This issue brief spotlights the opportunity to enhance health equity in maternity care through payment. The issue brief discusses the landscape of Medicaid reimbursement trends for midwifery and doula coverage and recommends strategies to enhance access to a diversity of maternal care providers through equitable reimbursement.
To encourage states’ take-up of unwinding-related section 1902(e)(14) waivers, the Centers for Medicare & Medicaid Services (CMS) announced an extension of these waivers through December 31, 2024 (or a later date approved by CMS) and offered new operational considerations and illustrative scenarios to assist states in implementing the waivers. This issue brief is intended to help states evaluate whether to take up additional section 1902(e)(14) waiver flexibilities and determine which to explore further based on emerging evidence of their effectiveness.
Collection of Self-Reported Disability Data in Medicaid Applications: A Fifty-State Review of the Current Landscape
Very little is known about people who self-identify as having a disability within the Medicaid program who are not a part of the group that qualifies for benefits through a disability-related eligibility category. This issue brief provides an overview of current disability data collection standards and documents how states are collecting self-reported disability information on their Medicaid applications.
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.