The unwinding related section 1902(e)(14) strategies newly available to Medicaid and CHIP agencies can provide significant relief to states facing pending eligibility and enrollment actions and processing delays, workforce and systems limitations, and other operational challenges. Ensuring eligible individuals do not lose coverage for procedural or administrative reasons and supporting those who are ineligible for Medicaid/CHIP transition to Marketplace coverage will be paramount for all states as they begin to resume normal operations when the federal public health emergency (PHE) ends. This expert perspective outlines the time-limited targeted enrollment flexibilities that CMS has availed to states through section 1902(e)(14) waiver authority and discusses considerations beyond the strategies described in federal guidance and supplemental resources.
Strategies for States to Drive Equitable Vaccine Distribution and Administration
Patricia Boozang, Nina Punukollu, and Michelle Savuto, Manatt Health
Since December 2020, the United States has administered more than 330 million COVID-19 vaccine doses, with 163 million people, or 49 percent of the population, completing a full vaccine series. While these results show significant progress by the federal government, states, local governments, and their community partners to reduce COVID-19 transmission, hospitalizations, and deaths, efforts to date have not produced equitable outcomes. Rates of COVID-19 vaccination vary widely within and across states, communities, and racial and ethnic groups, with those communities that are disproportionately experiencing the negative impacts of COVID-19 often having the lowest rates of vaccination. The disparities in vaccination rates among Black, Indigenous, and people of color (BIPOC) as compared with white Americans highlight the longstanding inequities and structural racism that underpin the United States health care delivery system and that contributed to disparities in health outcomes before and during the COVID-19 pandemic.
While more than 20 states and the District of Columbia reached the Biden-Harris administration’s goal of administering one or more COVID-19 vaccine doses to at least 70 percent of adults by early July, wide variation in vaccination rates persists across communities within these states and among the 30 states still working to reach this goal. The vaccination rate variation at the community level translates to disparities across racial and ethnic groups, as many states with relatively low vaccination rates overall have higher proportions of BIPOC, and most states continue to have disparities in vaccination rates between BIPOC and white populations. Federal, state, and local data shows that BIPOC have received smaller shares of COVID-19 vaccines compared with the shares received by the total population, despite experiencing disproportionately higher rates of COVID-19 cases, hospitalizations, and deaths. Across 40 states with available data, the percentage of people who are white and have received at least one COVID-19 vaccine dose was roughly 1.4 times higher than the rate for people who are Black and 1.2 times higher than the rate for people who are Latino(a) as of early July. These gaps began to close in recent weeks, however, as BIPOC comprised a greater share of newly administered vaccinations.
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.
A common thread across these state strategies, both near and long term, is meaningfully engaging, fostering, and funding close partnerships with CBOs and other community partners as a cornerstone for success. Community partners can help states understand barriers to vaccine uptake across communities and implement focused and tailored strategies that address concerns at the individual level, in the near term, while building the necessary structures to reimagine and rebuild a public health system that fosters trust, centers on the community, and addresses long-standing and underlying social drivers of health (SDOH) inequities.
On August 12, State Health and Value Strategies hosted a companion webinar during which experts will provide an overview of the strategies states can pursue in partnership with community-based organizations to reduce disparities in COVID-19 vaccine uptake, and in the longer term, to build a more equitable and sustainable public health system. States and their community partners are implementing a broad range of distribution and outreach strategies to improve vaccine equity and are looking to build sustainable infrastructure and capacity to advance health equity within state and local public health and health care delivery systems. This webinar shared the lessons learned from a larger project between the Rockefeller Foundation, Families USA, and State Health and Value Strategies’ program partners Manatt Health and Health Equity Solutions.