States Are Leveraging Medicaid Managed Care to Further Health Equity
Erin Taylor and Mary Beth Dyer, Bailit Health
To support state efforts, SHVS continues to sponsor ongoing updates to Medicaid Managed Care Contract Language: Health Disparities and Health Equity compendium. (See the related expert perspective for an introduction to the compendium.) The compendium provides Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality programs, and procurement processes, to promote health equity and address health disparities. Medicaid plays a central role in providing health care coverage to groups that have been economically and socially marginalized. Many states are turning their attention to their managed care programs to address persistent health disparities and the conditions that create health inequities for Medicaid enrollees.
This latest update to the SHVS compendium incorporates excerpts from Medicaid managed care procurements and model contracts in California, Indiana, Louisiana, and Nevada. Each of these states include managed care contractor key personnel requirements with specified responsibilities for promoting health equity and addressing health disparities. Three states newly added to the compendium–-Louisiana, Indiana, and Nevada–-will require their Medicaid managed care organizations (MCO) to develop and submit annual health equity plans. For example, Louisiana’s request for proposals (RFP) and Model Contract include requirements for:
- A Health Equity Administrator key position
- Health equity and social determinant of health training for contractor’s staff
- A Health Equity Plan to address disparities in care that exist in the contractor’s member population
- A health equity withhold linked to the Health Equity Plan and preferred value-based payment arrangements that reduce health disparities and improve equity
- Specific quality performance measures that must be stratified by race/ethnicity and rural/urban status
The SHVS compendium also contains examples of recent managed care RFP questions related to health equity, racial equity, reduction of disparities, and the provision of culturally specific care from the Indiana, Louisiana, and Nevada Medicaid procurements. For example, respondents to the Louisiana MCO RFP must describe:
- Management techniques, policies, procedures, and initiatives it has implemented to promote health equity for enrollees and the proposed approach to promoting health equity for its Medicaid managed care program in Louisiana.
- Strategies it uses or will use to recruit, retain, and promote at all levels, personnel and leadership who are representative of the demographic characteristics of its Medicaid managed care populations and, in particular, those persons who identify as members of communities underrepresented in the workforce to date.
- How it will use feedback from enrollees and their family members to identify and execute program improvements.
With support from SHVS, the authors will continue to monitor Medicaid managed care programs for innovative approaches related to improving equity and addressing health disparities.
 The compendium incorporates information from California Medi-Cal Managed Care Plans (MCP) Draft Request for Proposals (RFP), which was released on June 2, 2021, and included a sample contract package for 2024 implementation. The draft RFP and model contract are not complete. Additional provisions are expected to be included in the final RFP.