Addressing Health Equity: A Legal Roadmap for Policymakers aims to support state Medicaid policymakers working to address health inequities through state action.
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 brief summarizes the advantages and disadvantages of four common approaches to health equity benchmarking: 1) Using the best-performing group as a reference; 2) using the most socially advantaged group as a reference; 3) comparing against a population average; and 4) comparing against a set target or goal.
Medicaid Managed Care Strategies to Reduce Racial and Ethnic Health Disparities in Mental Healthcare for Adults
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. The issue brief identifies four approaches states can use to leverage their Medicaid managed care programs to advance their health equity goals. The brief also provides state examples to further illustrate how each approach has been implemented.
State Spotlight: Oklahoma’s Award-Winning Communications Campaign to Promote Medicaid Expansion Enrollment
The Affordable Care Act’s Medicaid expansion allows for the expansion of Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level (FPL) and provides states with an enhanced federal matching rate for their expansion populations. On June 30, 2020, the Oklahoma Medicaid Expansion Initiative, State Question 802, passed by a majority vote to expand Medicaid eligibility to adults ages 19 to 64 whose income is 138% of the FPL or lower. This state spotlight describes the Oklahoma Health Care Authority’s approach to outreach and education in support of overall enrollment goals.
Within government, policy and programmatic changes are often made without engaging the people they will affect or the people currently experiencing the challenges of existing policies and programs. Community engagement is one of the ways states are attempting to establish and maintain trust and improve the accessibility and quality of services. This issue brief outlines the ways in which such efforts can improve communication, lead to more effective and efficient programs, and result in ongoing collaboration with people who have experienced state-run systems and services. The brief also contains a list of strategies and tactics, which offers options for states to consider when working to advance towards transformational community engagement and achieve their community engagement goals.
Community engagement is a key component of health equity work because it fosters trust and mutual respect, unearths unforeseen or unintended barriers to health, and improves efficacy by ensuring programs respond to the experiences of the people they impact. Yet, there is little documentation of how to successfully engage program enrollees, translate engagement into policy change, or resolve challenges related to the resource-intensive nature of engagement. This issue brief provides two case studies highlighting work in Virginia and Colorado to meet these challenges. 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.
Under section 1115 authority, states can waive provisions of Medicaid law and obtain federal approval to fund initiatives not otherwise coverable by Medicaid, provided that proposals are budget neutral to the federal government and further the goals of the Medicaid program. In the past six months, the Centers for Medicare & Medicaid Services (CMS) has approved renewals and/or amendments to several long-standing section 1115 demonstrations, showcasing the Biden administration’s priorities for use of 1115 authority. This issue brief describes how recent approvals in Arizona, Arkansas, Massachusetts, Oregon, and Vermont highlight that states and CMS are leveraging 1115 demonstrations to implement new coverage strategies; address social drivers of health; strengthen the primary care and behavioral health delivery systems; institute value-based payment initiatives; and advance health equity.
Many consumers will find the relationship between Medicaid, the marketplace, and employer-sponsored insurance to be more complicated than ever in 2023 as the unwinding of the continuous coverage requirement begins. Much of the focus of Medicaid unwinding planning in states and the federal government has been on helping eligible people keep Medicaid coverage and steering the millions of people losing Medicaid eligibility toward the health insurance marketplace. Less attention has been devoted to the millions of people who are expected to be eligible for employer-sponsored insurance when their Medicaid coverage ends. This issue brief discusses how state Medicaid agencies, state-based marketplaces, labor departments, and employers can play critical roles in helping people understand and navigate their coverage options.
While much attention has been paid to how states can approach the unwinding of the continuous coverage requirement to prioritize the retention of Medicaid coverage and transitions to marketplace coverage, less attention has been paid to the role of employer-sponsored insurance. To get a sense for the size of the group that might have employer-sponsored coverage as an option, this issue brief discusses the proportion of individuals with an offer of employer-sponsored coverage by income and state, and the proportion of those offers that are considered affordable based on premium cost.
Recent Updates to Section 1115 Waiver Budget Neutrality Policy: Overview and Implications for States
Section 1115 Medicaid demonstrations are a powerful tool for states to pursue a range of innovative programs aimed at improving the health and well-being of Medicaid enrollees. While not required under federal law or regulation, longstanding federal policy requires that 1115 waivers be “budget neutral” to the federal government—in other words, demonstrations must not increase federal spending relative to a state not pursuing an 1115 demonstration. During the summer of 2022, CMS began to roll out a series of changes to budget neutrality policy through state waiver approvals. This issue brief summarizes the key policy changes established through the Oregon and Massachusetts waiver renewals (and reinforced through the Arizona and Arkansas approvals) and discusses key implications for states.