Apr, 07, 2023

What’s New in State Approaches to Promoting Health Equity in Medicaid Managed Care

Bailit Health

States are increasingly leveraging their Medicaid programs to transform healthcare delivery and improve individual and population health with a focus on promoting equity. States are implementing approaches within Medicaid managed care (MMC) to address longstanding, well-documented, and persistent health inequities.

State Health and Value Strategies continues to support states’ efforts by updating the Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity. This latest update describes approaches 21 states are taking within MMC to promote health equity, features state examples for further illustration, and includes excerpts from state contract and procurement documents. It also identifies states’ efforts to leverage their MMC programs to foster cultural humility. The new format aligns with the structure of the Addressing Health-Related Social Needs Through Medicaid Managed Care toolkit.

This latest edition incorporates examples from MMC procurements from Delaware, Mississippi, Missouri, Nebraska, Texas, and West Virginia, six states that are new to the Compendium. It also includes updated information for several states featured in prior versions. Below are highlights from the states that are new to the Compendium.

Delaware requires managed care plans (MCPs) to identify disparities in access, enrollee satisfaction, and outcomes; obtain member-identified race, ethnicity, disability, and other demographic data; and stratify measures, such as Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS), to determine populations at highest risk of poor health outcomes. MCPs in Delaware are also required to attain the National Committee for Quality Assurance’s (NCQA) Health Equity Accreditation within two years of the contract start date and maintain the status throughout the duration of the contract.

Mississippi MCPs must have at least one care manager on staff with “special training and knowledge of Care Management practices relevant to Mississippi’s Native American community.”[1]

Texas requires MCPs to have a cultural competency plan that describes how MCPs will implement the national standards for Culturally and Linguistically Appropriate Services (CLAS).  

Missouri requires MCPs to partner with and engage community members in designing and implementing culturally and linguistically appropriate services.  

Several states, such as Delaware and Texas, have included case-scenario questions in their procurements to understand how respondents would support individuals with limited-English proficiency and/or unique cultural considerations.

State policymakers and Medicaid officials can use this new edition of the Compendium to develop or update aspects of managed care procurements and MMC contract provisions to promote health equity. SHVS will continue to monitor MMC programs to support dissemination and cross-state learning of health equity activities.

[1] Mississippi Division of Medicaid. (2022). DOM CCO Procurement – Appendix A – CCO Contract. State of Mississippi. https://medicaid.ms.gov/coordinated-care-procurement/. Accessed April 3, 2023.