May, 31, 2024

Promoting Health Equity Through State Medicaid Managed Care Strategies, May 2024

Erin Taylor and Mary Beth Dyer, Bailit Health

States are increasingly identifying and implementing Medicaid managed care (MMC) strategies to confront longstanding and persistent health inequities and improve culturally and linguistically appropriate care. State Health and Value Strategies continues to support states’ efforts with updates to the Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity. The Compendium describes nine approaches states are taking within their MMC programs to promote health equity, including strategies to identify and reduce healthcare disparities and foster cultural competency and humility. The latest edition features examples from more than 20 states, including Florida, Georgia, New Hampshire, New Mexico, and Rhode Island, five states that are new to the Compendium.

Approaches used in many state MMC programs include stratification of managed care entity (MCE) performance measures by members’ race, ethnicity, language, or other factors and training requirements for MCE staff and network providers to promote health equity and/or cultural competency. This expert perspective highlights an MMC approach that was newly added to the Compendium.

Primary Care Assignment and Continuity of Care

The 2024 Compendium describes how some states are integrating health equity and cultural competency into MMC provisions related to member assignment to a primary care provider and continuation of culturally and linguistically appropriate services.

In general, MMC programs require members to select a primary care provider within a certain timeframe. If a member does not identify a primary care provider, states and MCEs may consider prior relationship with a primary care provider, claims history, proximity to a provider’s practice, or other factors to identify and assign a primary care provider for the member. This is often referred to as auto-assignment.

When a member does not identify a primary care provider, states provide guidance to their contracted Medicaid managed care entities (MCE) to establish a primary care relationship. Some states require that Medicaid MCEs ensure racial, ethnic, language, and/or cultural concordance or competence between the member and primary care provider when implementing auto-assignment algorithms. For example, when performing auto-assignment, Florida Medicaid MCEs must assign members to primary care providers who are linguistically and culturally competent to communicate with the members or have office staff who can do so. Similarly, Pennsylvania Medicaid MCEs must consider language and cultural compatibility between the member and assigned primary care provider.

In addition, for a new member, or when a provider is terminated for a reason other than cause, Minnesota requires MCEs upon request to authorize continuation of covered services from the member’s current provider for up to 120 days if a member is receiving culturally and linguistically appropriate healthcare services and there is not another provider in the network within the time and distance requirements of the MCE contract who can meet those needs.

The Compendium also includes updated information for several states featured in prior versions. State policymakers and Medicaid officials can use this 2024 edition of the Compendium to develop MMC procurements or update and operationalize key MMC contract provisions to promote health equity and improve linguistically and culturally appropriate care.