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.
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.
As states look to advance health equity, they need ways to measure whether their efforts result in improvements. Benchmarking can be used to identify health disparities and establish a standard for evaluating efforts to address health inequities. This issue brief summarizes the advantages and disadvantages of four common approaches to health equity benchmarking and describes the importance of acknowledging the role of societal inequity and structural racism in driving disparities.
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.
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 Maryland Department of Health announced Caring Out Loud, a year-long partnership with the Trevor Project to bring trainings, resources and support to LGBTQ+ Marylanders. The Caring Out Loud campaign will include LGBTQ+ focused training for the department’s Behavioral Health Administration staff, members of the Governor’s Commission for Suicide Prevention, and healthcare professionals across the state.
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 Joe Lombardo signed SB 163, which requires certain public and private policies of health insurance and healthcare plans, including Medicaid, to cover the treatment of conditions relating to gender dysphoria. The legislation also prohibits an insurer from engaging in discrimination on the basis of gender identity or expression.
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 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.
Governor Jay Inslee signed five bills that will protect access to abortion medication, enhance data privacy for people who share their health information with third party apps, protect Washington patients and providers who may face legal threats from other states, protect providers’ licenses, and eliminate out-of-pocket costs to make abortion access more equitable.
Governor Kotek announced that the state of Oregon has partnered with Oregon Health and Science University to secure a three-year supply of Mifepristone to ensure that reproductive health providers across the state can maintain access and continue to provide patients with safe and effective miscarriage management and abortion care.
Mayor Bowser announced that the District will cancel up to $90 million in medical debt for many of the 90,000 District residents who have unpaid medical bills. The initiative is funded by $900,000 in anticipated year-end surplus funds from the fiscal year 2023 budget to address health inequities and racial disparities related to medical care.
SB23-190 makes punishable certain deceptive actions regarding pregnancy-related services, such as falsely advertising availability or referrals for abortions or emergency contraceptives.
SB23-189 increases access to reproductive healthcare services, including HIV prevention drugs and abortion care.
SB23-188 prevents the state from recognizing or engaging in any criminal prosecutions or lawsuits for anyone who receives, provides, or assists in abortions and gender-affirming care.
Governor Jay Inslee announced that Washington state has taken action to purchase a three-year supply of mifepristone, an abortion medication. Inslee directed the state Department of Corrections, using its existing pharmacy license, to purchase the medication last month.
Governor Kathy Hochul announced that the state will stockpile the abortion medication Misoprostol as part of ongoing efforts to protect access to abortion. At the governor’s direction, the New York State Department of Health will immediately begin purchasing Misoprostol in order to stockpile 150,000 doses, a five-year supply, in order to meet anticipated needs.
Governor Maura Healey directed the University of Massachusetts and healthcare providers to take action to stockpile doses of Mifepristone.
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 Josh Shapiro launched a new website for reproductive healthcare access resources to provide help for those seeking critical services no matter what part of the state they live in or whether they are traveling from a state that has restricted abortion access. On the new site, the public can find information about medication abortions as well as in-clinic procedure abortions. Users can also take advantage of an interactive map and the “Find A Provider” tool to locate a local provider, seek assistance on their journey with help from the “Make A Plan” section, and get connected with financial support under “How to Pay.”
Governor Maura Healey issued an executive order confirming protections for medication abortion under existing state law.
Governor Phil Murphy and Chief Innovation Officer Beth Simone Noveck announced the launch of Transgender.NJ.gov—a new, one-stop hub designed to aid New Jersey’s transgender and non-binary community in finding information about essential programs and services. The website’s initial version contains information such as how to change a name, acquire legal assistance, obtain mental health and medical support, learn about rights and legal protections, and more. The website has launched as a beta version, allowing it to be continually updated and enhanced based on feedback from New Jerseyans and community stakeholders who use the site.
Governor Michelle Lujan Grisham signed into law Senate Bill 13, which codifies protections outlined in the governor’s August 2022 executive order, including prohibiting entities within the state from sharing patient information related to reproductive healthcare for New Mexico patients and providers, and prohibiting public bodies from restricting access to abortion and gender-affirming healthcare.
Governor Phil Murphy signed Executive Order No. 326 establishing New Jersey as a safe haven for gender-affirming healthcare by directing all state departments and agencies to protect all persons, including healthcare professionals and patients, against potential repercussions resulting from providing, receiving, and assisting in providing or receiving, seeking, or traveling to New Jersey to obtain gender-affirming healthcare services.
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.
On Thursday, March 23, State Health and Value Strategies will host a webinar that will review the recent adoption of statewide health equity data standards for the collection of self-reported patient demographic information by provider organizations, Medicaid and commercial insurers in Massachusetts. During the webinar, experts from MassHealth (Massachusetts Medicaid) and Bailit Health will review the adopted standards as well as a complementary framework for introducing accountability for advancing health equity into value-based contracting. Panelists will also describe how Massachusetts engaged a wide array of stakeholders in the development process and the plan for dissemination and adoption. The webinar will include a question and answer session for participants.
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.
This issue brief highlights community engagement work in Virginia and Colorado. Each state has invested in coordinated community engagement strategies that amplify the voices of those directly impacted by Medicaid and leverage their input to drive improvements. This pioneering work offers practical examples of how to structure community engagement to foster participation and improve program outcomes.
In March 2019 Governor Tony Evers established the Governor’s Health Equity Council, by issuing Executive Order 17 and charging the Council with developing a comprehensive plan designed to improve “all determinants of health including access to quality health care, economic and social factors, racial disparities, and the physical enviornments” and “address health disparities in populations based on race, economic status, educational level, histoy of incarceration and geographic location” by 2030.
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.
The Massachusetts Quality Measure Alignment Task Force recommended a health equity measure accountability framework and a set of data standards for use by all payers and providers across the Commonwealth in global risk-based contracts. The framework outlines principles for developing and implementing key contractual measures, and the data standards specify which data points payer and provider organizations need to track, as well as how data should be collected. The recommended framework and data standards go into effect on January 1, 2023. The Task Force endorses implementation of the race, ethnicity, and language data standards within one year of the effective date (January 1, 2024) and implementation of the disability, sexual orientation, gender identity, and sex data standards within two years of the effective date (January 1, 2025).
New York’s Acting Medicaid Director, Amir Bassiri, joined the Rockefeller Institute of Government’s latest podcast episode of Policy Outsider to examine how New York is using a Section 1115 waiver to address health equity issues. Discussion included how the waiver works, the goals the waiver seeks to accomplish, strategies for achieving those goals, and a vision for the future of Medicaid.
This issue brief documents how REL data are collected by the Medicaid programs in the 50 U.S. states, the District of Columbia, and five U.S. territories. This serves as an update to SHADAC’s previous brief, providing up-to-date information on Medicaid REL data collection among the states and extending the analysis to include the District of Columbia and the five territories.
Medicaid agencies make daily decisions about how to spend program dollars and use this opportunity to guide payment strategies to advance health equity. State agencies can involve a variety of stakeholders, including people served by Medicaid, to develop a comprehensive approach to guide spending and payment decisions focused on health equity. A new issue brief provides a checklist of eight key questions that can help state purchasers and other payers develop a robust payment and spending strategy focused on advancing health equity. Each question includes concrete state examples for adopting health equity-focused payment models. The brief, authored by the Center for Health Care Strategies (CHCS), is a product of Advancing Health Equity, a national initiative supported by the Robert Wood Johnson Foundation that is working with states to pursue payment innovations that support health equity. The initiative is led by the University of Chicago in partnership with CHCS and the Institute for Medicaid Innovation
The New Jersey Department of Health announced $116.5 million in grants that will help strengthen public health infrastructure across the state. The first grant, in the amount of $75 million, was awarded to the New Jersey Association of City and County Health Officials to administer grants to eligible county, municipal and regional local health departments across the state. The goal of these funds is to support the development or expansion of long-term health infrastructure improvements with a key emphasis on health equity, diversity, inclusion, and accessibility.
From its humble beginnings in 1965 as a supplement to Medicare designed to provide health insurance for individuals living in poverty, Medicaid has evolved to become a primary strategy to expand coverage and a critical part of the national social safety net. In recent years, with the expansion enabled by the Affordable Care Act (ACA) and the maintenance of coverage required by the Families First Coronavirus Response Act, Medicaid has significantly eclipsed Medicare in the number of individuals covered and arguably rivals it in importance. California has developed an ambitious agenda to fully realize the potential of Medicaid as a driver of health equity.
Health plans will never become reliable engines for quality improvement and disparities reduction if purchasers do not create clear economic incentives. Financial consequences need to be substantial, tied to a small set of epidemiologically important measures that can be improved by effective access to and coordination of care, and monitored and enforced by an aligned set of purchasers.
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.
Governor JB Pritzker and the Illinois Department of Public Health (IDPH) announced that the state is awarding up to $3.7 million to 18 different organizations across Illinois to address systemic health disparities that have been highlighted by the COVID-19 pandemic. The program, Activating Relationships In Illinois for Systemic Equity (ARISE), is a joint initiative of IDPH’s Center for Minority Health Services and the Center for Rural Health. The goal of the ARISE program is to work with trusted, community-based partners to take significant strides towards closing health equity gaps.
The Minnesota Department of Health, Center for Health Equity released a new request for proposals for the Eliminating Health Disparities Initiative, a grant program established to provide direct investments in organizations focused on improving the health and well-being of American Indians and people of color.
CMS approved a new section 1115 demonstration that will allow the state to address inadequate food, housing and other root-cause issues that lead to poor health. As part of the agreement, the federal government also approved expanded Oregon Health Plan (OHP) coverage for young children, as well as extended eligibility for youth and adults. Children determined eligible for Medicaid will stay continuously enrolled until they turn six years old, without their families needing to renew their coverage.
The Baker-Polito administration received federal approval to expand and extend its Medicaid section 1115 waiver through December 2027. The demonstration approved by CMS supports integrated, outcomes-based care for MassHealth’s two million members and brings a new focus on advancing health equity by closing disparities in quality and access. The demonstration also focuses on investing in primary, behavioral and pediatric healthcare.
The Minnesota Department of Health released its first-ever Minnesota Maternal Mortality Report, which examined maternal deaths during or within one year of pregnancy from 2017 to 2018. While the report shows the state’s overall maternal mortality rate is lower than the national average, it also shows stark disparities in mortality—especially among Black and American Indian Minnesotans. Black Minnesotans represent 13% of the birthing population but made up 23% of pregnancy-associated deaths, and American Indian Minnesotans represent 2% of the birthing population, but 8% of pregnancy-associated deaths.
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.
The Department of Health Care Policy and Financing published its Fiscal Year 2022-23 Department Health Equity Plan. The report identifies four initial Health First Colorado (Colorado’s Medicaid program) health disparity areas of focus, including: COVID-19 vaccination rates, maternal care, behavioral health and prevention.
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.
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.
The Department of Health and Human Services announced that it has established MaineCare eligibility for children under 21 years of age who would be otherwise eligible for federal Medicaid benefits but are not eligible due to their immigration status and for pregnant people who are not eligible for federal Medicaid benefits due to their immigration status, but are able to receive coverage under the federal Children’s Health Insurance Program.
State Health and Value Strategies published findings from a series of interviews with state Medicaid leaders about how to monitor the implementation of “social care.” State Medicaid agencies are increasingly exploring opportunities to incorporate “social care” into strategies for improving health, decreasing healthcare costs, and achieving equity. The findings are derived from a two-part research project conducted by the Social Interventions Research and Evaluation Network at the University of California, San Francisco (SIREN) for SHVS that explored ways to scale and sustain social care across the healthcare sector.
Pregnant undocumented immigrants and their children will be eligible for Medicaid starting in 2025 under a bill signed by Governor Jared Polis. Under the law, pregnant undocumented people who would otherwise qualify for Medicaid and the Children’s Basic Health Plan, or CHIP, would be provided full health insurance coverage for up to a year following a child’s birth. Undocumented children will be eligible until they turn 18.
Governor DeSantis signed into law HB 855 which establishes reporting requirements for managed care plans to begin stratifying data by age, sex, race and ethnicity. The new data reporting requirements will take effect in 2025.
Governor Ned Lamont signed into law the fiscal year 2023 budget adjustment bill, which expands HUSKY Health (Connecticut’s Medicaid and CHIP program) eligibility to children age 12 and under with a household income up to 323 percent of the federal poverty level, regardless of immigration status.
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.
As of May 1, Medi-Cal, the state’s Medicaid program, is extending eligibility for full coverage to more than 185,000 individuals who are 50 years of age or older, regardless of immigration status.
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.
A new issue brief by the Commonwealth Fund explores marketplace equity strategies pursued in California, Connecticut, the District of Columbia, and Massachusetts. While the brief finds that there is no consensus among the four marketplaces on how to approach health equity, the variety of state approaches described in the brief show there are multiple paths to improving health equity.
The New York State Department of Health filed an amendment to its Medicaid 1115 waiver seeking authority to spend $13.5 billion in Medicaid funds over five years for a demonstration project aimed at addressing health disparities and delivery system problems magnified by COVID-19. The state will conduct two virtual hearings on the waiver amendment. The public comment period is open until May 13.
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.
This report aims to continue the evolution of how policy within the Minnesota Department of Human Services (DHS) is designed, proposed and considered by intentionally striving for community co-creation. At the outset of drafting this report, staff met with individuals from the U.S.-born Black community, leaders of organizations that are a part of the community and those working to advance racial equity in health care for Black Minnesotans.
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
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.
On October 13, the Wisconsin Department of Health Services (DHS) announced funds will be made available to promote racial and geographic equity in the COVID-19 response. DHS was awarded $27 million by the Centers of Disease Control and Prevention (CDC) to combat inequities related to COVID-19 infection, illness, and death, including $9 million dedicated to rural communities. In a separate appropriation, an additional $13 million in funding has been set aside to continue the Vaccine Community Outreach grant program, which funds organizations across Wisconsin to increase vaccinations by serving as trusted messengers within their communities, build vaccine confidence, and reduce barriers that hinder vaccine access for marginalized or underserved populations.
This Health Equity Guidebook provides guidance related to providing culturally appropriate community testing and contact tracing services in a manner that is inclusive of elevated-risk individuals and communities.
Governor Tony Evers and the Wisconsin Department of Health Services (DHS) announced the hiring of Dr. Michelle Robinson as the Director of the newly formed Office of Health Equity. The Office of Health Equity and its team is attached to the Office of the Secretary and will lead work to advance diversity, equity, and inclusion within the department while also coordinating the development and implementation of policies and programs to address root causes of health inequities.
To bolster local organizations supporting health equity in communities across Kansas, Governor Laura Kelly announced the “Increase the Reach” Grant Initiative. The program specifically aims to reach groups that have been socially marginalized and those experiencing low vaccination rates, including both racial and ethnic minority populations as well as rural communities, and empower community organizations promoting equitable access to the COVID-19 vaccine for all Kansans. The grants will enable these organizations to expand access to vaccines and increase vaccine uptake among those who are unvaccinated.
Many states are looking to fill gaps in race and ethnicity data for Medicaid and related agencies. Working with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, with support from the State Health and Value Strategies (SHVS) program, New York tested multiple strategies aimed at encouraging applicants to answer the optional race and ethnicity questions. This expert perspective highlights an effort by New York’s official state-based marketplace, NY State of Health, to improve the completeness of race and ethnicity data that applicants share when applying for Medicaid; Child Health Plus, the state’s Children’s Health Insurance Program (CHIP); the Essential Plan, New York’s Basic Health Program (BHP); or Qualified Health Plan (QHP) coverage through its Marketplace.
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.
This document promotes a set of uniform data collection standards for race and ethnicity information conducted by, sponsored by, or reported to the Utah Department of Health (UDOH).
This report includes five perspectives of a health equity mindset: why these perspectives are important to advance health equity, ideas for how to put the perspectives into action, and examples of how they were used to shape the CCP project.
A snapshot of the perception of Utah’s community health workers in considering the state’s racial and ethnic minority communities’ attitudes and hesitancy toward the COVID-19 vaccine. Analysis of local data compared with national narratives around vaccine hesitancy may inform strategic approaches to respond to barriers and improve timely vaccine uptake.
The goal of this report is to highlight how factors like race, gender, and class intersect with historical injustices and forces in our institutions and systems to drive health inequities for many individuals and families in Rhode Island.
This State Health Assessment is organized to provide information on social determinants of health, health equity, and health factors, and then focus specifically on eight health themes, as well as the populations impacted in each theme.
The North Dakota COVID Special Populations Strategic Plan will address the concerns found in the data presented at this moment in time and address the specific concerns expressed by North Dakota’s Special Populations related to COVID-19. As a living document, this plan and associated target dates may be modified to reflect community needs.
Longstanding racial and ethnic injustices contribute to disparities in vaccination rates among historically marginalized populations. We are building equity into every aspect of vaccine distribution in order to close the vaccination gap between white populations and Black/African American, Hispanic/Latinx, and American Indian populations in North Carolina.
The Office of Health Equity seeks to acknowledge systemic racism and the social determinants of health to eliminate disparities by addressing and promoting health equity among all people in every community in New Mexico. The Office of Health Equity strives to provide equitable health opportunities by building relationships with communities, establishing collaborations with care providers and forging partnerships with stakeholders to provide quality service in a culturally and linguistically appropriate manner. These measures focus on ensuring all New Mexicans, especially in rural and under-served areas and borderlands, have increased opportunities to be healthy and promote the public health mission of the New Mexico Department of Health.
The purpose of this report is to highlight existing health disparities by race/ethnicity in Nevada, with a focus upon the most current data available. The race/ethnic groups represented in this report are White-non-Hispanic, Black-non-Hispanic, American Indian/Alaskan Native (AI/AN) -non-Hispanic, Asian/Pacific Islander (API) -non-Hispanic, and Hispanic. Racial and ethnic minorities are disproportionately affected by health problems and disease in Nevada and throughout the nation. This report is intended to present current and available data, from the state of Nevada, broken down by race/ethnicity and region, in order to inform health professionals, policy makers, community members, and researchers about existing disparities among Nevada’s population.
This report assesses the current state of Nebraska’s racial and ethnic minority populations and the changes, both positive and negative, which occurred over the 15-year period from 2000-2015. The report focuses primarily on health disparities between Nebraska’s racial and ethnic populations, including diseases, health status, and health behaviors. However, various disparities by gender, immigrant status, language ability, income, and education are also included.
To ensure the positive health trends are not reversed and to create a healthier Montana, the Public Health and Safety Division (PHSD) of the Montana Department of Public Health and Human Services (DPHHS) initiated a strategic planning process in 2017. Twenty-four members, representing healthcare and public health agencies across the state, served on the steering committee for this process. This steering committee is called the State Health Improvement Coalition and it developed the five-year State Health Improvement Plan (SHIP) contained in this report.
To assess Mississippians’ COVID-19 Vaccine confidence, the Mississippi Community Engagement Alliance Against COVID-19 Disparities (CEAL) Team and the Mississippi State Department of Health (MSDH) Office of Preventive Health and Health Equity (OPHHE) disseminated a statewide vaccine confidence survey beginning end of December 2020 and collecting data until March 2021. The survey is intended to be representative of Mississippians, with intentional efforts invested to reach lower income and rural Mississippi populations, as well as the state’s Black, Hispanic (Latino/ Latinx), Asian (including the Vietnamese population of the Gulf Coast), and Native American/Choctaw communities.
We encourage dissemination of these strategies to improve health outcomes for racial and ethnic minorities. Our goal is to share material included in the literature and promote effective interventions. We hope you will review the findings included in this report and consider them when you are developing programs, issuing request for proposals, and determining the types of endeavors to fund. We are committed to sharing research findings and evaluation results as it pertains to improving health and social outcomes for racial and ethnic populations and encourage dissemination of this information widely.
As part of the Health Policy Commission’s (HPC) work to apply an equity lens to all of its workstreams, it is important to develop a shared understanding of the context of racism and inequities affecting health and a common vocabulary for communicating about equity that avoids bias, encourages inclusion, and prompts reflection in all of our work. The purpose of this guide is to be a practical resource for all HPC staff: (1) to promote intentional and consistent use of language and terminology across the agency when possible and practical; (2) to encourage reflection among staff as they communicate about equity within their workstreams; and (3) to provide resources, tools (including preferred terms), and HPC-specific use cases that can support staff.
The Racial Equity Data Road Map is not a toolkit or one-size-fits all approach. Instead, it is a living document that outlines a number of steps for using data that have been piloted and tested within MDPH as one part of our journey towards achieving racial equity. As such, while the sections are presented in a way that is hopefully easy to follow, there is no set order in which they should be followed. Instead, users of the Road Map can move through the document at the pace and in the manner that makes the most sense for the program or issue being addressed, taking into consideration funding requirements, approval processes, and decision-making structures as needed.
Tackling inequity at its source is a complex challenge that must start with addressing barriers to economic participation, education, and health care that are holding families of color—and the state’s economy—back from their fullest potential. This report will explore the social determinants of health that lead to such inequities, defined here as the conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of liferisks and outcomes.1 The social determinants of health fall into five domains: (1) economic stability; (2) education access and quality; (3) health care access and quality; (4) neighborhood and built environment; and (5) social and community context.2 The first section of the report provides Recommendations By Subject that impact these domains, while the second section outlines Subjects For Future Study.
Leading health improvement and tackling health equity is the mission of the public health system. In the state of Illinois, one initiative to fulfill this mission is a coordinated project titled Healthy Illinois 2021. This initiative is composed of three statewide efforts: the State Health Assessment (SHA), the State Health Improvement Plan (SHIP), and the plans for state health system innovation that started under the State Innovation Model (SIM). Collectively, these components work together to align and coordinate plans, processes, and resources to drive health improvement and work toward health equity.
This report represents a collaborative effort between the Hawaiʻi State Department of Health and a diverse group of academic and community partners. As the magnitude of the COVID-19 pandemic grew over time, it became clear that public health authorities could not adequately address the threats posed by this disease alone. Partnerships with the Native Hawaiian and Pacific Islander COVID-19 Response, Recovery, and Resilience Team and other community-based organizations serving the Native Hawaiian, Pacific Islander, and Filipino communities as well as the input from the Office of Public Health Studies and Department of Native Hawaiian Health at University of Hawaiʻi at Mānoa were instrumental to mounting an effective response. Their perspectives are included through the voices of the authors and contributors to this report who represent these organizations as well as through feedback provided by reviewers.
Healthy Connecticut 2025 is designed to provide an even more focused framework for agencies, coalitions, organizations, groups, and individuals to use in leveraging resources, coordinating and aligning efforts, eliminating redundancies and duplicative efforts, and sharing data and best practices to improve the health of Connecticut residents in a purposeful and measurably impactful way.
This document is intended to support local communities in achieving their Health Equity Measure as part of the California’s Blueprint for a Safer Economy and building an equitable recovery. More specifically, counties can use this document to inform Targeted Investment Plans that will be leveraging Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (Strategy 5: Use Laboratory Data to Enhance Investigation, Response, and Prevention) grant funds throughout implementation. This living document will continue to be updated as the pandemic progresses and as more is learned about what strategies are working on the ground.
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.
Governor Laura Kelly announced that her Commission on Racial Equity and Justice has released its second report, which makes recommendations on ways that Kansas can improve racial equity around the social determinants of health, focusing on economic systems, education access, and health care. The recommendations address topics including teacher diversity, tax policy, early childhood education, and maternal and child health.
The University at Albany published a new report that researches why communities of color in New York have been disproportionately impacted by COVID-19. The research, carried out in partnership with the New York State Department of Health and other partners, adds to the existing well of knowledge about health disparities in New York by identifying the environmental, socioeconomic and occupational factors that explain why COVID-19 has disproportionately harmed Black and Hispanic New Yorkers and proposes practical intervention strategies to eliminate these disparities and save lives. Additionally, the work suggests important differences exist in the way different minority groups experience the progression of the disease. This project is an important initial step toward filling some of these gaps and identifying interventions that, by necessity, must be informed by and rooted in community experiences and insight.
The COVID-19 pandemic has highlighted health inequities across the nation and in Wisconsin. COVID-19 has been hard on everyone, but data shows that Wisconsin’s Black, Indigenous, and people of color (BIPOC) have been disproportionately affected by COVID-19. Inequities are reflected in COVID-19 vaccination rates. Many of the factors that contribute to health disparities may also be barriers that prevent people from getting vaccinated, as the data shows that white populations have higher vaccination rates.
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.
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 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.
The Oregon Health Authority published a report on COVID-19 race, ethnicity, language and disability (REALD) data that highlights the inequitable impact of the disease on specific racial and ethnic groups, and challenges faced by those with language, disability and health access barriers. In 2020, the Oregon Legislature passed a law (House Bill 4212) that requires health care providers to collect REALD information at health care visits related to COVID-19, and to share this information with Oregon Health Authority (OHA).
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.
Pennsylvania Department of Human Services Racial Equity Report 2021
Presentation that Oregon Health Authority made at the 2020 NAHDO conference about Oregon’s APAC/APCD and leveraging race and ethnicity data from other state data sources.
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.
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.
California’s Blueprint for a Safer Economy includes a health equity metric which will be used (along with other metrics) to determine a county’s tier. The purpose of this metric is to ensure California reopens its economy safely by reducing disease transmission in all communities. This document outlines the equity metric and requirements which is effective October 6, 2020.
The Louisiana Department of Health’s (LDH) Office of Community Partnerships and Health Equity, in partnership with LDH agencies, is working to assess, understand, and improveexisting practices and policies, as well as deliver intentional strategies that will build health equity and be informed by (i.e., leverage) Louisiana’s health disparities and inequities.
The Louisiana Department of Health’s (LDH) Office of Community Partnerships and Health Equity, in partnership with LDH agencies, is working to assess, understand, and improveexisting practices and policies, as well as deliver intentional strategies that will build health equity and be informed by (i.e., leverage) Louisiana’s health disparities and inequities.
In the Louisiana Department of Health (LDH), barriers to health (BTH), are seen as those factors that prevent an individual, popu-lation, and/or community from acquiring a) access to health services and/or b) achieving their best health.1 LDH also recognizes that barriers to health can be systems (i.e. structural determinants) that offer health care and services; these systems are shaped by a wider set of forces: economics, social policies/social norms, and politics.3Further, it is also important to note what may be a barrier to one person, population, and/or community may be an asset to others, based on social and cultural factors. Thus, all people, populations, and communities are not all the same and there must be intentionality in ensuring that all whom LDH serve are treated and provided services in a matter that take into consideration-programmatically respond to the environments and circumstances of people, populations, and communities—supporting them in achieving their fullest, best health.
As announced on August 28, 2020, the Blueprint for a Safer Economy includes a health equity metric which will be used (along with other metrics) to determine a county’s tier. The purpose of this metric is to ensure California reopens its economy safely by reducing disease transmission in all communities. This document outlines the equity metric and requirements which is effective October 6, 2020.
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.
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.
Based on recommendations of the Health Disparity Task Force, Governor Tom Wolf announced the state is now collecting sexual orientation and gender identity data as part of the state’s COVID-19 data collection effort.
The Ohio Department of Health created a new position that will build on existing efforts to respond to health inequity by working directly with local communities on their specific long-term health needs and Ohio’s response to COVID-19.
Governor Mike DeWine formed the COVID-19 Minority Health Strike Force on April 20, 2020, in response to the disproportionate impact of COVID-19 on minorities in Ohio. The strike force contracted with the Health Policy Institute of Ohio (HPIO) to develop this “COVID-19 Ohio Minority Health Strike Force Blueprint.”
The state of New York is expanding access to testing for communities of color and low-income neighborhoods by establishing an initial 24 testing sites at churches in predominantly minority communities in downstate New York.
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.
In a letter to the state’s Patient Protection Commission, the Governor of Nevada requested that the Commission develop long-term policy recommendations that address COVID-19 and broader health equity concerns.
The Wisconsin Department of Health Services (DHS) announced $10 million in funding for health care providers serving the state’s most underserved populations, including rural health clinics, tribal health clinics, community health centers, and free and low cost clinics.
The Virginia Department of Health and the Health Equity Task Force partnered with a local media outlet to provide information about the next phases of the recovery process and its implications for health equity.
The Virginia Department of Health and the Health Equity Task Force partnered with a local media outlet to provide information about the next phases of the recovery process and its implications for health equity.
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 task force will act in an advisory capacity to the Governor and study the causes of racial disparities in the impact of COVID-19 and recommend actions to immediately address such disparities and the historical and systemic inequities that underlie them.
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.
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.