Furthering health equity is a priority under the Biden-Harris administration which provides an important opportunity for Medicaid to be leveraged to reduce heath disparities. Because of Medicaid’s ability to support and even incentivize state-level innovation, its disproportionate coverage of people of color, and its national breadth, it has the potential to reduce racial disparities and shrink system-level barriers to achieving health equity. Focusing on equity within a federal Medicaid context can help guide all states towards meeting equity goals, recognizing that states differ in terms of how well-positioned they are to innovate and address equity. The Center for Medicaid and CHIP Services (CMCS) and Center for Medicare and Medicaid Innovation (CMMI) have outlined their commitment to promoting policies and investing in health care service and delivery models that focus on health equity.
This post summarizes lessons from the panel “Medicaid and Health Equity: Federal Policy Context and Priorities” which featured presentations from CMCS, CMMI, and Dr. Cara James, President and CEO of Grantmakers in Health, at the AcademyHealth co-hosted meeting “Harnessing Medicaid to Improve Health Equity: A Research and Policy Agenda.” Presenters from CMCS and CMMI discussed upcoming policy priorities and James emphasized the importance of improving data quality in Medicaid and ensuring that strides made towards health equity are sustainable in the long-term.
CMCS Policy Priorities
CMCS has identified three policy priorities to strengthen the administration of the Medicaid program – (1) enhancing coverage and access, (2) ensuring equity, and (3) promoting innovation and whole person care. Proposed efforts to improve performance in these areas include using funds and regulations to shape the dialogue and requirements around measures states should be reporting, determining how and where to allocate money, and identifying measures to ensure accountability and progress. However, officials acknowledged that variability across state Medicaid programs means that the capacity to conceptualize these measures and use these tools can differ based on each state’s capabilities and indicated that investing in supports that integrate equity into health care delivery systems and in progress measures that maintain accountability are important to furthering health equity across states.
CMMI Health Equity Pillars
In 2021, CMMI identified four pillars to advance health equity. These pillars will be included in new health care payment and service delivery models that launch in 2023 and will also be incorporated into current health care models.
Pillar 1: Develop new models and modify existing models to promote equity
CMMI is planning to advance health equity by embedding reliable measures of equity and social determinants of health into Medicaid payment and service delivery models. By embedding equity measures as part of financial and technical assistance and in service delivery model ideation, CMMI seeks to reach new providers in underserved communities. Recording the race and geographic environment of patients can help reduce racial and ethnic disparities in patient outcomes by illuminating service gaps and tailoring responses to address those needs. While there is opportunity for Medicaid to advance health equity, historically, addressing health disparities has not been a focus in these programs. Moreover, providers in underserved communities have been underrepresented in delivery models, facing both financial and technical barriers to participation. Incorporating equity measures into Medicaid models could help identify successful programs to mitigate these gaps and barriers.
Pillar 2: Increase the number of beneficiaries from underserved communities receiving care through value-based models
Underserved populations include consumers who receive fewer health care services, encounter barriers to accessing primary health care services or providers, or those who have a lack of familiarity with the health care delivery system. To better serve these individuals, CMMI plans to increase participation of traditional safety-net providers in delivery system innovations. This includes recruiting providers who have not joined models in the past and ensuring the application and selection processes encourage participation. For example, CMS is proposing to provide technical and financial assistance in the application process to promote a diverse portfolio of providers.
Pillar 3: Evaluate models specifically for their impact on health equity
To evaluate the impact of care delivery models, CMMI plans to introduce health equity evaluation measures. Additionally, they plan to share data and lessons learned to inform future work. Currently, the success of models is narrowly defined to include cost and quality, but not equity. The impact different models have on health equity is not known because evaluation criteria were not designed with equity in mind.
Pillar 4: Strengthen data collection and collaborative partnerships
CMMI plans to strengthen data collection and intersectional analyses for populations defined by demographic factors, such as race, ethnicity, language, geography, disability, sexual orientation, and gender identity, to identify gaps in care and develop interventions to address them. CMMI sees collaborative partnerships outside of the U.S. Department of Health and Human Services as necessary for understanding how social determinants of health and systemic barriers may combine to shape access to care.
Both CMCS and CMMI recognize and are prioritizing the substantial opportunities to increase Medicaid’s role in addressing health disparities. Further research identifying gaps Medicaid can address and how to incentivize action through flexible funding streams would allow CMS to be more actionable raising health equity standards nationally. However, even as the current federal administration is prioritizing equity in its policy decisions, it is too early to tell what impacts these efforts will have or how long-lasting they will be.
This blog post highlights learnings from the panel “Medicaid and Health Equity: Federal Policy Context and Priorities” presented at the meeting “Harnessing Medicaid to Improve Health Equity: A Research and Policy Agenda” on December 1 and 2, 2021 This meeting was co-hosted by Julie Donohue of the University of Pittsburgh, Susan Kennedy of AcademyHealth, Genevieve M. Kenney of the Urban Institute, Chima Ndumele of Yale University, and Kosali Simon of Indiana University.