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.
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.
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
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.
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 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.
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.