Drawing on insights learned through discussions with state officials, informed by grassroots community organization input and a review of the literature, this issue brief outlines key barriers states face in their efforts to increase vaccination rates among BIPOC and highlights strategies states are pursuing in partnership with community-based organizations (CBOs) to address these challenges. This issue brief also considers future phases of the COVID-19 vaccine rollout and planning, including near-term efforts to vaccinate children and adolescents, as well as longer-term opportunities to build sustainable infrastructure and capacity to advance health equity related to the pandemic, emergency preparedness, and beyond within state and local public health and health care delivery systems.
Collection of Race, Ethnicity, Language (REL) Data in Medicaid Applications: A 50-state Review of the Current Landscape
This issue brief documents how states are collecting information about race, ethnicity, and language on their Medicaid applications. The information presented here draws from the State Health Access Data Assistance Center’s (SHADAC’s) review of 50 states’ paper Medicaid applications and 33 states’ online Medicaid applications. For this resource, the authors provide an overview of REL data collection standards and examine state Medicaid application’s question structure, answer options, and instructional language. They also provide an overview of the frequency of different iterations of questions and responses and provide state examples to illustrate common and unique data collection practices.
The American Rescue Plan Act includes a number of provisions that will significantly impact state and federal health care policies and programs, including enhanced federal funding for state Medicaid spending on home- and community-based services (HCBS). Beginning April 1, 2021 and through March 31, 2022, states will be eligible to receive a 10 percentage point increase in their federal medical assistance percentage (FMAP)—the share of state Medicaid spending that is paid for by the federal government—for specified HCBS. This updated brief describes ARP’s HCBS enhanced FMAP provision, CMS’s recent implementation guidance, and considerations and next steps for state policymakers.
The American Rescue Plan Act of 2021 (ARP) establishes a new state option to extend Medicaid and CHIP coverage for pregnant women for one year following the baby’s birth. ARP’s new state option to extend continuous coverage for one-year postpartum enables states to take a major step towards improving health outcomes for postpartum women and their babies. This issue brief reviews the policy and operational considerations for states who are considering extending postpartum coverage.
Assessing the Fiscal Impact of Medicaid Expansion Following the Enactment of the American Rescue Plan Act of 2021
A substantial body of evidence indicates that adopting the Medicaid expansion delivers myriad benefits to states and Medicaid enrollees at a modest cost to states. Currently, 12 states have not yet taken up the ACA Medicaid expansion, leaving approximately 2.2 million adults in the so-called “coverage gap” without an affordable source of coverage. The recent enactment of the American Rescue Plan Act of 2021 (ARP) makes the fiscal case for Medicaid expansion even stronger by providing states that implement expansion after the enactment of ARP with a significant increase in Medicaid funding. This issue brief describes the ARP matching rate provision and also assesses its fiscal impact for each of the states that have not yet expanded Medicaid, while comparing the available new federal dollars to the cost of expansion.
CMS Guidance to States on Resuming Public Health Program Operations Post the COVID-19 Public Health Emergency
On December 22, 2020, the Centers for Medicare and Medicaid Services released long-awaited guidance to state Medicaid and CHIP agencies on resuming normal operations following the end of the COVID-19 public health emergency. This issue brief provides a high-level summary of the CMS guidance related to: (1) conducting redeterminations for Medicaid enrollees who were continuously enrolled; (2) terminating, or extending where appropriate, temporary flexibilities; and (3) developing a consumer and provider communication strategy.
The Affordable Care Act (ACA) sets up a structure with key roles for both federal and state policymakers. From establishing a state-based marketplace to a temporary Maryland supplemental reinsurance program, Maryland has taken steps to make health insurance more affordable. This case study describes the measures taken by the state to improve affordability and coverage, identifies unique program design features, and discusses their bipartisan appeal as experienced in Maryland. Maryland’s efforts can serve as a helpful framework for other similarly situated states seeking to address pressing health coverage affordability issues.
After a dynamic few weeks of negotiations, President Trump signed into law on December 27, 2020 a nearly 6,000-page legislative package (The Consolidated Appropriations Act, 2021) that includes government appropriations through September 30, 2021; COVID-19 relief funding and targeted policy changes, a subset of which impact health programs; extensions of expiring health programs; a ban on surprise billing; and an amalgam of odds-and-ends health policy provisions. This analysis includes a summary of those health care provisions.
The COVID-19 pandemic has highlighted longstanding health inequities which have resulted in an increased risk of sickness and death for people of color. The crisis has also propelled a nationwide focus on understanding and addressing health inequities. This issue brief explores impediments and accelerants to advancing health equity as states are increasingly being called upon to drive change.
This issue brief is designed as a resource for states looking to adopt a measure to assess social risk factor screening rates. It is the result of a series of convenings that the authors facilitated with three states—Massachusetts, Oregon, and Rhode Island—which helped them consider, discuss, and share perspectives related to the development of their own social risk factor screening process measures. The issue brief looks at the progress these states and North Carolina have made in developing their own social risk factor screening measures and highlights considerations for other states either planning to adopt an existing or develop a new screening measure.