This document provides excerpts of health disparities and health equity contract language from Medicaid managed care (MMC) contracts from 12 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California. The criteria for inclusion in this compendium were contracts that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available.
On Wednesday, February 24, State Health and Value Strategies hosted a webinar on analyzing health disparities in Medicaid managed care. Health disparities are a key indicator of health equity and understanding health care disparities is a critical component of informing systems changes to improve health care outcomes. Stratifying performance data by race, ethnicity, disability, gender identity, or sexual orientation can inform targeted interventions to reduce health care disparities; yet many states lack complete and reliable data to do so. During the webinar, experts from Bailit Health discussed how states can use performance rates and disparities analyses from Medicaid managed care programs in other states to determine where disparities are likely to exist in their own state and develop interventions.
Many states are experiencing budget shortfalls due to the COVID-19 induced recession. Since Medicaid accounts for a significant portion of states’ budgets, states often look to the Medicaid program for savings. Since the Great Recession, states have invested in initiatives that can improve care and also lower costs—such as improving coordination of behavioral health and physical health services, making home and community-based options more available to those who might otherwise go into nursing homes, addressing social drivers of health, and lowering pharmacy costs. Not all of these initiatives can generate short-term savings, but they offer other actions that states facing budget shortfalls may take to achieve savings. This toolkit outlines state options to address Medicaid spending without harming enrollee health and provider stability and access to care.
On Thursday, January 21 State Health and Value Strategies hosted a webinar on the long-awaited guidance to state Medicaid and CHIP agencies on resuming normal operations following the end of the COVID-19 public health emergency. During the webinar experts from Manatt Health discussed the sub-regulatory guidance and the implications for states, in light of the recent public health emergency renewal by Secretary Azar. The webinar reviewed the expectations laid out in the guidance related to timelines, consumer communications, and fair hearing processes for redetermining Medicaid eligibility for those who have had their coverage continuously maintained as a condition of receiving the temporary 6.2 percent FMAP increase under the Families First Coronavirus Response Act. Additionally, presenters discussed the expected processes and timelines for terminating, or making permanent where allowable, temporary federal flexibilities that were obtained.
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.
In the waning days of 2020, Congress enacted a $900 billion COVID-19 relief package and government funding bill. Included in the measure is the “No Surprises Act,” which contains new protections for consumers from surprise medical bills from out-of-network providers. State Health & Value Strategies hosted a webinar during which experts from Georgetown University’s Center on Health Insurance Reforms, Manatt Health, and tax expert Jason Levitis reviewed the provisions of this legislation and their implications for states. The webinar reviewed the No Surprises Act and provided an overview of the next steps for implementing the federal balance billing protections and what the law will mean for state-level protections. Additionally, presenters discussed a number of other key health care provisions, including state and locality funding for COVID-19 vaccine distribution and testing as well as policy changes to the Provider Relief Fund, and the impact of additional unemployment compensation and relief payments on eligibility for financial assistance for health coverage.
Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and End Dates
To help states respond to the ongoing coronavirus (COVID-19) pandemic, the White House, the U.S. Department of Health and Human Services, and the Centers for Medicare and Medicaid Services have invoked their emergency powers to authorize temporary flexibilities in Medicaid and the Children’s Health Insurance Program. Congress’s legislative relief packages have provided additional federal support for state Medicaid programs, subject to certain conditions. The timeframes for these emergency measures are summarized in the chart, including the effective dates and expiration timelines dictated by law or agency guidance. The chart also includes current end dates, which are subject to change as federal and state officials take actions to renew or terminate particular authorities.
On Tuesday, December 15 State Health and Value Strategies hosted a webinar on how states can support children and youth with special health care needs during COVID-19. The COVID-19 pandemic has created significant health and economic hardships for many children and families. Children who receive health services in school settings to support their education are losing access to those services. In addition, a pre-COVID-19 shortage of home health providers has worsened due to the pandemic, placing a significant burden on families who rely on home health services. The result can lead to gaps in care and caregiver burnout, putting children and youth with special health care needs at risk of regression and long-term negative health outcomes. Recognizing these risks, states and the federal government have broadly expanded telehealth coverage, established continuous coverage requirements and eased regulatory requirements for delivery of services. The webinar, produced by Manatt Health with the American Academy of Pediatrics, Family Voices, and the Georgetown Center for Children and Families with funding from the Robert Wood Johnson Foundation and the Lucile Packard Foundation for Children’s Health, explored strategies for state Medicaid agencies to enforce coverage requirements and make permanent the temporary regulatory flexibilities that have expanded access to services during the pandemic.