Mar, 16, 2021

Highlights from the Updated Medicaid Managed Care Contract Language: Health Disparities and Health Equity

Erin Taylor, Rachel Isaacson, and Mary Beth Dyer, Bailit Health

Nationally, managed care is the primary delivery system for administering Medicaid benefits, with Medicaid managed care plans providing coverage for nearly 70 percent of Medicaid enrollees.[i] Population groups covered by Medicaid are often among the most economically and socially marginalized. Many states are turning their attention to their managed care programs to address persistent health disparities and the conditions that create health inequities for Medicaid enrollees.

While state Medicaid programs may define health equity differently, in general, health equity means that everyone has a fair and just opportunity to attain their optimal health, regardless of race, ethnicity, disability, gender identity, sexual orientation, or socioeconomic status. Health disparities are avoidable differences in health outcomes experienced by people with one characteristic (race, gender, sexual orientation) as compared to the socially dominant group, e.g., white, male, cis-gender, heterosexual male, etc. The inequitable distribution of resources, racism and discriminatory policies contribute to disparate health outcomes for Medicaid enrollees. Reducing health disparities is but one way to promote health equity.

To support state efforts, SHVS sponsored the development of a compendium of health disparities and health equity language and activities that states are incorporating in their Medicaid managed care programs. SHVS recently released the third update to the Medicaid Managed Care Contract Language: Health Disparities and Health Equity, which includes excerpts from managed care contracts, procurement questions, and other policy documents from twelve states and the District of Columbia. This compendium is a resource for Medicaid officials to see how different states are leveraging managed care to promote health equity and address health disparities, including to identify specific contract and procurement language examples.

The compendium includes fifteen different summaries of managed care documents organized by state and by type of managed care program. Each state summary highlights contract provisions across common categories of state managed care contracts, including general language and definitions, population and community health management, measurement and data analytics, interventions, performance monitoring and incentives, quality improvement, and specialized initiatives.

For example, the compendium includes excerpts from the Ohio Department of Medicaid’s 2020 Request for Applications (RFA) for Medicaid MCOs in which the state establishes key staff requirements for MCOs, including a senior-level Health Equity Director. Ohio’s RFA also establishes expectations of MCOs’ senior leadership related to monitoring health disparities and promoting health equity and will require contracted entities to exchange information about effective strategies and interventions to reduce disparities. The compendium also contains questions from the Minnesota Department of Human Services 2021 Medicaid managed care Request for Procurement (RFP) pertaining to health equity, racial equity, reduction of disparities, and the provision of culturally specific care which respondents must address in their managed care proposals.

Medicaid managed care contracts and procurements represent important levers and opportunities for states to advance health equity. However, addressing conditions that create inequities and contribute to health disparities will require an array of interventions across the health care system, community, provider, and patient levels.[ii],[iii]  Consequently, a number of states profiled in the compendium are complimenting their Medicaid managed care strategies with broader Medicaid and other initiatives that together are designed to make progress toward advancing health equity.

[i] Hinton, Elizabeth, Robin Rudowitz, Lina Stolyar, and Natalie Singer. Issue Brief. 10 Things to Know about Medicaid Managed Care. Kaiser Family Foundation, October 29,2020.  

[ii] “Achieving health equity—where every person has a fair and just opportunity to be healthier— must be the priority. Getting to this goal requires removing barriers to care, such as poverty, discrimination, racism, sexism, and other societal ills.” Taylor, Jamila, Cristina Novoa, Katie Hamm, and Shilpa Phadke. Issue brief. Eliminating Racial Disparities in Maternal and Infant Mortality. Center for American Progress, May 2, 2019.

[iii] Petersen, Emily E., Nicole L. Davis, David Goodman, Shanna Cox, Carla Syverson, Kristi Seed1, Carrie Shapiro-Mendoza, William M. Callaghan, and Wanda Barfield. “Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016,” September 6, 2019.