. When combined, these strategies have helped Oregon develop a foundation to build and implement subsequent health equity efforts in the state.
A new Health Affairs blog post authored by Dr. Nathan Chomilo, Medical Director for the State of Minnesota’s Medicaid program and a practicing pediatrician and an internal medicine hospitalist with Park Nicollet Health Services/HealthPartners, highlights how racial equity can be built into research and policy and why this is important step as states and policymakers seek to dismantle structure racism in the health care system. Dr. Chomilo notes several examples of how stakeholders can assess research and policy for racial equity at the start. These examples include requiring a racial equity assessment at the start of the development of research proposals aimed at answering policy questions to help ensure investigators have, at the very least, stopped to ask how their work may or may not contribute to structural racism or advance racial justice and improving and standardizing ways to collect race, ethnicity, and language demographic data for not only public payers such as Medicare and Medicaid but all health insurers, social safety-net programs, and education systems.
The COVID crisis is revealing the extent of the disparities facing black, indigenous, and people of color. People of color are infected by COVID and dying of COVID at rates higher than their percentage of the population. Black, Hispanic, and American Indian and Alaska Native people are also at higher risk of being hospitalized with COVID. Medicaid has an opportunity and a responsibility to lead efforts to advance health equity by virtue of the population it serves and its unique leverage point within states as a payer. Medicaid Directors at NAMD’s Fall 2020 meeting illustrated how they are taking steps to address equity both internally, among their staff, and externally, among the members they serve.
The COVID-19 pandemic has highlighted longstanding health inequities which have resulted in an increased risk of sickness and death for people of color. The crisis has also propelled a nationwide focus on understanding and addressing health inequities. While COVID-19 and the reckoning on racial justice have mobilized some state officials working in Medicaid, public health, insurance departments, and Marketplaces, alike, states are at different places on their journeys to confront systemic racism and inequities in health care, and each faces unique and challenging barriers. This issue brief explores impediments and accelerants to advancing health equity as states are increasingly being called upon to drive change.
A collection of essays from various authors which is JHPPL’s first effort to make sense of the pandemic as a political, social, and comparative phenomenon that is likely to redefine public health, health policy,and health care politics for years to come.
Public health policies have catalyzed major health improvements for people living in the United States. But without enforcement — that is, a means of incentivizing compliance — these policies are less likely to produce their intended effects. Equitable enforcement is a process of ensuring compliance with law and policy that considers and minimizes harms to people affected by health inequities.
By posing a series of questions to consider when drafting, implementing, and enforcing a policy, ChangeLab Solutions’ resource helps policymakers, advocates, and enforcement officials explore (1) the equity implications of traditional public health enforcement tools, and (2) strategies to avoid unintended negative consequences when enforcing violations of the law. Equitable Enforcement to Achieve Health Equity also discusses best practices in design and development of enforcement provisions to help avoid inequitable impacts and promote community health.
The M-HEAT is a tool to help measure health insurance marketplace progress and performance toward health equity. It compiles and orders data from two perspectives: the health insurance marketplace andcommunity stakeholders.
With the rapid expansion of telemedicine in light of the COVID-19 pandemic, ensuring that remote care reaches diverse, low-income patients and promotes health equity, rather than exacerbating health disparities, is critical. Through a partnership between the Center for Care Innovations, UCSF’s Center for Vulnerable Populations (CVP), and the Commonwealth Fund, we have developed this toolkit to provide background information as well as concrete guidance relevant to safety-net healthcare systems looking to initiate, expand, or improve their telemedicine programs.
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.
This expert perspective provides a survey of actions that state and local governments have taken to intentionally incorporate equity into their recovery and reopening policies.
Three reports that profile solutions from abroad.
An executive plan of action in response to Ohio’s Minority Health Strike Force’s report, “COVID-19 Ohio Minority Strike Force Blueprint,” which addresses racism and promotes long-term health equity through 34 recommendations.
This post will present a framework for understanding health disparities during the COVID-19 pandemic, as well as provide short-term and long-term solutions to reduce these disparities.
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
In April 2020, Louisiana announced the formation of a COVID-19 Health Equity Task Force. In June 2020, the task force provided recommendations relative to health inequities which are affecting communities that are most impacted by the coronavirus.
Members of Governor Gavin Newsom’s Task Force on Business and Jobs Recovery urge business and civic leaders to take action to build a more inclusive, resilient economy.
In an effort to address health disparities, the Governor of North Carolina signed an executive order directing resources to historically underutilized businesses, ensuring equitable distribution of pandemic relief funds, and supporting mass testing of migrant farm workers and food processing plant workers.
The Governor of New Jersey signed legislation, S2357, requiring hospitals to report demographic data to the Department of Health, including age, ethnicity, gender, and race of individuals who have tested positive for COVID-19, who have died from COVID-19, and who have tried to get testing but have been turned away.
The state of Michigan established the Michigan Coronavirus Task Force on Racial Disparities, which is charged with identifying the drivers of existing racial disparities in COVID-19 outcomes and recommending policies addressing such disparities. The Michigan Safe Start Plan utilizes public health metrics such as impacts on at-risk populations as criteria to trigger movement into consequent phases of reopening.
This resource highlights solutions to ensure more equitable enforcement of public health laws.
This report outlines three guiding principles for state policymakers in their equity efforts.
The state of Virginia has formed a Health Equity Work Group that is intentionally embedded into the state’s Uniform Command center addressing COVID-19. Both the Work Group and the Taskforce meet on a regular basis and work to apply a health equity lens to each phase of the state’s response, ranging from preparedness to mitigation to recovery.
This comprehensive report begins by describing the link between social injustice and COVID-19 outcomes at the local level, including original analysis of economic and disease data for 11 counties with high Black and Latino populations that are among the hardest-hit counties in the United States. The second section of this report provides an action guide for health equity advocates, identifying short-term policy options that respond to the current pandemic and longer-term policy.
This Health Affairs blog post highlights states’ policy responses to the COVID-19 pandemic, as well as their proactive approaches to addressing a wide range of health concerns.
Public conversations surrounding COVID-19 health outcomes in Black and Latino communities must address the role of structural racism, including how community trauma, neighborhood disinvestment, and environmental toxins can cause or further exacerbate those conditions, and how these, in turn, are driven by inequities in political power and economic opportunities. This webinar, co-hosted by Families USA and the National Urban League, highlights findings from “The Fierce Urgency of Now: Federal and State Policy Recommendations to Address Health Inequities in the Era of COVID-19”, and discusses how COVID-19 reveals legacies of disinvestment and inequities in communities of color, and how you can take action to organize for justice at the state and federal level.
The second edition of the Health Equity Guide for Public Health Practitioners and Partners is intended to support practitioners and partners engagement in multifaceted approaches to addressing health equity.
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.
A report which gives some practical suggestions for public health departments wanting to become equity focused
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.