NASHP Advancing Equity Health Reform

7/28/2019 NASHP Advancing Equity Health Reform

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National Academy for State Health Policy

0ORTLAND -AINE /FCE &REE 3TREET ND &LOOR0ORTLAND -% 0HONE ;=

7ASHINGTON $# /FCE TH 3TREET .7 3UITE 7ASHINGTON $# 0HONE ;=

&OR MORE INFORMATION ABOUT .!3(0 AND ITS WORK VISIT WWWNASHPORG

I I

4HE .ATIONAL !CADEMY FOR 3TATE (EALTH 0OLICY.!3(0 IS AN INDEPENDENT ACADEMY OF STATEHEALTH POLICYMAKERS 7E ARE DEDICATED TO HELPING STATES ACHIEVE EXCELLENCE IN HEALTH POLICYAND PRACTICE ! NONPROT AND NONPARTISANORGANIZATION .!3(0 PROVIDES A FORUM FOR CONSTRUCTIVE WORK ACROSS BRANCHES AND AGENCIES OFSTATE GOVERNMENT ON CRITICAL HEALTH ISSUES /UR

FUNDERS INCLUDE BOTH PUBLIC AND PRIVATE ORGANIZATIONS THAT CONTRACT FOR OUR SERVICES

4O ACCOMPLISH OUR MISSION WE

#ONVENE STATE LEADERS TO SOLVE PROBLEMSAND SHARE SOLUTIONS#ONDUCT POLICY ANALYSES AND RESEARCH$ISSEMINATE INFORMATION ON STATE POLICIESAND PROGRAMS0ROVIDE TECHNICAL ASSISTANCE TO STATES

4HE RESPONSIBILITY FOR HEALTH CARE AND HEALTHCARE POLICY DOES NOT RESIDE IN A SINGLE STATEAGENCY OR DEPARTMENT !T .!3(0 WE PROVIDE AUNIQUE FORUM FOR PRODUCTIVE INTERCHANGE ACROSSALL LINES OF AUTHORITY INCLUDING EXECUTIVE OFCESAND THE LEGISLATIVE BRANCH

7E WORK ACROSS A BROAD RANGE OF HEALTH POLICYTOPICS INCLUDING

!FFORDABLE #ARE !CT AND 3TATE (EALTH#ARE 2EFORM#OVERAGE AND !CCESS-EDICAID1UALITY #OST AND (EALTH 3YSTEM 0ERFORMANCE

,ONG 4ERM AND #HRONIC #ARE1UALITY AND 0ATIENT 3AFETY0OPULATION AND 0UBLIC (EALTH)NSURANCE #OVERAGE AND #OST #ONTAINMENT

/UR STRENGTHS AND CAPABILITIES INCLUDE

!CTIVE PARTICIPATION BY A LARGE NUMBEROF VOLUNTEER STATE OFCIALS$EVELOPING CONSENSUS REPORTS THROUGHACTIVE INVOLVEMENT IN DISCUSSIONS AMONG

PEOPLE WITH DISPARATE POLITICAL VIEWS0LANNING AND EXECUTING LARGE AND SMALLCONFERENCES AND MEETINGS WITH SUBSTANTIAL USER INPUT IN DENING THE AGENDA$ISTILLING THE LITERATURE IN LANGUAGE USEABLE AND USEFUL FOR PRACTITIONERS)DENTIFYING AND DESCRIBING EMERGING ANDPROMISING PRACTICES$EVELOPING LEADERSHIP CAPACITY WITHINSTATES BY ENABLING COMMUNICATION WITHINAND ACROSS STATES

&OLLOW US NASHPHEALTH ON 4WITTER

#OPYRIGHT .ATIONAL !CADEMY FOR 3TATE (EALTH 0OLICY &OR REPRINT PERMISSION PLEASE CONTACT .!3(0 AT

4HIS PUBLICATION IS AVAILABLE ON THE WEB AT WWWNASHPORG

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3TATE 0OLICYMAKERS 'UIDE &OR !DVANCING (EALTH %QUITY 4HROUGH (EALTH 2EFORM )MPLEMENTATION


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!CKNOWLEDGEMENTS

%XECUTIVE 3UMMARY

)NTRODUCTION #OMMON $ENITIONS

3TATE /PPORTUNITIES TO !DVANCE (EALTH %QUITY THROUGH (EALTH 2EFORM )MPLEMENTATION 4ABLE 3ELECT !#! 0ROVISIONS THAT #AN !DVANCE (EALTH %QUITY

)NSURANCE #OVERAGE (EALTH #ARE $ELIVERY 2EFORM $ATA 0OPULATION (EALTH 4HE .!3(0 3TATE (EALTH %QUITY ,EARNING #OLLABORATIVE

3TATE 3ELECTION 0ROCESS 4ABLE (EALTH %QUITY ,EARNING #OLLABORATIVE 3TATES 7ORKPLAN 0RIORITY !REAS

3TATE !CTION TO !DVANCE (EALTH %QUITY USING 3ELECT !#! AND 3TATE 0OLICY ,EVERS

3TATE !CTION 2ELATED TO #OVERAGE AND !CCESS %XCHANGE PLANNING AND LEADERSHIP

#ONNECTICUT -INNESOTA 4ABLE 3TATE !CTION THROUGH THE (EALTH %QUITY ,EARNING #OLLABORATIVE TO !DVANCE (EALTH

%QUITY USING 3ELECT !#! AND 3TATE 0OLICY ,EVERS #ONSUMER ASSISTANCE AND OUTREACH IN NAVIGATOR PROGRAMS

!RKANSAS

$ATA AGREEMENTS AND ANALYSIS TO INFORM -EDICAID ENROLLMENT AND SERVICE PROVISION 6IRGINIA

2ECOMMENDATIONS BASED ON STATE ACTIONS TO ADVANCE HEALTH EQUITY THROUGH COVERAGE AND

ACCESS STRATEGIES 3TATE !CTION 2ELATED TO 1UALITY AND $ELIVERY 2EFORM (EALTH AND MEDICAL HOMES

/HIO -INNESOTA

(AWAII 2%, DATA COLLECTION GUIDELINES AND RECOMMENDATIONS

-INNESOTA

#ONNECTICUT #ULTURAL COMPETENCY TRAINING FOR -EDICAID PROVIDERS

6IRGINIA

-EDICAID MANAGED CARE CONTRACTING AND EDUCATION

/HIO 6IRGINIA

5SING $ATA TO %NGAGE #OMMUNITIES IN 0OLICY $EVELOPMENT IN .EW -EXICO 2ECOMMENDATIONS BASED ON STATE ACTIONS TO ADVANCE HEALTH EQUITY USING QUALITY ANDDELIVERY SYSTEM STRATEGIES

3USTAINING 3TATE %FFORTS TO !DVANCE (EALTH %QUITY


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&EDERAL $ATA AND 4OOLS TO 3UPPORT 3TATE %FFORTS 4HE 2OLE OF 3TATES IN &ACILITATING #OMMUNITY %NGAGEMENT #ROSSAGENCY #OLLABORATION

%QUITY AS A 1UALITY #OST AND *USTICE )SSUE ,ESSONS

#ONCLUSION

!PPENDIX (EALTH %QUITY ,EARNING #OLLABORATIVE )N0ERSON -EETING 0ARTICIPANTS

%NDNOTES


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UHE AUTHORS WISH TO THANK THE !ETNA &OUNDATION FOR ITS SUPPORT OF THIS PROJECT SPECICALLY $R 'ILLIAN"ARCLAY 6ICE 0RESIDENT OF 0ROGRAMS AND -ELENIE -AGNOTTA 'RANTS -ANAGER 7E ALSO THANK THEMANY STATE OFCIALS WHO GAVE GENEROUSLY OF THEIR TIME TO PARTICIPATE IN THE PROJECTS LEARNING COLLAB

ORATIVE ATTEND THE INPERSON MEETING SEE APPENDIX FOR ALL MEETING ATTENDEES ANDOR PROVIDE SUBSTANTIVECOMMENTS AND GUIDANCE FOR THIS REPORT ESPECIALLY

!RKANSAS 4EAM -EMBERS -ARQUITA ,ITTLE $EPARTMENT OF (UMAN 3ERVICES $R #RESHELLE .ASH &AY 7"OOZMAN #OLLEGE OF 0UBLIC (EALTH $R -ICHELLE 3MITH $EPARTMENT OF (EALTH

#ONNECTICUT 4EAM -EMBERS $R -ARGARET (YNES AND ,EONARD ,EE $EPARTMENT OF 0UBLIC (EALTH 2ODERICK "REMBY AND 3YLVIA 'AFFORD!LEXANDER $EPARTMENT OF 3OCIAL 3ERVICES -ATT 3ALNER /FCE OF(EALTH 2EFORM AND )NNOVATION $R 2AJA 3TAGGERS(AKIM #ONNECTICUT #OMMISSION ON (EALTH %QUITY

(AWAII 4EAM -EMBERS $R #HRISTIAN +IMO !LAMEDA +AREN +RAHN AND $R $AVID 3AKAMOTO $EPARTMENT OF (EALTH $R #URTIS 4OMA AND $R +ENNETH &INK $EPARTMENT OF (UMAN 3ERVICES

-INNESOTA 4EAM -EMBERS *EANNE !YERS *OSm 'ONZfLEZ AND $AVID 3TROUD $EPARTMENT OF (EALTH!NTONIA !POLINfRIO7ILCOXON ,AUREN 'ILCHRIST AND $AVID 'ODFREY $EPARTMENT OF (UMAN 3ERVICES

.EW -EXICO 4EAM -EMBERS "ETH ,EOPOLD AND *EFF ,ARA $EPARTMENT OF (EALTH

/HIO 4EAM -EMBERS *OHNNIE #HIP !LLEN $EPARTMENT OF (EALTH !NGELA $AWSON /HIO #OMMISSIONON -INORITY (EALTH #AROL 7ARE $EPARTMENT OF *OB AND &AMILY 3ERVICES

6IRGINIA 4EAM -EMBERS $R -ICHAEL 2OYSTER AND $R $IANE (ELENTJARIS $EPARTMENT OF (EALTH 2EBECCA -ENDOZA AND !SHLEE (ARRELL $EPARTMENT OF -EDICAL !SSISTANCE 3ERVICES

4HE FOLLOWING PROJECT ADVISORY COMMITTEE MEMBERS PROVIDED HELPFUL GUIDANCE AND EXPERTISE THROUGHOUT THISPROJECT $R $ENNIS !NDRULIS 4EXAS (EALTH )NSTITUTE AND 5NIVERSITY OF 4EXAS *OHN !UERBACH -ASSACHUSETTS

$EPARTMENT OF 0UBLIC (EALTH $R *UDY!NN "IGBY -ASSACHUSETTS %XECUTIVE /FCE OF (EALTH AND (UMAN3ERVICES #ARRIE "RIDGES 2HODE )SLAND $EPARTMENT OF (EALTH $R 2OSANNA #OFFEY 4HOMSON 2EUTERS 3COTT,EITZ -INNESOTA $EPARTMENT OF (UMAN 3ERVICES $R $ENA .ED 5NIVERSITY OF 5TAH $R %RNEST -OY !GENCYFOR (EALTHCARE 2ESEARCH AND 1UALITY #HERYL 2OBERTS 6IRGINIA $EPARTMENT OF -EDICAL !SSISTANCE 3ERVICESAND $R 'EORGE 2UST -OREHOUSE 3CHOOL OF -EDICINE

&INALLY THIS REPORT BENETED FROM THE THOUGHTFUL INPUT OF ANDOR REVIEW BY *ILL 2OSENTHAL !LAN 7EIL .EVA+AYE AND $IANE *USTICE OF .!3(0

!NY ERRORS OR OMISSIONS ARE THOSE OF THE AUTHORS


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DOMPARED TO OTHER POPULATIONS RACIAL AND ETHNIC MINORITIES SUFFER FROM POORER HEALTH STATUS HEALTHOUTCOMES HEALTH CARE QUALITY HEALTHY LIFESTYLE OPTIONS AND ACCESS TO HEALTH CARE 4HE 0ATIENT0ROTECTION AND !FFORDABLE #ARE !CT !#! OFFERS STATES MULTIPLE POLICY LEVERS TO IMPROVE THE HEALTH

STATUS OF AND QUALITY OF CARE FOR RACIAL AND ETHNIC MINORITY POPULATIONS THROUGH BROAD DELIVERY SYSTEM REFORMSTARGETED PUBLIC HEALTH AND COMMUNITY INTERVENTIONS AND EXPANDED HEALTH INSURANCE COVERAGE AND ACCESS ASWELL AS PROVISIONS SPECIC TO RACIAL AND ETHNIC MINORITIES 4HIS REPORT DRAWS FROM THE EXPERIENCES OF TEAMSOF STATE OFCIALS IN SEVEN STATES THAT PARTICIPATED IN THE (EALTH %QUITY ,EARNING #OLLABORATIVE SPONSORED BYTHE !ETNA &OUNDATION AND ADMINISTERED BY THE .ATIONAL !CADEMY FOR 3TATE (EALTH 0OLICY )T HIGHLIGHTS SELECTPOLICY LEVERS THAT CAN ADVANCE HEALTH EQUITY OPPORTUNITIES FOR STATE AND FEDERAL AGENCY COLLABORATIONS TOSTRENGTHEN THESE EFFORTS AND IMPORTANT LESSONS AND CONSIDERATIONS FOR ADVANCING HEALTH EQUITY

4HIS REPORT RST DISCUSSES SELECT !#! PROVISIONS AND POLICY LEVERS IN FOUR BROAD CATEGORIES THAT CAN BE USEDTO ADVANCE HEALTH EQUITY FOR RACIAL AND ETHNIC MINORITIES

)NSURANCE COVERAGE PROVISIONS PARTICULARLY THE -EDICAID EXPANSION AND DEVELOPMENT OF INSURANCEEXCHANGES TO IMPROVE RACIAL AND ETHNIC MINORITY POPULATIONS ACCESS TO NEEDED HEALTH CARE SERVICESAS WELL AS CULTURALLY AND LINGUISTICALLY COMPETENT ELIGIBILITY AND ENROLLMENT SERVICES

(EALTH CARE DELIVERY REFORM PROVISIONS RELATED TO THE DEVELOPMENT AND IMPLEMENTATION OF MEDICALAND HEALTH HOMES FEDERAL OPPORTUNITIES TO SUPPORT DELIVERY INNOVATIONS AND SUPPORT FOR DEVELOPINGA MORE DIVERSE HEALTH CARE WORKFORCE

0ROVISIONS RELATED TO DATA COLLECTION AND STANDARDIZATION TO ANALYZE HEALTH CARE ACCESS AND UTILIZATIONBY RACE ETHNICITY AND LANGUAGE

0ROVISIONS TO IMPROVE POPULATION HEALTH THROUGH COMMUNITYBASED PREVENTIVE HEALTH PROGRAMSSUPPORT FOR PUBLIC HEALTH INFRASTRUCTURE SAFETYNET CAPACITY AND COMMUNITY HEALTH NEEDS ASSESS

MENTS TO APPROPRIATELY PLAN FOR HEALTH SERVICES IN UNDERSERVED COMMUNITIES AND AMONG POPULATIONSOF COLOR

.EXT THIS REPORT SYNTHESIZES THE WORK OF AND RECOMMENDATIONS FROM !RKANSAS #ONNECTICUT (AWAII -INNESOTA .EW -EXICO /HIO AND 6IRGINIA THE STATES THAT PARTICIPATED IN THE .!3(0 (EALTH %QUITY ,EARNING#OLLABORATIVE 4HESE STATES PURSUED A NUMBER OF STRATEGIES TO ADDRESS RACIAL AND ETHNIC DISPARITIES IN COVERAGE OR ACCESS TO CARE AND HEALTH CARE QUALITYDELIVERY THROUGH IMPLEMENTATION OF HEALTH REFORM 7ITH REGARDTO COVERAGE AND ACCESS THE STATE TEAMS INTEGRATED HEALTH EQUITY INTO

/UTREACH AND ENROLLMENT STRATEGIES TO CREATE AND PROVIDE CULTURALLY SENSITIVE EDUCATIONAL MATERIALS TO THE PUBLIC INCORPORATE HEALTH EQUITY CONSIDERATIONS INTO CONSUMER ASSISTANCE AND OUTREACHTHROUGH NAVIGATOR PROGRAMS AND DEVELOP DATA SHARING AGREEMENTS TO ANALYZE ENROLLMENT AND PRIORI

TIZE AREAS FOR OUTREACH AND ENROLLMENT EFFORTS AND%XCHANGE PLANNING BY DEVELOPING GUIDELINES FOR COLLECTING RACEETHNICITYLANGUAGE 2%, DATA ANALYZING HEALTH EQUITY DATA AND PROVIDING EDUCATION FOR EXCHANGE PLANNING AND ADVISORY BOARD MEMBERS AND ENSURING DIVERSE STAKEHOLDER REPRESENTATION ON PLANNING AND ADVISORY BOARDS


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)N TERMS OF ADDRESSING QUALITY AND HEALTH CARE DELIVERY REFORM PARTICIPATING STATES PURSUED

.EW PROVIDER TRAINING AND EXPECTATIONS BY DEVELOPING CULTURAL COMPETENCY TRAINING ANDOR PROVIDINGANTIOPPRESSION ASSESSMENTS FOR -EDICAID PROVIDERS AND FACILITATING MANAGED CARE CONTRACT LANGUAGECHANGES TO INCREASE ACCOUNTABILITY TO DELIVER CULTURALLY SENSITIVE CARE ANDOR REDUCE HEALTH DISPARITIES AND

(EALTH AND MEDICAL HOMES WITH AN EMPHASIS ON HEALTH EQUITY BY CONDUCTING OUTREACH TO DIVERSECOMMUNITIES TO INFORM HEALTH HOME PLANNING MEDICAL HOME ROLLOUT IN RACIALLYETHNICALLY DIVERSECOMMUNITIES DEVELOPING AND CONDUCTING CULTURAL COMPETENCY TRAINING FOR MEDICAL HOME PROVIDERSAND PURSUING FEDERAL SUPPORT OPPORTUNITIES TO IMPROVE PAYMENT AND CARE DELIVERY

4HIS REPORT THEN OFFERS IMPORTANT HEALTH EQUITY CONSIDERATIONS AND THEMES FROM AN INPERSON MEETING OF THE(EALTH %QUITY ,EARNING #OLLABORATIVE AND FEDERAL OFCIALS +EY LESSONS FROM THIS MEETING INCLUDE THE VALUE OFFEDERAL DATA AND TOOLS IN SUPPORTING PARTICIPATING STATES EFFORTS THE ROLE OF STATES IN ENGAGING COMMUNITIESAND STAKEHOLDERS IN POLICY DEVELOPMENT THE IMPORTANCE OF CROSSAGENCY COLLABORATION TO ADVANCING HEALTHEQUITY AND THE NEED TO FRAME HEALTH EQUITY

/VERALL THE FOLLOWING LESSONS EMERGED FROM THE ACTIVITIES OF (EALTH %QUITY ,EARNING #OLLABORATIVE STATE

TEAMS

!DVANCING HEALTH EQUITY DOES NOT DEPEND SOLELY ON !#! IMPLEMENTATION BUT !#! PROVIDES AUNIQUE PLATFORM TO CATALYZE STATE EFFORTS

,ANGUAGE MATTERS QUALITY IMPROVEMENT POPULATION HEALTH PUBLIC HEALTH SYSTEMS CHANGE ANDPATIENTCENTEREDNESS ALL HAVE HEALTH EQUITY COMPONENTS

3TATE AGENCIES WOULD LIKE MORE OPPORTUNITIES FOR PEERTOPEER LEARNING AROUND ISSUES OF HEALTHEQUITY

0ARTICIPATION IN MULTISTATE EFFORTS HELPS LEGITIMIZE EFFORTS TO ADVANCE HEALTH EQUITY

#OMMUNITIES NEED TO BE PARTNERS IN POLICY DEVELOPMENT AND IMPLEMENTATION

$ATA ARE POWER AND STATES CONTINUE TO WORK TO IMPROVE 2%, DATA COLLECTION TO ADVANCE HEALTHEQUITY

0ARTICIPATING STATE TEAMS IDENTIED AND PURSUED A NUMBER OF STRATEGIES TO ADVANCE HEALTH EQUITY THROUGHHEALTH REFORM IMPLEMENTATION 4HE RECENT 3UPREME #OURT RULING ENABLES THE (EALTH %QUITY ,EARNING #OLLABORATIVE STATES IMPROVEMENT EFFORTS TO CONTINUE MOVING FORWARD 7ITH THE RULING ALL STATES NOW HAVE CRITICALDECISIONS TO MAKE THAT CAN ADDRESS DISPARITIES THE STRATEGIES OF PARTICIPATING STATES OFFER EXAMPLES OF HOWPOLICY MAKERS CAN ADVANCE HEALTH EQUITY USING !#! AND STATELEVEL POLICY LEVERS


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DOMPARED TO OTHER POPULATIONS RACIAL AND ETHNIC MINORITIES SUFFER FROM POORER HEALTH STATUSHEALTH OUTCOMES HEALTH CARE QUALITY HEALTHY LIFESTYLE OPTIONS AND ACCESS TO HEALTH CARE 4HE0ATIENT 0ROTECTION AND !FFORDABLE #ARE !CT !#! OFFERS STATES MULTIPLE POLICY LEVERS TO IM

PROVE THE HEALTH STATUS OF AND QUALITY OF CARE FOR RACIAL AND ETHNIC MINORITY POPULATIONS THROUGH BROADDELIVERY SYSTEM REFORMS TARGETED PUBLIC HEALTH AND COMMUNITY INTERVENTIONS AND EXPANDED HEALTH INSURANCE COVERAGE AND ACCESS AS WELL AS PROVISIONS SPECIC TO RACIAL AND ETHNIC MINORITIES 3INCE INDIVIDUALSFROM RACIAL AND ETHNIC MINORITY COMMUNITIES ARE PROJECTED TO COMPRISE PERCENT OF THE 53 POPULATIONBY STATE HEALTH POLICYMAKERS ARE IN A PRIME POSITION TO UTILIZE TOOLS IN THE !#! TO ADVANCE HEALTHEQUITY ATTAINMENT OF THE HIGHEST LEVEL OF HEALTHFOR THEIR MOST VULNERABLE MINORITY POPULATIONS &ROM/CTOBER THROUGH *UNE TEAMS FROM SEVEN STATES PARTICIPATED IN THE (EALTH %QUITY ,EARNING#OLLABORATIVE WHICH WAS SUPPORTED BY THE !ETNA &OUNDATION AND ADMINISTERED BY THE .ATIONAL !CADEMYFOR 3TATE (EALTH 0OLICY .!3(0 0ARTICIPATING STATES ENGAGED IN TECHNICAL ASSISTANCE ACTIVITIES AND PEERTOPEER LEARNING TO PLAN AND CARRY OUT COORDINATED APPROACHES TO ADVANCE HEALTH EQUITY THROUGH !#!IMPLEMENTATION 4HIS REPORT DRAWS FROM THE EXPERIENCES OF THE (EALTH %QUITY ,EARNING #OLLABORATIVE TO

HIGHLIGHT SELECT !#! AND STATE POLICY LEVERS THAT CAN ADVANCE HEALTH EQUITY OPPORTUNITIES FOR STATE ANDFEDERAL AGENCY COLLABORATIONS TO STRENGTHEN THESE EFFORTS AND IMPORTANT LESSONS AND CONSIDERATIONS FORADVANCING HEALTH EQUITY

#OMMON $ENITIONS

!CHIEVING HEALTH EQUITY FOR RACIAL AND ETHNIC MINORITIES REQUIRES A WORKING UNDERSTANDING OF THE FACTORS INUENCING THE HEALTH OF THESE POPULATIONS SOME OF WHICH REFER TO FACTORS BEYOND THE SCOPEOF THE HEALTH CARE SYSTEM "ELOW ARE A FEW COMMON DENITIONS

(EALTH EQUITY !TTAINMENT OF THE HIGHEST LEVEL OF HEALTH FOR ALL PEOPLE !CHIEVING HEALTH EQUITYREQUIRES VALUING EVERYONE EQUALLY WITH ONGOING EFFORTS TO ADDRESS AVOIDABLE INEQUALITIES AND

INJUSTICES AND ELIMINATE DISPARITIES

(EALTH INEQUITY ! DIFFERENCE OR DISPARITY IN HEALTH OUTCOMES THAT IS SYSTEMATIC AVOIDABLEAND UNJUST

(EALTH INEQUALITY $IFFERENCE VARIATION AND DISPARITY IN THE HEALTH ACHIEVEMENTS OF INDIVIDUALS AND GROUPS OF PEOPLE

(EALTH DISPARITY ! TYPE OF DIFFERENCE IN HEALTH OUTCOME THAT IS CLOSELY LINKED WITH SOCIAL ORECONOMIC DISADVANTAGE (EALTH DISPARITIES NEGATIVELY AFFECT GROUPS OF PEOPLE WHO HAVE SYSTEMATICALLY EXPERIENCED GREATER SOCIAL OR ECONOMIC OBSTACLES TO HEALTH 4HESE OBSTACLES STEMFROM CHARACTERISTICS HISTORICALLY LINKED TO DISCRIMINATION OR EXCLUSION SUCH AS RACE OR ETHNICITY

RELIGION SOCIOECONOMIC STATUS GENDER MENTAL HEALTH SEXUAL ORIENTATION OR GEOGRAPHIC LOCATION /THER CHARACTERISTICS INCLUDE COGNITIVE SENSORY OR PHYSICAL DISABILITY

3OCIAL DETERMINANTS OF HEALTH 4HE COMPLEX INTEGRATED AND OVERLAPPING SOCIAL STRUCTURESAND ECONOMIC SYSTEMS THAT ARE RESPONSIBLE FOR MOST HEALTH INEQUITIES 4HESE SOCIAL STRUCTURESAND ECONOMIC SYSTEMS INCLUDE THE SOCIAL ENVIRONMENT PHYSICAL ENVIRONMENT HEALTH SERVICESAND STRUCTURAL AND SOCIETAL FACTORS 3OCIAL DETERMINANTS OF HEALTH ARE SHAPED BY THE DISTRIBUTION OF MONEY POWER AND RESOURCES THROUGHOUT LOCAL COMMUNITIES NATIONS AND THE WORLD


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34!4% /00/245.)4)%3 4/ !$6!.#% (%!,4( %15)49 4(2/5'( (%!,4( 2%&/2- )-0,%-%.4!4)/.4HIS SECTION EXPLORES PROVISIONS AND POLICY LEVERS IN THE !#! THAT CAN ADVANCE HEALTH EQUITY FOR RACIAL ANDETHNIC MINORITIES 4HESE POLICY MECHANISMS FALL UNDER FOUR BROAD CATEGORIES COVERAGE DELIVERY SYSTEMREFORM DATA AND POPULATION HEALTH 4ABLE BELOW PROVIDES AN OVERVIEW OF KEY !#! PROVISIONS THATEXPLICITLY REFERENCE CARE OR ACCESS FOR RACIAL OR ETHNIC MINORITY POPULATIONS OR ARE BROADER BUT CAN BE USEDTO ADVANCE HEALTH EQUITY

4!",% 3%,%#4 !#! 02/6)3)/.3 4(!4 #!. !$6!.#% (%!,4( %15)49

!#! 0ROVISION 4OPIC AND

3ECTIONS"RIEF $ESCRIPTION

#OVERAGEAND!CCESS

-EDICAID %XPANSION

#REATES OPTION TO COVER ADULTS UNDER AGE WITH INCOMES AT OR BELOW

OF THE FEDERAL POVERTY LEVEL INCLUDING ADULTS WITHOUT CUSTODIAL CHILDREN

&ROM OFFERS STATES &-!0 PHASING DOWN TO &-!0

BY FOR COVERING THE NEWLY ELIGIBLE UNDER THE ABOVE OPTION

3ETS NEW STANDARDS FOR SIMPLIFYING HEALTH INSURANCE ELIGIBILITY AND ENROLLMENT

PROCESSES

)NSURANCE %XCHANGES

"EGINNING CREATES A MARKETPLACE FOR LEGAL RESIDENTS AND SMALL EMPLOY

ERS TO SHOP FOR AFFORDABLE PRIVATE HEALTH INSURANCE PLANS AND MAKE INFORMEDDECISIONS ABOUT THEIR PLAN OPTIONS

/FFERS SLIDING SCALE FEDERAL TAX CREDITS FOR INDIVIDUALS BETWEEN AND

OF THE FEDERAL POVERTY LINE TO PURCHASE PLANS OR BETWEEN AND

IN STATES THAT DO NOT EXPAND -EDICAID

2EQUIRES PARTICIPATING PLANS TO PROVIDE CERTAIN HEALTH SERVICES ESSENTIAL

HEALTH BENETS FOR BENECIARIES

2EQUIRES PARTICIPATING PLANS TO CONTRACT WITH PROVIDERS THAT INCLUDE COMMU

NITY HEALTH CENTERS AND SAFETYNET PROVIDERS

2EQUIRES EXCHANGE PLANS TO DEVELOP CONSUMER ASSISTANCE .AVIGATOR PROGRAMS

THAT OFFER CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES

1UALITYAND$ELIVERY3YSTEM

2EFORM

(EALTH (OMES

#REATED 3TATE 0LAN !MENDMENT OPTION TO SERVE -EDICAID ENROLLEES WITH OR

MORE CHRONIC CONDITIONS CONDITION AND THE RISK OF DEVELOPING ANOTHER OR

AT LEAST SERIOUS AND PERSISTENT MENTAL HEALTH CONDITION

/FFERS STATES &-!0 FOR YEARS FOR PROVIDING HEALTH HOMES SERVICES

EG CARE MANAGEMENT CARE COORDINATION HEALTH PROMOTION REFERRALS TO

COMMUNITY AND SOCIAL SUPPORTS AND USE OF HEALTH INFORMATION TECHNOLOGY

#ENTER FOR -EDICARE

AND -EDICAID

)NNOVATION

#REATED A #ENTER DESIGNED TO TEST HEALTH CARE PAYMENT AND SERVICE DELIVERY

MODELS THAT LOWER -EDICARE -EDICAID AND #()0 SPENDING WHILE MAINTAINING

OR IMPROVING QUALITY CARE

!CCOUNTABLE #ARE

/RGANIZATIONS !#/S

%STABLISHED THE -EDICARE 3HARED 3AVINGS 0ROGRAM THROUGH WHICH NETWORKS

OF PROVIDERS AGREE TO SERVE AS !#/S TO COORDINATE THE FULL CONTINUUM OF CAREFOR BENECIARIES FOR AT LEAST YEARS AND BE HELD ACCOUNTABLE FOR CARE QUALITY

AND COST

7ORKFORCE $IVERSITY

0ROVIDES SUPPORT TO INCREASE DIVERSITY OF PRIMARY CARE AND LONGTERM CARE

PROVIDERS RECRUIT AND TRAIN COMMUNITY HEALTH WORKERS TO PROVIDE EDUCATION

AND OUTREACH TO DIVERSE COMMUNITIES AND DEVELOP STRATEGIES TO PROVIDE CUL

TURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH CARE SETTINGS


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!#! 0ROVISION 4OPIC AND

3ECTIONS"RIEF $ESCRIPTION

$

ATA

$ATA #OLLECTION

3TANDARDS

2EQUIRES ALL NATIONAL POPULATION HEALTH SURVEYS TO INCLUDE DATA ON RACE ETH

NICITY SEX PRIMARY LANGUAGE AND DISABILITY STATUS

2EQUIRES DATA COLLECTED UNDER A -EDICAID OR #()0 PLAN TO MEET THESE STAN

DARDS

2EQUIRES THESE DATA TO BE SELFREPORTED

0OPULATION(EALTH

0REVENTION AND 0UBLIC

(EALTH &UND

%STABLISHED AND ALLOCATED MONEY FOR THE 0REVENTION AND 0UBLIC (EALTH &UND

TO CREATE A REGULAR SOURCE OF FUNDING FOR PROGRAMS ADDRESSING PRESSING PUBLIC

HEALTH PRIORITIES SUCH AS PREVENTIVE HEALTH CARE AND DISEASE PREVENTION

#OMMUNITY

4RANSFORMATION 'RANTS

3UPPORTED BY THE 0REVENTION AND 0UBLIC (EALTH &UND THESE GRANTS ARE

DESIGNED TO HELP STATE AND LOCAL AGENCIES NONPROT ORGANIZATIONS NETWORKS

OF COMMUNITYBASED ORGANIZATIONS AND )NDIAN TRIBES ENGAGE COMMUNITIES IN

LOCAL CHRONIC DISEASE PREVENTION STRATEGIES

#OMMUNITY (EALTH

#ENTERS AND THE 3AFETY

.ET

%STABLISHED THE (EALTH #ENTER 0ROGRAM %XPANSION TO EXPAND OPERATIONAL

CAPACITY IMPROVE EXISTING FACILITIES AND ENHANCE HEALTH SERVICES4HE .ATIONAL (EALTH 3ERVICE #ORPS WILL RECEIVE BILLION OVER THE NEXT

VE YEARS TO DECREASE PRIMARY CARE PROVIDER SHORTAGES IN UNDERSERVED COM

MUNITIES

$EVELOPED #OMMUNITY"ASED #OLLABORATIVE #ARE .ETWORKS TO ORGANIZE COM

MUNITY HEALTH CENTERS AND OTHER SAFETY NET PROVIDERS TO DELIVER COORDINATED

CARE TO VULNERABLE COMMUNITIES IN TARGETED GEOGRAPHIC AREAS

2EQUIRES EXCHANGE HEALTH PLANS TO CONTRACT WITH ESSENTIAL COMMUNITY PROVID

ERS INCLUDING SAFETY NET PROVIDERS

)23 #OMMUNITY "ENET

2EQUIRES NONPROT HOSPITALS TO PERIODICALLY CONDUCT COMMUNITY HEALTH NEEDS

ASSESSMENTS THAT INCORPORATE COMMUNITY FEEDBACK AND IMPLEMENT STRATE

GIES TO ADDRESS IDENTIED COMMUNITY HEALTH NEEDS TO RECEIVE EXEMPTION FROMFEDERAL TAXES

! COMPREHENSIVE LIST OF PROVISIONS IS AVAILABLE IN THE FOLLOWING DOCUMENT FROM WHICH THIS TABLE WAS ADAPTED !NDRULIS $ 3IDDIQUI. 0URTLE * AND $UCHON , 0ATIENT 0ROTECTION AND !FFORDABLE #ARE !CT OF !DVANCING (EALTH %QUITY FOR 2ACIALLY AND %THNICALLY $IVERSE 0OPULATIONS *OINT #ENTER FOR 0OLITICAL AND %CONOMIC 3TUDIES *ULY !VAILABLE ONLINE HTTPWWWJOINTCENTERORGHPISITESALLLES0ATIENT0ROTECTION?02%0?PDF

)N *UNE THE 5NITED 3TATES 3UPREME #OURT UPHELD THE CONSTITUTIONALITY OF THE !#! EXCEPT FOR THEMANDATE THAT STATES EXPAND -EDICAID ELIGIBILITY TO !MERICANS UNDER AGE WITH INCOMES AT OR BELOW PERCENT OF THE FEDERAL POVERTY LEVEL OR RUN THE RISK OF LOSING ALL FEDERAL -EDICAID FUNDING

).352!.#% #/6%2!'%!CCESS TO INSURANCE COVERAGE IS AN IMPORTANT DETERMINANT OF POSITIVE HEALTH OUTCOMES AND A LACK OFHEALTH INSURANCE IS ASSOCIATED WITH UNDERUTILIZATION OF PREVENTATIVE SERVICES AND MEDICAL TREATMENT AMONGRACIAL AND ETHNIC MINORITIES )N ABOUT PERCENT OF (ISPANICS AND PERCENT OF !FRICAN !MERICANS WERE UNINSURED COMPARED TO ONLY PERCENT OF WHITE !MERICANS 4HROUGH PROVISIONS TO EXPANDTHE -EDICAID PROGRAM AND CREATE HEALTH INSURANCE EXCHANGES HIGHLIGHTED IN 4ABLE THE !#! HOLDSOPPORTUNITIES TO INCREASE HEALTH INSURANCE COVERAGE AND ACCESS TO HEALTH CARE FOR MINORITY POPULATIONS

4!",% 3%,%#4 !#! 02/6)3)/.3 4(!4 #!. !$6!.#% (%!,4( %15)49 #/.4).5%$
http://www.jointcenter.org/hpi/sites/all/files/PatientProtection_PREP_0.pdfhttp://www.jointcenter.org/hpi/sites/all/files/PatientProtection_PREP_0.pdfhttp://www.jointcenter.org/hpi/sites/all/files/PatientProtection_PREP_0.pdfhttp://www.jointcenter.org/hpi/sites/all/files/PatientProtection_PREP_0.pdf


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3PECICALLY

3TATES THAT CHOOSE TO PARTICIPATE IN THE !#! -EDICAID EXPANSION WILL PROVIDE CRITICAL COVERAGE TOTHE UNINSURED A GROUP DISPROPORTIONATELY COMPRISED OF RACIAL AND ETHNIC MINORITIES

3TATE -EDICAID PROGRAMS NEED TO BE PREPARED TO PROVIDE EDUCATION ABOUT THE PROGRAM AD

EQUATELY COMMUNICATE ENTITLED HEALTH BENETS AND EMPLOY STRATEGIES TO RETAIN THE NEWLY ELIGIBLEALL IN CULTURALLY AND LINGUISTICALLY APPROPRIATE WAYS

4HE !#!S EMPHASIS ON SIMPLIFYING HEALTH INSURANCE ELIGIBILITY AND ENROLLMENT PROCESSES WILL BEESPECIALLY IMPORTANT FOR STATES WITH HARD TO REACH ,IMITED %NGLISH 0ROCIENCY ,%0 POPULATIONSTHAT OFTEN EXPERIENCE TRANSLATIONAL DIFCULTIES WHEN SEEKING COVERAGE

3TATES HAVE THE EXIBILITY TO INCORPORATE HEALTH DISPARITIES TRACKING MEASURES AND CULTURAL COMPETENCY REQUIREMENTS INTO THEIR -EDICAID MANAGED CARE ORGANIZATIONS WHICH WILL BE AN IMPORTANTCONSIDERATION FOR -EDICAID MANAGED CARE PROGRAMS THAT CONTRACT WITH COMMUNITY HEALTH ANDSAFETY NET PROVIDERS AS PERCENT OF FEDERALLY QUALIED HEALTH CENTERS PROVIDE CLINICAL SERVICES TO,%0 POPULATIONS EACH DAY

%XCHANGES WILL PROVIDE A MARKETPLACE TO SHOP FOR AFFORDABLE PRIVATE HEALTH INSURANCE PLANS4HE EXCHANGE POPULATION IS EXPECTED TO BE MORE RACIALLY AND ETHNICALLY DIVERSE THAN PRIVATELYINSURED POPULATIONS WITH PERCENT OF ENROLLEES BEING WHITE PERCENT BLACK AND PERCENT(ISPANIC

3TATES MAY REQUIRE THEIR 1UALIED (EALTH 0LANS 1(0SDENED AS HEALTH PLANS PARTICIPATINGIN THE EXCHANGE MARKETPLACETO PROVIDE SERVICES BEYOND THOSE THAT ARE FEDERALLY REQUIRED TOMEET THE SPECIC NEEDS OF DIVERSE POPULATIONS AND STRATEGICALLY CHOOSE PLANS THAT ADVANCE HEALTHEQUITY

!T THE GOVERNANCE LEVEL STATES HAVE THE OPPORTUNITY TO ENSURE PARTICIPATION OF MINORITY COMMUNITIES BY PRIORITIZING COMMUNITY REPRESENTATIVES AS MEMBERS OF EXCHANGE ADVISORY BOARDS AND BY

FACILITATING OPPORTUNITIES FOR PUBLIC EDUCATION AND COMMENT ON EXCHANGE POLICY DEVELOPMENTS

(%!,4( #!2% $%,)6%29 2%&/2-!LTHOUGH COVERAGE EXPANSIONS CREATED BY THE !#! HOLD SIGNICANT OPPORTUNITIES FOR STATES TO ADVANCEHEALTH EQUITY THE !#! ALSO ADDRESSES CARE COORDINATION PAYMENT REFORM AND DELIVERY SYSTEM INNOVATION4HE !#! CAN SUPPORT STATES SEEKING TO IMPROVE RACIAL AND ETHNIC MINORITIES HEALTH OUTCOMES AND THEIREXPERIENCES WITHIN THE HEALTH SYSTEM &OR EXAMPLE

2ACIAL AND ETHNIC MINORITIES ARE DISPROPORTIONATELY BURDENED BY CHRONIC DISEASE AND ILLNESS

%STABLISHED AS A STATE OPTION IN !#! HEALTH HOMES ARE DESIGNED TO SERVE CHRONICALLY ILL -EDICAIDENROLLEES !#! SPECICALLY DENES CHRONIC CONDITIONS SERVED BY A HEALTH HOME AS INCLUDING AMENTAL HEALTH CONDITION A SUBSTANCE USE DISORDER ASTHMA DIABETES HEART DISEASE AND OBESITY

4HE LATTER THREE CONDITIONS REPRESENT SERIOUS MORBIDITY RISK FACTORS FOR MINORITY POPULATIONS

(EALTH HOMES HAVE AN EMPHASIS ON PATIENTCENTERED CARE !LL HEALTH HOME SERVICES MUST BE OFFERED BY A HEALTH HOME PROVIDER ARRANGEMENT CHOSEN BY BENECIARIES !S STATES DEVELOP HEALTHHOME SERVICE DELIVERY MODELS THEY CAN CONSIDER HEALTH HOME DESIGN ELEMENTS TO DECREASE HEALTHDISPARITIES AND IMPROVE HEALTH OUTCOMES FOR MINORITY COMMUNITIES DISPROPORTIONATELY BURDENEDBY CHRONIC DISEASE


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8

3TATES CAN LOOK TO THE #ENTER FOR -EDICARE AND -EDICAID )NNOVATION AS A MEANS FOR EXPLORINGDELIVERY SYSTEM REFORM MODELS TO ADVANCE HEALTH EQUITY FOR MINORITY POPULATIONS &OR STATES THATWILL EXPERIENCE A LARGE INUX OF RACIAL AND ETHNIC MINORITY -EDICAID ENROLLEES IN TAKING ADVANTAGE OF THE LESSONS LEARNED FROM #ENTER INITIATIVES CAN HELP POLICYMAKERS INCENTIVIZE -EDICAIDINNOVATION AND PROGRAM ADVANCES AS WELL AS INCREASE THE PARTICIPATION OF MINORITIES IN PRIMARYCARE SERVICES THAT REDUCE HEALTH DISPARITIES AND ADVANCE HEALTH EQUITY

$EVELOPING AND SUPPORTING A DIVERSE HEALTH CARE WORKFORCE WILL BE ESSENTIAL FOR STATES TO ENGAGEAND RETAIN MINORITY POPULATIONS IN THE HEALTH CARE SYSTEM -OREOVER RESEARCH SUGGESTS THATRACIALLY AND ETHNICALLY DIVERSE PRACTITIONERS ARE MORE LIKELY TO SERVE IN UNDERSERVED AREAS AND TREATUNINSURED OR UNDERINSURED PATIENTS OF COLOR

2ACIAL AND ETHNIC MINORITY POPULATIONS ALSO COULD GREATLY BENET FROM !CCOUNTABLE #ARE /RGANIZATIONS!#/S WHICH ARE SUPPORTED BY !#! AS A MECHANISM TO INCENTIVIZE PROVIDERS TO DELIVER QUALITYDRIVENCARE THAT PROMOTES COSTSAVINGS

#-3 REGULATION DIRECTS !#/S TO CONSIDER THE NEEDS OF THESE POPULATIONS IN PLANNING DEVELOPINGAND SUSTAINING THESE MODELS

0ROVIDERS APPLYING AS AN !#/ MUST MEET EIGHT PATIENTCENTEREDNESS CRITERIA WHICH INCLUDES APROCESS FOR EVALUATING THE HEALTH NEEDS OF THE !#/S ASSIGNED POPULATION INCLUDING CONSIDERATIONOF DIVERSITY IN ITS PATIENT POPULATIONS AND A PLAN TO ADDRESS THE NEEDS OF ITS POPULATION !PPLYING !#/S MUST DESCRIBE THIS PROCESS FOR ADDRESSING PATIENT DIVERSITY IN THEIR APPLICATIONS AS WELLAS HOW THE !#/ WOULD CONSIDER DIVERSITY IN ;ITS= PATIENT POPULATION

3TATES MUST BE AWARE OF THE GEOGRAPHIC CONCENTRATIONS OF !#/S AND ENSURE THAT !#/S AREDEVELOPED IN GEOGRAPHICALLY AND INCOMEDIVERSE AREAS TO ENSURE EQUAL ACCESS FOR RACIAL AND ETHNICMINORITY COMMUNITIES

#-3 GRANTS !#/S THE EXIBILITY TO DECIDE THE MOST EFFECTIVE MEASURES TO ADDRESS THE HEALTHNEEDS OF THEIR DIVERSE POPULATIONS WHICH MAY BE AN OPPORTUNITY FOR STATES TO MONITOR HOW !#/S

ARE DECREASING HEALTH DISPARITIES AMONG MINORITY -EDICARE POPULATIONS

!S A MEANS TO PLAN AND ADDRESS POPULATION HEALTH NEEDS #-3 ENCOURAGES !#/S TO PARTNER WITHSTATES OR LOCAL HEALTH DEPARTMENTS THAT PERFORM COMMUNITY HEALTH ASSESSMENTS

$!4!#OLLECTING TIMELY RELIABLE AND STANDARDIZED DATA ON HEALTH CARE ACCESS AND UTILIZATION BY RACE ETHNICITY AND LANGUAGE CAN HELP STATES STRATEGICALLY ASSESS AND RENE THEIR HEALTH SYSTEMS TO ELIMINATE HEALTHDISPARITIES AND PROMOTE HEALTH EQUITY "UILDING UPON THE /FCE OF -ANAGEMENT AND "UDGET STANDARDS FORRACE AND ETHNICITY DATA COLLECTION 3ECTION OF THE !#! REQUIRES THAT ALL NATIONAL POPULATION HEALTHSURVEYS INCLUDE DATA ON RACE ETHNICITY SEX PRIMARY LANGUAGE AND DISABILITY STATUS 4HROUGH THIS PART OF

!#! 3TATES ARE PERMITTED TO FURTHER GRANULATE THE MINIMUM DATA STANDARDS IF THESE MEASURES ARE REPRESENTATIVE OF A SAMPLE SIZE OF THE TARGET POPULATION

3TATES CAN WORK TO STANDARDIZE RACEETHNICITYLANGUAGE 2%, DATA COLLECTION AND REPORTING MOREBROADLY EG AS PART OF ALLPAYER CLAIMS DATABASES TO ASSESS COST QUALITY AND ACCESS SEE PAGE FOR MORE ON ALLPAYER CLAIMS DATABASES !S A RESULT STATES WILL BE BETTER EQUIPPED TO TRACK HEALTHDISPARITIES JUSTIFY POLICY INITIATIVES TO ADVANCE HEALTH EQUITY AND ADOPT PAYMENT REFORMS THAT USEDATADRIVEN EQUITY PERFORMANCE MEASURES


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9

0/05,!4)/. (%!,4()MPROVING POPULATION HEALTH MAY REQUIRE IMPLEMENTING STRATEGIES THAT ADDRESS LARGER SOCIAL DETERMINANTSOF HEALTH BEYOND THE SCOPE OF THE HEALTH CARE DELIVERY SYSTEM !DDITIONALLY THESE STRATEGIES MAY ADDRESSTHE UNDERLYING SOCIETAL FACTORS INUENCING HEALTH DISPARITIES AMONG RACIAL AND ETHNIC MINORITY POPULATIONS3EVERAL !#! PROVISIONS ADDRESS DISPARITIES THROUGH COMMUNITY AND POPULATION HEALTH INTERVENTIONS &OR

EXAMPLE4HE !#! ALLOCATES FUNDING TO THE 0REVENTION AND 0UBLIC (EALTH &UND TO SUPPORT PUBLIC HEALTHINITIATIVES AT LOCAL STATE AND FEDERAL LEVELS )N &9 THESE FUNDS WERE USED TO SUPPORT COMMUNITYBASED PREVENTIVE HEALTH PROGRAMS CLINICAL PREVENTION SERVICES BUILDING PUBLIC HEALTH INFRASTRUCTURE AND PUBLIC HEALTH RESEARCH AND DATA COLLECTION EFFORTS 3TATES CAN INCORPORATE 2%, DATAIMPROVEMENT AND ADDRESS PUBLIC HEALTH ISSUES DISPROPORTIONATELY AFFECTING MINORITIES

#OMMUNITY 4RANSFORMATION 'RANTS SUPPORTED BY THE 0REVENTION AND 0UBLIC (EALTH &UND ARE ANIMPORTANT RESOURCE FOR STATES AND LOCALITIES LOOKING TO EXPLICITLY ADDRESS HEALTH DISPARITIES AMONGRACIALLY AND ETHNICALLY DIVERSE POPULATIONS )N THE PROGRAM AWARDED MILLION IN IMPLEMENTATION GRANTS TO STATE AND LOCAL AGENCIES TRIBES AND TERRITORIES AND NONPROT ORGANIZATIONS

TO SUPPORT COMMUNITY HEALTH AND WELLNESS 4HESE AWARDEES WILL ENGAGE IN ACTIVITIES TO ADDRESSCOMMUNITY TOBACCOFREE LIVING ACTIVE LIFESTYLES AND HEALTHY EATING AND SUPPORT HIGHQUALITYCLINICAL PREVENTIONS 4HE PROGRAM IS EXPECTED TO RUN FOR VE YEARS AND IMPACT APPROXIMATELY MILLION !MERICANS

!N ESTIMATED MILLION INDIVIDUALS WILL REMAIN UNINSURED AFTER MOST OF THE LAWS PROVISIONS AREIMPLEMENTED /F THIS GROUP APPROXIMATELY ONETHIRD WILL BE IMMIGRANT POPULATIONS INELIGIBLE FOR-EDICAID OR EXCHANGE PROGRAMS IN ADDITION TO THE QUARTER OF INDIVIDUALS THAT WILL BE ELIGIBLE FOR-EDICAID BUT UNENROLLED #OMMUNITY HEALTH CENTERS WILL BE AN IMPORTANT POINT OF ACCESS TO CAREFOR UNINSURED AND NEWLY INSURED POPULATIONS 4HROUGH COORDINATED APPROACHES TO SUPPORTINGCOMMUNITY HEALTH CENTERS AND SYSTEM CAPACITY THE !#! AFFORDS STATES OPPORTUNITIES TO BUILD ASUSTAINABLE SAFETY NET AND PUBLIC HEALTH INFRASTRUCTURE TO ADDRESS THE HEALTH CARE NEEDS OF RACIALLY

AND ETHNICALLY DIVERSE POPULATIONS

"EGINNING WITH TAXABLE YEARS AFTER -ARCH THE !#! REQUIRES NONPROT HOSPITALS TO PERIODICALLY CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENT STRATEGIES TO ADDRESS IDENTIED COMMUNITY HEALTH NEEDS IF THE HOSPITALS ARE TO RECEIVE EXEMPTION FROM FEDERAL TAXES 4HECOMMUNITY HEALTH NEEDS ASSESSMENTS ARE TO INCORPORATE FEEDBACK FROM COMMUNITIES WHICH WILLINCLUDE THE UNDERSERVED AND POPULATIONS OF COLOR AS WELL AS LOCAL HEALTH DEPARTMENTS -ANYLOCAL HEALTH DEPARTMENTS NOT ONLY HAVE EXPERIENCE CONDUCTING THESE ASSESSMENTS BUT ALSO OFTENWORK WITH STATE HEALTH DEPARTMENTS TO COMPILE DATA FOR STATEWIDE PUBLIC HEALTH REPORTS WHICHOFTEN INCLUDE 2%, DATA 3TATES CAN HELP LOCAL HEALTH DEPARTMENTS SHARE 2%, AND CRUCIAL DISPARITIESDATA WITH NONPROT HOSPITALS

4(% .!3(0 34!4% (%!,4( %15)49 ,%!2.).' #/,,!"/2!4)6%!CHIEVING HEALTH EQUITY FOR THE NATIONS RACIAL AND ETHNIC MINORITY POPULATIONS HAS BECOME A PRIORITY ATBOTH THE FEDERAL AND STATE LEVELS (OWEVER STATES ARE IN A UNIQUE POSITION TO DEVELOP AND ADAPT HEALTHEQUITY AGENDAS THAT MEET THE SPECIC NEEDS OF THEIR COMMUNITIES )N FACT ALL STATES HAVE ESTABLISHED AMINORITY HEALTH OR HEALTH EQUITY OFCE OR ENTITY )MPLEMENTATION OF THE !#! PROVIDES A VEHICLE FOR MOVING HEALTH DISPARITIES ISSUES OUT OF THE SILOS OF OFCE OF MINORITY HEALTH AND INTO THE LARGER CONTEXT OF STATE


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10

HEALTH POLICY 3TATE POLICYMAKERS HAVE AN OPPORTUNITY TO WORK ACROSS AGENCIES SYSTEMS AND SECTORS TODEVELOP SUSTAINABLE AND COMPREHENSIVE STATEBASED APPROACHES TO ADVANCE HEALTH EQUITY FOR THEIR MINORITY POPULATIONS

4O HELP STATE POLICYMAKERS MAINTAIN MOMENTUM TOWARDS ACHIEVING HEALTH EQUITY IN A COMPLEX IMPLEMENTATION ENVIRONMENT .!3(0 WITH FUNDING FROM THE !ETNA &OUNDATION DEVELOPED THE 3TATE (EALTH %QUITY

,EARNING #OLLABORATIVE FOR TEAMS OF STATE OFCIALS 4HE PURPOSE OF THIS ,EARNING #OLLABORATIVE WAS TO PROVIDE CONCRETE ASSISTANCE TO SEVEN STATES THROUGH ACCESS TO EXPERT CONSULTATION IMPLEMENTATION RESOURCESAND NETWORKING WITH OTHER STATE OFCIALS TO SUPPORT STATES IN SIMULTANEOUSLY ACHIEVING HEALTH REFORM ANDHEALTH EQUITY GOALS .!3(0 ANTICIPATED THE FOLLOWING OUTCOMES FOR PARTICIPATING STATES

)MPLEMENTATION OF THE !#! WITH A CONSCIOUS CONSIDERATION OF THE IMPACT OF STATE POLICY

DECISIONS ON DIVERSE POPULATIONS AND THE ABILITY TO IDENTIFY OPPORTUNITIES TO PROMOTE HEALTHEQUITY AS THEY CARRY OUT REQUIRED !#! ROLES AND POLICIES

%LEVATION OF HEALTH EQUITY AGENDAS (ISTORICALLY INITIATIVES THAT PROMOTE HEALTH EQUITY HAVE BEENSILOED AND VULNERABLE TO POLITICAL AND NANCIAL SHIFTS )NCORPORATING HEALTH EQUITY INTO THE BROADERSCOPE OF HEALTH SYSTEMS WILL FOCUS GREATER ATTENTION ON THE NEEDS OF DIVERSE POPULATIONS

)NTEGRATION OF HEALTH EQUITY INITIATIVES ACROSS STATE PROGRAMS )MPROVING THE HEALTH OF DIVERSEPOPULATIONS IS AN OBJECTIVE OF MULTIPLE STATE AGENCIES AND BRANCHES OF GOVERNMENT 4O BE SUCCESSFUL AND HAVE THE GREATEST IMPACT -EDICAID MINORITY HEALTH PUBLIC HEALTH AND OTHER AGENCIESSHOULD BUILD SUSTAINABLE PARTNERSHIPS AND PROMOTE CROSSCUTTING HEALTH EQUITY AGENDAS

3TATE 3ELECTION 0ROCESS

)N !UGUST .!3(0 SOLICITED A NATIONAL REQUEST FOR APPLICATIONS FOR STATES INTERESTED IN PARTICIPATING IN THE (EALTH %QUITY ,EARNING #OLLABORATIVE .!3(0 SOUGHT APPLICATIONS FROM STATES THAT HAD RMLYCOMMITTED TO ADVANCING HEALTH EQUITY AND WANTED TO LEVERAGE THE OPPORTUNITIES PRESENTED IN HEALTH CAREREFORM 3TATE APPLICATIONS WERE ASSESSED BASED ON THE FOLLOWING CRITERIA

0ARTNERSHIPS #OMMITMENT FROM -EDICAID PUBLIC HEALTH AND MINORITY HEALTH AGENCIES TO PARTICIPATE IN A CORE PROJECT TEAM AS WELL AS ENGAGE OTHER RELEVANT STATE AGENCIES AND STAKEHOLDERORGANIZATIONS

2ELEVANT HEALTH REFORM ACTIVITY %VIDENCE OF CORE TEAM MEMBER ENGAGEMENT IN STATE HEALTH CAREREFORM EFFORTS

2EASONABLE OBJECTIVES %VIDENCE THAT THE CORE TEAM WILL ESTABLISH FEASIBLE OBJECTIVES FOR THEEIGHTMONTH PROJECT PERIOD PARTICULARLY BY BUILDING UPON EXISTING COMPLEMENTARY EFFORTS

0OTENTIAL IMPACT OF TECHNICAL ASSISTANCE %VIDENCE THAT PARTICIPATION WOULD STRENGTHEN THESTATES AND INFORM OTHER STATES HEALTH EQUITY AND HEALTH REFORM AGENDAS

"ASED ON THE ABOVE CRITERIA AND AFTER CONSULTING WITH A .!3(0 PROJECT ADVISORY COMMITTEE COMPRISEDOF NATIONAL AND FEDERAL HEALTH EQUITY EXPERTS .!3(0 SELECTED !RKANSAS #ONNECTICUT (AWAII -INNESOTA.EW -EXICO /HIO AND 6IRGINIA TO PARTICIPATE IN THE (EALTH %QUITY ,EARNING #OLLABORATIVE

3ELECTED STATES WERE EXPECTED TO

&ORM A CORE LEADERSHIP TEAM OF STATE OFCIALS FROM -EDICAID MINORITY HEALTH AND PUBLIC HEALTHAGENCIES TO FACILITATE INTERAGENCY COLLABORATION


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11

$EVELOP A WORKPLAN AND ACHIEVE REASONABLE PROGRESS TOWARDS WORKPLAN OBJECTIVES WITHINTHREE POLICY PRIORITY AREAS FOR ADVANCING HEALTH EQUITY THROUGH HEALTH REFORM IMPLEMENTATION

"ASED ON HEALTH CARE REFORM IMPLEMENTATION PRIORITIES IDENTIED BY .!3(0S %XECUTIVE #OMMITTEE ANDFEEDBACK FROM THE PROJECT ADVISORY COMMITTEE .!3(0 PROVIDED A LIST TO SELECTED STATES OF AREAS 3EE4ABLE FROM WHICH THEY IDENTIED THREE PRIORITIES AS THE FOCUS OF THEIR EFFORTS OVER THE EIGHTMONTH

TECHNICAL ASSISTANCE PERIOD OF THE (EALTH %QUITY ,EARNING #OLLABORATIVE

4!",% (%!,4( %15)49 ,%!2.).' #/,,!"/2!4)6% 34!4%3 7/2+0,!. 02)/2)49 !2%!3

0OLICY !REA 3AMPLE !CTIONS TO !DVANCE (EALTH %QUITY

#O

VERAGEAND!CCESS "E 3TRATEGIC WITH )NSURANCE

%XCHANGES

$EVELOP DESCRIPTIONS OF PLANS AND SUBSIDIES THAT ARE CULTURALLY AND

LINGUISTICALLY APPROPRIATE

#ONDUCT TARGETED OUTREACH TO RACIAL AND ETHNIC MINORITY COMMUNI

TIES TO INCREASE THEIR AWARENESS OF INSURANCE SUBSIDIES

3IMPLIFY AND )NTEGRATE

%LIGIBILITY 3YSTEMS

!DOPT TESTED OUTREACH ENROLLMENT AND RETENTION STRATEGIES TO

MAXIMIZE PARTICIPATION OF UNDERSERVED POPULATIONS IN -EDICAID AND

%XCHANGES

2EDUCE DOCUMENTATION BURDEN OF CITIZEN VERICATION

)NCREASE TRANSLATION AND INTERPRETATION SERVICES

1UALITYAND$ELIVERY2EFORM

%MPHASIZE #OORDINATION OF

#ARE

%STABLISH HEALTH HOMES IN RACIAL AND ETHNIC MINORITY COMMUNITIES

TARGETED TO PEOPLE WITH MULTIPLE CHRONIC CONDITIONS

)NTEGRATE DELIVERY SYSTEM OF BEHAVIORAL AND PHYSICAL HEALTH FOR -ED

ICAID RECIPIENTS THROUGH SAFETY NET PROVIDERS

0ROMOTE 1UALITY AND

%FCIENCY FROM THE (EALTH

#ARE 3YSTEM

!DOPT PAYMENT REFORM DEMONSTRATIONS TO IMPROVE CARE FOR PERSONS

WITH CHRONIC DISEASES AND CONCENTRATE PUBLIC RESOURCES FOR PILOT

PROGRAMS IN RACIAL AND ETHNIC MINORITY COMMUNITIES

)MPROVE 0ROVIDER AND (EALTH

3YSTEM #APACITY

3TRENGTHEN THE ABILITY OF SAFETY NET PROVIDER TO SERVICE PERSONS NEWLY

ELIGIBLE FOR -EDICAID INSURANCE BENETS MANY OF WHOM WILL LIKELY BEETHNIC MINORITIES WITH CHRONIC CONDITIONS

$EVELOP FEDERAL GRANT PROPOSALS TO SUPPORT INCREASED WORKFORCE

DIVERSITY AND EXPANDED PROVIDER CAPACITY IN UNDERSERVED AREAS

0OPULA

TION(EALTH

%NGAGE THE 0UBLIC IN

0OLICY $EVELOPMENT AND

)MPLEMENTATION

$EVELOP STRATEGIES TO EMPOWER RACIAL AND ETHNIC COMMUNITIES TO

WEIGH IN ON POLICY OPTIONS BEFORE THAT ARE ADOPTED AND TO PROVIDE

FEEDBACK ON HOW THAT ARE BEING IMPLANTED SO THEY CAN BE IMPROVED

5SE 9OUR $ATA

$EVELOP STRATEGIES TO ANALYZE THE MYRIAD NEW DATA ELEMENTS MANDAT

ED FOR COLLECTION IN ORDER TO IDENTITY AND DRIVE NEEDED IMPROVEMENTS

IN HEALTH EQUITY

5SE DATA TO ESTABLISH PROVIDER PERFORMANCE MEASURES FOR REDUCING

HEALTH DISPARITIES AND CHRONIC DISEASE

0URSUE 0OPULATION (EALTH

'OALS

2EVITALIZE PUBLIC HEALTH STRATEGIES THAT FOCUS ON DISEASE PREVENTION

AND HEALTH PROMOTION

$EVELOP FEDERAL GRANT PROPOSALS TO ACCESS OPPORTUNITIES PROVIDED BY

THE 0REVENTION AND 0UBLIC (EALTH &UND

%XPAND THE SUPPLY AND SCOPE OF COMMUNITY HEALTH WORKERS


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12

3TATES PRIORITY AREAS WERE THE BASIS FOR MONTHLY EXPERT TECHNICAL ASSISTANCE ACTIVITIES AND ONGOING PEERLEARNING OPPORTUNITIES WHICH FOCUSED ON THE FOLLOWING SIX TOPICS

3TRATEGIES TO ENSURE PARTICIPATION OF DIVERSE POPULATIONS IN -EDICAID AND EXCHANGE PLANS

%NGAGING RACIAL AND ETHNIC MINORITY COMMUNITIES IN POLICY DEVELOPMENT AND IMPLEMENTATION

(EALTH AND MEDICAL HOME DESIGN CONSIDERATIONS FOR HEALTH EQUITY

-EDICAID MANAGED CARE CONTRACT OPTIONS FOR ADVANCING HEALTH EQUITY

#ULTURAL COMPETENCY TRAINING FOR PROVIDERS AND POLICY MAKERS AND

$ATA COLLECTION AND USE TO ADVANCE HEALTH EQUITY

4HE PROJECT CULMINATED WITH AN INPERSON STATEFEDERAL MEETING FOLLOWED BY A STATEONLY MEETING OF(EALTH %QUITY ,EARNING #OLLABORATIVE TEAM MEMBERS 4HIS REPORT FOCUSES ON THE EXPERIENCES OF THE PARTICIPATING STATES AND THEIR STRATEGIES TO ADVANCE HEALTH EQUITY THROUGH HEALTH REFORM AS PART OF THIS PROJECT


17/39

13



Tubuf!Bdujpo!up!Bewbodf!Ifbmui!Frvjuz!vtjoh!Tfmfdu!BDB!!

boe!Tubuf!Qpmjdz!Mfwfst

TTATES PARTICIPATING IN THE (EALTH %QUITY ,EARNING #OLLABORATIVE HAVE USED SELECT !#! STATE POLICYLEVERS TO ADVANCE HEALTH EQUITY BY BUILDING ON EXISTING INITIATIVES AND PARTNERSHIPS 4HIS SECTION RSTDESCRIBES STATES ACTION TO ADVANCE HEALTH EQUITY RELATED TO HEALTH COVERAGE AND ACCESS AND THEN

HIGHLIGHTS ACTION RELATED TO QUALITY OF CARE AND DELIVERY SYSTEM REFORM 4ABLE NEXT PAGE PROVIDES ANOVERVIEW OF STATES ACTIONS IN THESE AREAS !S PREVIOUSLY NOTED THE ACTIVITIES DESCRIBED HERE ARE THOSE THATWERE THE FOCUS OF THIS PARTICULAR LEARNING COLLABORATIVE AND DO NOT REPRESENT THE TOTALITY OF STATES HEALTHEQUITY OR HEALTH REFORM EFFORTS

34!4% !#4)/. 2%,!4%$ 4/ #/6%2!'% !.$ !##%330ARTICIPATING STATES HAVE UNDERTAKEN A NUMBER OF ACTIVITIES THAT CAPITALIZE ON INCREASED INSURANCE COVERAGEUNDER THE !#! 4HEY ARE TAKING STEPS TO ENSURE THAT NEWLY COVERED RACIAL AND ETHNIC MINORITIES UNDER THE!#! -EDICAID EXPANSION AND HEALTH INSURANCE EXCHANGE HAVE EQUITABLE ACCESS TO CARE 4HESE STATES AREWORKING TO ADVANCE HEALTH EQUITY THROUGH

)NSURANCE EXCHANGE PLANNING AND LEADERSHIP

#ONSUMER ASSISTANCE AND OUTREACH IN NAVIGATOR PROGRAMS AND

$ATA SHARING AGREEMENTS AND ANALYSES TO INFORM -EDICAID PROGRAM ENROLLMENT AND SERVICE PROVISION

%XCHANGE PLANNING AND LEADERSHIP

!S ACTIVITY IN #ONNECTICUT AND -INNESOTA SHOW INTEGRATING HEALTH EQUITY INTO INSURANCE EXCHANGE PLANNINGRST ENTAILS EDUCATING POLICYMAKERS TASKED WITH DEVELOPING THE EXCHANGE ABOUT THE NEEDS OF DIVERSE POPULATIONS AND WAYS THAT POLICYMAKERS CAN PURSUE HEALTH EQUITY AS A GOAL OF EXCHANGE IMPLEMENTATION &ROMTHERE EXCHANGE LEADERS CAN WEAVE HEALTH EQUITY INTO EACH STAGE OF PLANNING

#ONNECTICUT

#ONNECTICUTS /FCE OF (EALTH 2EFORM AND )NNOVATION IS DEVELOPING HEALTH EQUITY TRAINING FOR ITS (EALTH)NSURANCE %XCHANGE "OARD OF $IRECTORS !N OUTSIDE EXPERT WILL LEAD THE TRAINING HOWEVER THE /FCE WILLCOLLABORATE WITH OTHER STATE AGENCIES TO INCORPORATE INTERNAL EXPERTISE AND RESOURCES ON HEALTH DISPARITIESWITHIN THE STATE 3TATE HEALTH DISPARITIES DATA FROM THE PUBLIC HEALTH DEPARTMENT WILL BE SHARED DURING THETRAINING AS WILL INFORMATION ON HEALTH EQUITY IMPROVEMENT EFFORTS IN OTHER STATES !DDITIONALLY THE /FCE WILLPROVIDE HEALTH EQUITY TRAINING TO THE 'OVERNORS (EALTH #ARE #ABINET WHICH ADVISES THE 'OVERNOR ON IMPLEMENTATION OF FEDERAL HEALTH REFORM AND DEVELOPMENT OF AN INTEGRATED HEALTH CARE SYSTEM IN THE STATE

-INNESOTA

%ARLIER THIS YEAR MEMBERS OF THE -INNESOTA (EALTH )NSURANCE %XCHANGE !DVISORY 4ASK &ORCE DEVOTED ANENTIRE MEETING TO THE TOPIC OF HEALTH EQUITY 4HE -EDICAID AND HEALTH COMMISSIONERS SHARED DATA ABOUTHEALTH DISPARITIES IN THE STATE SOCIAL DETERMINANTS OF HEALTH IN THE STATE AND THE NANCIAL IMPLICATIONS OFDISPARITIES #ONSUMERS AND CONSUMER REPRESENTATIVES PROVIDED CONCRETE POLICY RECOMMENDATIONS FOR ADDRESSING DISPARITIES THROUGH THE EXCHANGE SUCH AS ADOPTING DATA COLLECTION STANDARDS TO CAPTURE DISPARITIES AND ENSURING CULTURALLY APPROPRIATE CONSUMER OUTREACH "ASED ON THE INFORMATION PRESENTED THE TASKFORCE VOTED TO COMMIT TO MAKING EACH OF ITS POLICY RECOMMENDATIONS OR DECISIONS ONLY AFTER CONSIDERING


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14

4!",% 34!4% !#4)/. 4(2/5'( 4(% (%!,4( %15)49 ,%!2.).' #/,,!"/2!4)6% 4/ !$6!.#% (%!,4( %15)49 53).'3%,%#4 !#! !.$ 34!4% 0/,)#9 ,%6%23

!#!2ELATED &OCUS !REA AND 3TATE !CTIVITY !2 #4 () -. .- /( 6!

#OVERAGEAND!CCESS

/UTREACH AND %NROLLMENT

#REATE AND PROVIDE CULTURALLY SENSITIVE EDUCATIONAL

MATERIALS TO THE PUBLIC

)NCORPORATE HEALTH EQUITY CONSIDERATIONS INTO

CONSUMER ASSISTANCE AND OUTREACH THROUGH

NAVIGATOR PROGRAMS

$EVELOP DATA SHARING AGREEMENTS TO ANALYZE

ENROLLMENT AND PRIORITIZE AREAS FOR OUTREACH AND

ENROLLMENT EFFORTS

(EALTH )NSURANCE"ENET %XCHANGE

$EVELOP GUIDELINES FOR COLLECTING RACEETHNICITY

LANGUAGE DATA

0ROVIDE HEALTH EQUITY DATA AND EDUCATION FOR

PLANNING OR ADVISORY BOARD MEMBERS

%NSURE DIVERSE STAKEHOLDER REPRESENTATION ON

PLANNING OR ADVISORY ENTITIES

1UALITYAND$ELI

VERY2EFORM

-EDICAID 0ROVIDER 4RAINING AND %XPECTATIONS

$EVELOP CULTURAL COMPETENCY TRAINING ANDOR

PROVIDE ANTIOPPRESSION ASSESSMENTS FOR -EDICAID

PROVIDERS

&ACILITATE MANAGED CARE CONTRACT LANGUAGE CHANGES

TO INCREASE ACCOUNTABILITY TO DELIVER CULTURALLY

SENSITIVE CARE ANDOR REDUCE HEALTH DISPARITIES

(EALTH AND -EDICAL (OMES#ONDUCT OUTREACH TO DIVERSE COMMUNITIES ABOUT

HEALTH HOMES TO INFORM PLANNING

0LAN FOR MEDICAL HOME ROLLOUT IN RACIALLYETHNICALLY

DIVERSE COMMUNITIES

$EVELOP AND CONDUCT CULTURAL COMPETENCY TRAINING

FOR MEDICAL HOME PROVIDERS

0URSUE FEDERAL SUPPORT OPPORTUNITIES TO IMPROVE

PAYMENT AND CARE DELIVERY

$ATA

2ACE%THNICITY,ANGUAGE 2%, $ATA

)NVENTORY -EDICAID PUBLIC HEALTH AND OTHER AGENCYDATABASES TO ASSESS AND IMPROVE COLLECTION OF 2%,

DATA

$EVELOP POLICES TO GOVERN 2%, DATA COLLECTION

THROUGH ALLPAYER CLAIMS DATABASES

%XPLORE DEVELOPMENT OF STANDARDIZED AND

INTEGRATED METRICS TO ANALYZE DISPARITIES DATA

ACROSS STATE AGENCIES


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15

THE POLICYS IMPACT ON HEALTH DISPARITIES )N THIS WAY EFFORTS TO ADVANCE HEALTH EQUITY ARE INTEGRATED INTOEXCHANGE PLANNING ! CRITICAL PRECURSOR THAT MADE THIS ACTION POSSIBLE IN -INNESOTA WAS HAVING TASK FORCEMEMBERSTHE VOICES WITH AUTHORITY AT THE POLICYMAKING TABLEWHO REPRESENT COMMUNITIES AND WHOTHEMSELVES ARE RACIAL OR ETHNIC MINORITIES

#ONSUMER ASSISTANCE AND OUTREACH IN NAVIGATOR PROGRAMS

5NDER THE !#! STATES HAVE THE OPTION TO RUN HEALTH INSURANCE EXCHANGES INDEPENDENTLY OR IN PARTNERSHIP WITH THE FEDERAL GOVERNMENT )N &EBRUARY !RKANSAS DECIDED TO PURSUE THE OPTION TO A DEVELOPA FEDERALLYFACILITATED EXCHANGE &&% WHILE MAINTAINING STATE OPERATION OF CORE EXCHANGE FUNCTIONS SUCHAS CONSUMER ASSISTANCE PLANNING AND PLAN MANAGEMENT 4HROUGH THIS 3TATE 0ARTNERSHIP MODEL !RKANSASHAS THE EXIBILITY TO DESIGN ITS NAVIGATOR PROGRAM IN COMPLIANCE WITH GUIDELINES SET FORTH IN THE !#! ANDSUPPORT THE CERTICATION AND TRAINING OF ELIGIBLE INDIVIDUALS TO SERVE AS NAVIGATORS

!RKANSAS

!RKANSAS IS USING ITS NAVIGATOR PROGRAM TO ADVANCE POLICY LEVERS AFFORDED BY THE EXCHANGE TO ADDRESSHEALTH EQUITY THROUGH CONSUMER ENGAGEMENT OUTREACH AND NAVIGATOR PROGRAM DESIGN &OR EXAMPLE THE

!RKANSAS )NSURANCE $EPARTMENT AND )NSURANCE $EPARTMENT (EALTH "ENETS %XCHANGE 0ARTNERSHIP $IVISIONHAS ENGAGED COMMUNITYBASED ORGANIZATIONS CONSUMER ADVOCATES AND COMMUNITY MEMBERS IN EDUCATIONAL ACTIVITIES TO COMMUNICATE OPPORTUNITIES WITHIN THE EXCHANGE TO ADVANCE HEALTH EQUITY 4HE STATE ISALSO CURRENTLY WORKING ON A 4RAIN THE 4RAINER CURRICULUM AND RESOURCE TOOLBOX FOR COMMUNITY ORGANIZERSTO FACILITATE COMMUNICATION OF EXCHANGE POLICY DEVELOPMENTS BETWEEN THE STATE AND POTENTIAL EXCHANGEENROLLEES AND SOLICIT FEEDBACK THROUGH PUBLIC COMMENT ON PLANNED POLICY DEVELOPMENTS ,ESSONS LEARNEDFROM THESE COMMUNITY ENGAGEMENT ACTIVITIES WILL BE SHARED WITH STATE POLICYMAKERS DESIGNING EXCHANGEPLANS AND THE NAVIGATOR PROGRAM TO ADDRESS THE NEEDS OF MINORITY COMMUNITIES

!DDITIONALLY THE !RKANSAS )NSURANCE $EPARTMENTS (EALTH "ENET %XCHANGE 0LANNING $IVISION WHICHOVERSEES THE DEVELOPMENT OF THE 3TATE 0ARTNERSHIP MODEL ESTABLISHED A #ONSUMER !DVISORY #OMMITTEEAND CONDUCTS CONSUMER FOCUS GROUPS TO DEVELOP OUTREACH RECOMMENDATIONS TO REACH DIVERSE POPULATIONS

4HROUGH THE NAVIGATOR PROGRAM THE STATE IS LOOKING TO IMPLEMENT CERTICATION POLICIES THAT WILL ALLOWBROAD PARTICIPATION IN THE PROGRAM 4HIS WILL BE AN IMPORTANT CONSIDERATION FOR OUTREACH IN RURAL AREAS ANDLOCALITIES WITH HIGH CONCENTRATIONS OF INDIVIDUALS FROM RACIAL AND ETHNIC MINORITY GROUPS &INALLY !RKANSAS ISWORKING TO DEVELOP CULTURAL COMPETENCY CONTRACT LANGUAGE TO BE INCLUDED IN 2&0S FOR ORGANIZATIONS APPLYING TO PARTICIPATE IN THE NAVIGATOR GRANT PROGRAM %XAMPLES OF PROVISIONS ARE AS FOLLOWS

4O ENSURE SELECTED .AVIGATORS ARE TRUSTED SOURCES OF HEALTH CARE COVERAGE INFORMATION IN THE COMMUNITIES THEY CHOOSE TO SERVE THAT SERVICES ARE CULTURALLY AND LINGUISTICALLY APPROPRIATE AND THATINFORMATION IS RELAYED IN A WAY THAT SIMPLIES CHOICES AND CONSIDERS THE INDIVIDUAL NEEDS OF EACHCONSUMER AND THEIR FAMILIES

4O CREATE A POSITIVE OPINION OF THE EXCHANGE ITS BENETS AND THE IMPORTANT ROLE HEALTH INSURANCE

COVERAGE CAN PLAY IN REDUCING HEALTH CARE DISPARITIES

4O MAXIMIZE COVERAGE FOR THE UNINSURED OR UNDERINSURED IN THE EXCHANGE

$ATA AGREEMENTS AND ANALYSIS TO INFORM -EDICAID ENROLLMENT AND SERVICE PROVISION

!S DESCRIBED BELOW 6IRGINIA IS ESTABLISHING A DATA SHARING AGREEMENT TO INFORM -EDICAID ENROLLMENT ANDSERVICE PROVISION


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6IRGINIA

6IRGINIA HAS CREATED A NEW MECHANISM FOR CROSSAGENCY COLLABORATION TO UNDERSTAND AND ADDRESS DISPARITIESIN ENROLLMENT AND OUTCOMES )N THE STATE UNINTENDED PREGNANCY RATES ARE HIGHEST AMONG CERTAIN GROUPSOF WOMEN SUCH AS WOMEN AGES TO WOMEN WHOSE INCOME IS BELOW THE POVERTY LINE AND "LACK OR(ISPANIC WOMEN 0LAN &IRST A FAMILY PLANNING PROGRAM WITHIN -EDICAID HAS TARGETED OUTREACH EFFORTS TO

AREAS WITH HIGH INFANT MORTALITY RATES 2ECENTLY THE STATES HEALTH AND -EDICAID -EDICAL !SSISTANCE 3ERVICES DEPARTMENTS ENTERED INTO A DATA SHARING AGREEMENT TO EVALUATE AND INFORM 0LAN &IRST ENROLLMENT ANDPROVISION OF SERVICES 4HE HEALTH DEPARTMENT ANALYZED 0LAN &IRST DATA USING GEOGRAPHIC INFORMATION SYSTEMS')3 MAPPING IN CONJUNCTION WITH MULTILEVEL SPATIAL ANALYSIS ')3 MAPPING AND SPATIAL ANALYSIS ARE TOOLSTHAT ANALYZE AND DISPLAY GEOGRAPHICALLY REFERENCED AND OTHER DATA TO DESCRIBE THE GEOGRAPHIC RELATIONSHIPS AND PATTERNS

3PATIAL ANALYSIS WAS USED TO IDENTIFY COMMUNITIES WHERE MULTIPLE RISK FACTORS SUCH AS LOW INCOME OR-EDICAID ELIGIBILITY AND SHORT BIRTH INTERVALS OVERLAP 7ITH THIS INFORMATION -EDICAID CAN MORE EFCIENTLYTARGET 0LAN &IRST OUTREACH ENROLLMENT AND PROGRAM SERVICES TO THE COMMUNITIES WITH THE MOST RISK FACTORSAND HIGHEST NEED 'IVEN GENERAL DEMOGRAPHIC INFORMATION ABOUT THE STATES GEOGRAPHIC AREAS AGENCY STAFFCAN SURMISE WHICH LOCALITIES ARE MOST RACIALLY AND ETHNICALLY DIVERSE AND BEST ENABLE THEM TO ADDRESS RACIAL

AND ETHNIC DISPARITIES IN INFANT MORTALITY 4HEIR NEXT STEPS WILL BE INCLUDING RACE AND ETHNICITY DATA IN THEANALYSIS FOR A MORE ACCURATE ASSESSMENT OF RACIAL AND ETHNIC DIFFERENCES IN ENROLLMENT )NCLUDING THIS DATAFROM THE OUTSET STRENGTHENS THE STATES ABILITY TO ASSESS DISPARITIES IN RISK FACTORS AND PRIORITIZE COMMUNITIES WITH POPULATIONS OF COLOR FACING DISPARITIES IN OUTCOMES

2ECOMMENDATIONS BASED ON STATE ACTIONS TO ADVANCE HEALTH EQUITY THROUGH COVERAGE AND ACCESS

STRATEGIES

4HE FOLLOWING RECOMMENDATIONS EMERGED FROM PARTICIPATING STATES EXPERIENCES ADVANCING HEALTH EQUITYTHROUGH EXCHANGE PLANNING NAVIGATOR PROGRAMS -EDICAID AND HEALTH AGENCY DATA AGREEMENTS AND ANALYSIS AND HEALTH PLAN EDUCATION ABOUT HEALTH EQUITY

&OSTER COLLABORATION BETWEEN -EDICAID AGENCIES HEALTH DEPARTMENTS AND MINORITY HEALTH AGENCIES THE LATTER HAVE EXISTING EDUCATIONAL RESOURCES COMMUNITY NETWORKS RELEVANT RACEETHNICITYLANGUAGE DATA AND QUANTITATIVE ANALYTIC EXPERTISE THAT CAN HELP -EDICAID AGENCIES PRIORITIZE OUTREACH AND SERVICE PROVISION EFFORTS AND ALLOCATION OF RESOURCES TO MAXIMIZE RETURN ON INVESTMENT

%NSURE EXCHANGEPLANNING AND ALL OTHER POLICYMAKING ENTITIES HAVE DIVERSE MEMBERSHIP ANDINCLUDE COMMUNITY MEMBERS WHO WILL LIKELY PARTICIPATE AS CONSUMERS IN THE EXCHANGE

34!4% !#4)/. 2%,!4%$ 4/ 15!,)49 !.$ $%,)6%29 2%&/2-)N ADDITION TO ADDRESSING EQUITY IN ACCESS THROUGH !#! AND STATE POLICY LEVERS PARTICIPATING STATES HAVEIDENTIED OPTIONS FOR CAPITALIZING ON THE HEALTH DELIVERY REFORM AND QUALITY IMPROVEMENT COMPONENTS OF!#! 3TATES ARE TAKING STEPS TO ENSURE THAT DELIVERY REFORM INITIATIVES INTEGRATE A HEALTH EQUITY LENS TO ENSURE HIGHQUALITY EQUITABLE CARE FOR ALL 0ARTICIPATING STATES SEEK TO ADVANCE HEALTH EQUITY THROUGH

(EALTH AND MEDICAL HOMES

2ACEETHNICITYLANGUAGE DATA GUIDELINES AND RECOMMENDATIONS

#ULTURAL COMPETENCY TRAINING FOR -EDICAID PROVIDERS AND



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(EALTH AND MEDICAL HOMES

.ATIONALLY THERE HAS BEEN A PROLIFERATION OF STATE LEGISLATION AND INITIATIVES TO PROMOTE ADOPTION OF THEPATIENTCENTERED MEDICAL HOME 0#-( CARE DELIVERY MODEL ,IKE HEALTH HOMES AUTHORIZED UNDER !#!THE 0#-( IS AN ENHANCED MODEL OF PRIMARY CARE THAT OFFERS CONTINUOUS TEAMBASED COORDINATED HIGHQUALITY SAFE AND WHOLEPERSON ORIENTED CARE TO PATIENTS AND A PAYMENT STRUCTURE TO SUPPORT THE NECES

SARY INVESTMENTS FOR THIS CARE BY PROVIDERS

"OTH HEALTH AND MEDICAL HOMES PLAY AN IMPORTANT ROLE INTRANSFORMING THE DELIVERY OF PATIENTCENTERED HEALTH CARE FOR RACIAL AND ETHNIC MINORITIES !S EXAMPLESFROM /HIO -INNESOTA AND (AWAII SHOW PARTICIPATING STATES ARE ADVANCING HEALTH EQUITY BY INTEGRATINGTHE NEEDS OF DIVERSE POPULATIONS INTO HEALTH AND MEDICAL HOME INITIATIVES VIA SITE SELECTION CRITERIA PROVIDER EDUCATION AND COMMUNITY ENGAGEMENT IN PLANNING 4HEIR WORK OFFERS IDEAS HOW STATES CAN ENSUREHEALTH HOMES AND MEDICAL HOMES MEET THE NEEDS OF DIVERSE POPULATIONS

/HIO

)N /HIO LEGISLATION (OUSE "ILL ESTABLISHED THE 0ATIENT#ENTERED -EDICAL (OME %DUCATION 0ILOT 0ROGRAM THROUGH WHICH PRACTICES AFLIATED WITH MEDICAL AND NURSING SCHOOLS WERE SELECTED TO PROMOTE ADOPTION OF THE PATIENTCENTERED MEDICAL HOME 0#-( MODEL OF PRIMARY CARE 4HE PILOT PROGRAM

OFFERS TUITION ASSISTANCE TO PRIMARY CARE CAREER STUDENTS TRAINS THEM IN THE 0#-( MODEL AND ENGAGESTHEM IN PRACTICAL ONTHEGROUND 0#-( EXPERIENCE %ARLIER THIS YEAR THE STATE ANNOUNCED NOT ONLY ANANCIAL COMMITMENT TO SUPPORT IMPLEMENTATION OF THE EXISTING PROJECT BUT ALSO AN EXPANSION TO SIX ADDITIONAL PRACTICES #OLLABORATION BETWEEN THE /HIO (EALTH %QUITY ,EARNING #OLLABORATIVE 4EAM AND THE/HIO /FCE OF (EALTH 4RANSFORMATION LED TO THE DECISION TO TARGET THE EXPANSION TO HEALTH PROVIDERS WHOPRIMARILY SERVE RACIAL AND ETHNIC MINORITIES AND UNDERSERVED COMMUNITIES 4HE STATE SELECTED ADDITIONALPRACTICES BASED ON SOCIOECONOMIC FACTORS AND RACIAL AND ETHNIC DIVERSITY )N ADDITION EVERY PRACTICE THATRECEIVES TRAINING DOLLARS MUST SUPPORT AT LEAST PERCENT UNINSURED OR -EDICAIDELIGIBLE PATIENTS 4HIS EFFORT TO TARGET POPULATIONS WHO BEAR A DISPROPORTIONATE BURDEN OF DISEASES AND POOR HEALTH OUTCOMES WILLPROVIDE FASTER RETURN ON INVESTMENT THROUGH IMPROVED OUTCOMES AND HEALTH STATUS AND IN COST SAVINGS )TALSO PROVIDES A WAY TO HELP ADVANCE HEALTH EQUITY 4HROUGH THE /HIO 0ATIENT#ENTERED 0RIMARY #ARE #OL

LABORATIVE THE STATES HEALTH DEPARTMENT IS FACILITATING THE 0#-( PROJECT EXPANSION AND WILL HELP INFORMSTATEWIDE 0#-( POLICY

-INNESOTA

! SECOND WAY PARTICIPATING STATES HAVE INTEGRATED HEALTH EQUITY INTO MEDICAL HOMES IS VIA PROVIDER TRAINING %ARLIER THIS YEAR -INNESOTA DEVELOPED AND HOSTED A HEALTH EQUITY EDUCATIONAL SESSION FOR MEDICALHOME KNOWN AS HEALTH CARE HOME PROVIDERS AS PART OF BROAD PROVIDER TRAINING 4HE HEALTH EQUITYWORKSHOP WAS HOSTED BY HEALTH DEPARTMENT STAFF AND FEATURED BEST PRACTICES IN PROVIDING CULTURALLY COMPETENT CARE AND INCLUDED TOPICS SUCH AS RACEETHNICITYLANGUAGE DATA COLLECTION AND USE AND PROVISION OFPATIENT AND FAMILYCENTERED CARE FOR DIVERSE POPULATIONS 4HE WORKSHOP WAS NOT A ONETIME EVENT ASHEALTH EQUITY AND CULTURAL COMPETENCE ARE NOW TOPICS FOR CONSIDERATION AS FUTURE EDUCATION SESSIONS ARE

PLANNED AMONG THE STATE S HEALTH CARE HOMES LEARNING COLLABORATIVE

(AWAII

(AWAII HAS INTEGRATED HEALTH EQUITY INTO HEALTH AND MEDICAL HOME PLANNING THROUGH EDUCATIONAL WORKSHOPS AND FOCUS GROUPS WITH RACIAL AND ETHNIC MINORITIES (AWAIIS DECISION TO DEVELOP THESE WORKSHOPSWAS INUENCED BY #ONNECTICUTS NDING OF SIGNICANT PUBLIC LEARNING CURVES ABOUT THE CONCEPT AND FUNCTION OF MEDICAL AND HEALTH HOMES AS WELL AS PUBLIC UNDERSTANDING OF THE IMPLICATIONS OF HEALTH REFORM4AKING A LESSON FROM #ONNECTICUT S EXPERIENCE (AWAII DECIDED TO DESIGN COMMUNITYBASED WORKSHOPS TO


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EDUCATE THE PUBLIC ABOUT KEY IMPLICATIONS OF HEALTH REFORM WITHIN COMMUNITIES 4HE MINUTE WORKSHOPSPROVIDED INFORMATION ABOUT HEALTH CARE REFORM FROM A CONSUMER PERSPECTIVE AND DESCRIBED HEALTH ANDMEDICAL HOMES

!DDITIONALLY THE (AWAII $EPARTMENT OF (EALTH HELD FOCUS GROUPS WITH MENTAL HEALTH CONSUMERS SERVED BYCOMMUNITY MENTAL HEALTH CENTERS AND FEDERALLY QUALIED HEALTH CENTERS TO SOLICIT FEEDBACK ABOUT CULTURAL

NEEDS AND PREFERENCES FOR ACCESSING HEALTH HOMES AND ENSURING QUALITY SERVICE DELIVERY PARTICULARLY CARECOORDINATION AMONG MEDICAL AND BEHAVIORAL HEALTH TREATMENT PROVIDERS 4HE STATE WILL SHARE FEEDBACK FROMTHE WORKSHOPS AND FOCUS GROUPS WITH GROUPS GUIDING HEALTH HOME AND OTHER PROJECT PLANNING )NSIGHTS WILLCONTINUE TO INFORM DELIVERY SYSTEM REFORM EFFORTS &OR EXAMPLE THE STATE IS PURSUING A 0RIMARY AND "EHAVIORAL (EALTH #ARE )NTEGRATION 0"(#) GRANT FROM THE FEDERAL 3UBSTANCE !BUSE AND -ENTAL (EALTH 3ERVICES!DMINISTRATION TO FACILITATE IMPLEMENTATION OF THE STATES PILOT "I$IRECTIONAL )NTEGRATION OF "EHAVIORAL(EALTH0RIMARY #ARE $EMONSTRATION 0ROJECT

2%, DATA COLLECTION GUIDELINES AND RECOMMENDATIONS

(EALTH %QUITY ,EARNING #OLLABORATIVE STATES ARE ALL INVESTED IN INCREASING THE VALIDITY AND USE OF RACEETHNICITYLANGUAGE 2%, DATA TO UNDERSTAND ASSESS AND IMPROVE QUALITY OF CARE FOR MINORITIES 7ORKING

THROUGH RESPECTIVE STATE OFCES OR ENTITIES DEVOTED TO HEALTH REFORM BOTH -INNESOTA AND #ONNECTICUTHAVE IDENTIED POLICY LEVERS AND OPPORTUNITIES FOR IMPROVING 2%, DATA GUIDELINES AND RECOMMENDATIONS

-INNESOTA

)N AS A RESULT OF STATE LEGISLATION THE HEALTH AND -EDICAID (UMAN 3ERVICES DEPARTMENTS IN -INNESOTA CONDUCTED AN INVENTORY OF 2%, HEALTHRELATED DATA THEY COLLECT AND CONSULTED WITH A STAKEHOLDERWORKGROUP TO DEVELOP RECOMMENDATIONS FOR IMPROVING 2%, DATA COLLECTION TO ENSURE SUFCIENT INFORMATIONTO ASSES PROGRAM OUTCOMES AND MAKE POLICIES TO ADDRESS HEALTH DISPARITIES 4HE WORKGROUPS DATA COLLECTION POLICY AND COMMUNICATION RECOMMENDATIONS WERE INCLUDED IN A REPORT TO THE STATE LEGISLATURE

4HE WORKGROUP RECOMMENDED THAT IT OR A SIMILAR ENTITY CONTINUE TO MEET 4HE (EALTH %QUITY ,EARNING#OLLABORATIVE HAS ENERGIZED THE MEMBER WORKGROUP BY GIVING IT THE CONCRETE TASK OF CREATING A CONSEN

SUS RECOMMENDATION ON THE STANDARDIZED COLLECTION OF 2%, DATA FOR STATE HEALTH REFORM ACTIVITIES /VER THESUMMER THE WORKGROUP WILL PRESENT ITS RECOMMENDATIONS TO TWO BROAD ENTITIES GUIDING POLICYMAKING IN THESTATE THE 'OVERNORS 4ASK &ORCE ON (EALTH 2EFORM COMPRISED OF PUBLIC AND PRIVATE SECTOR REPRESENTATIVESTASKED WITH IMPROVING HEALTH AND ACCESS LOWERING COSTS AND ADDRESSING DISPARITIES AND THE (EALTH )NSURANCE %XCHANGE 4ASK &ORCE 4HE WORKGROUPS RECOMMENDATIONS INCLUDE

(EALTH CARE ORGANIZATIONS IN -INNESOTA WILL COLLECT DATA ON RACE ETHNICITYTRIBAL AFLIATION ANDLANGUAGE ADHERING TO STANDARDS ADOPTED BY THE STATE

!DDITIONAL DATA COLLECTION VARIABLES SHOULD REPRESENT FACTORS THAT INUENCE HEALTH SUCH ASSOCIOECONOMIC STATUS AND ACCULTURATION

! UNIFORM CODING STRUCTURE SHOULD BE DEVELOPED TO FACILITATE DATA EXCHANGE AMONG HEALTH CAREORGANIZATIONS AND

4HE WORKGROUP WILL CONTINUE TO DENE LOCALLY RELEVANT CATEGORIES FOR ETHNICITY AND LANGUAGE ANDDEVELOP RECOMMENDATIONS FOR THE REPORTING AND SHARING OF 2%, DATA WITH STAKEHOLDERS


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#ONNECTICUT

)N RECOGNITION THAT ACCURATE AND STANDARDIZED DATA ARE CRUCIAL TO IDENTIFYING NEEDS AND PRIORITIZING IMPROVEMENT #ONNECTICUTS /FCE OF (EALTH 2EFORM AND )NNOVATION /FCE IS EXPLORING OPTIONS FOR COLLECTING AND UTILIZING 2%, FROM THE STATES ALLPAYER CLAIMS DATABASE !0#$ .INE STATES HAVE AN !0#$ ANDSEVEN STATES INCLUDING #ONNECTICUT ARE IN THE PROCESS OF IMPLEMENTING ONE !0#$S ARE A CRITICAL TOOL

STATES USE TO GENERATE COMPARABLE HEALTH CARE COST QUALITY AND UTILIZATION INFORMATION FROM ALL PAYERS IN ASTATE 4HE DATA HELPS TARGET AREAS FOR IMPROVEMENT BY IDENTIFYING VARIATIONS WHEN PUBLIC THE DATA ALSO ENABLE CONSUMERS AND PURCHASERS TO COMPARE COST AND QUALITY TO MAKE MORE INFORMED DECISIONS !S HEALTHCARE REFORM IS IMPLEMENTED !0#$S WILL PLAY AN IMPORTANT ROLE IN THE EVALUATION OF KEY REFORM EFFORTS SEEKING TO ADDRESS RISING HEALTH CARE COSTS INCREASED ACCESS TO CARE AND POPULATION HEALTH IMPROVEMENT

*UNE LEGISLATION IN #ONNECTICUT ENABLES THE /FCE TO PROMULGATE REGULATIONS FOR !0#$ DATA COLLECTION /FCE STAFF WANT TO ENSURE THAT AS THE !0#$ IS DEVELOPED IT CONTAINS CONSISTENT 2%, DATA TO INFORMHEALTH SYSTEM IMPROVEMENT STRATEGIES AND POLICY RECOMMENDATIONS THAT ADDRESS DISPARITIES AND ADVANCEHEALTH EQUITY #ONNECTICUT HAS EXISTING POLICIES TO DRAW FROM SPECICALLY THE PUBLIC HEALTH DEPARTMENT SDATA COLLECTION STANDARDS FOR RACEETHNICITY CATEGORIES WHICH PRECEDED THE !FFORDABLE #ARE !CT BUT ARECONSISTENT WITH THE !CT S PROVISIONS RELATED TO 2%, DATA COLLECTION /FCE AND PUBLIC HEALTH STAFF AREINTERESTED IN EXPLORING A STATEWIDE CROSSAGENCY APPROACH TO IMPROVED 2%, DATA COLLECTION

#ULTURAL COMPETENCY TRAINING FOR -EDICAID PROVIDERS

)N THE 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES /FCE OF -INORITY (EALTH DEVELOPED NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES #,!3 IN HEALTH CARE 4HE #,!3STANDARDS ARE RELEVANT FOR ALL HEALTH CARE PROVIDERS THEY ADDRESS CULTURALLY COMPETENT CARE LANGUAGE ACCESS SERVICES AND ORGANIZATIONAL SUPPORTS FOR CULTURAL COMPETENCE 4HEIR PURPOSE IS TO REDUCE DISPARITIESBY HELPING ORGANIZATIONS AND PROVIDERS RESPOND TO THE CULTURAL AND LINGUISTIC NEEDS OF DIVERSE POPULATIONS4HE STANDARDS INCLUDE SEVERAL GUIDELINES AS WELL AS REQUIREMENTS FOR FEDERAL GRANTEES

6IRGINIA

!S PART OF THE (EALTH %QUITY ,EARNING #OLLABORATIVE 6IRGINIA HAS HELPED MAKE #,!3 STANDARDS INFORMATION MORE AVAILABLE TO FAMILY PLANNING PROVIDERS !S PREVIOUSLY MENTIONED 6IRGINIA -EDICAID HAS A STATEPLAN AMENDMENT FOR A FAMILY PLANNING PROGRAM BRANDED AS 0LAN &IRST 0LAN &IRST OFFERS ELIGIBLE MEN ANDWOMEN SERVICES TO HELP PREVENT UNPLANNED PREGNANCIES -EDICAID UPDATED ITS 0LAN &IRST PROVIDER TRAININGS TO INCLUDE INFORMATION ON #,!3 7HEN -EDICAID CONDUCTED VE FACETOFACE STATEWIDE TRAININGS OFFAMILY PLANNING PROVIDERS IT SHARED INFORMATION FROM THE HEALTH DEPARTMENTS #,!3 TRAININGS TO ADDRESSAND ENSURE CULTURAL COMPETENCY 4HESE TRAININGS WILL ENSURE THAT AS MORE CONSUMERS BECOME ELIGIBLE FORSERVICES UNDER THE -EDICAID EXPANSION THEIR FAMILY PLANNING PROVIDERS WILL PROVIDE CULTURALLY APPROPRIATEAND SENSITIVE CARE


0ARTICIPATING STATES ALSO HAVE PURSUED STRATEGIES TO RECOMMEND OR REQUIRE -EDICAID MANAGED CARE ORGANIZATIONS -#/S TO COMPLETE SPECIC HEALTH EQUITY RESPONSIBILITIES WHICH A NUMBER OF STATES INCLUDING.EW -EXICO AND #ALIFORNIA CURRENTLY DO !DDITIONALLY STATES ARE PROVIDING HEALTH EQUITY INFORMATION TO-EDICAID -#/S 4HROUGH THESE STRATEGIES THE STATES HOPE TO LEVERAGE COVERAGE EXPANSIONS TO PROMOTEQUALITY CARE AND HEALTH EQUITY


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/HIO

/HIO HAS HAD MANDATORY MANAGED CARE FOR -EDICAIDELIGIBLE FAMILIES AND CHILDREN SINCE CURRENTLYTHE STATE HAS CONTRACTS WITH SEVEN -#/S /HIO -EDICAID $EPARTMENT OF *OB AND &AMILY 3ERVICES REVIEWS MANAGED CARE PLAN CONTRACT PROVIDER AGREEMENT LANGUAGE A COUPLE OF TIMES EACH YEAR TO DETERMINE IF ADDITIONAL POLICIES OR CLARICATIONS ARE NEEDED 4HE MOST RECENT REVIEW OCCURRED IN SPRING /HIO (EALTH %QUITY TEAM MEMBERS MET WITH CONTRACT STAFF AND PROPOSED THE FOLLOWING OF MANAGED CAREORGANIZATIONS -#/S

3YSTEMATIC COLLECTION OF SELFIDENTIED 2%, PATIENT DATA

"ETTER IDENTICATION AND MANAGEMENT OF GROUPS KNOWN TO EXPERIENCE HEALTH CARE DISPARITIES

5SE OF CULTURALLY APPROPRIATE MATERIALS BY THE WORKFORCE AND

%STABLISHMENT OF AND PARTICIPATION IN A -EDICAID (EALTH %QUITY 7ORKGROUP THAT WILL REGULARLYREVIEW MANAGED CARE CONTRACTS CREATE AND IMPLEMENT BASELINE DATA MEASURES AND LINK -#/S TOORGANIZATIONS THAT CAN HELP THEM DEVELOP CULTURALLY APPROPRIATE MATERIALS AND IMPLEMENT EFFECTIVE SOLUTIONS TO DECREASE HEALTH DISPARITIES

)N ADDITION TO -#/S AND -EDICAID THE (EALTH %QUITY 7ORKGROUP WOULD INCLUDE REPRESENTATIVES OF THEHEALTH DEPARTMENT AND THE /HIO #OMMISSION ON -INORITY (EALTH 4HE -EDICAID AGENCY IS CURRENTLY REVIEWING THE RECOMMENDED LANGUAGE THE TEAM PARTICIPATING IN THIS PROJECT HOPES TO HAVE IT NALIZED FORIMPLEMENTATION LATER THIS YEAR TO BE EFFECTIVE WITH THE NEXT CONTRACT PERIOD BEGINNING *ANUARY

6IRGINIA

4HIS SUMMER 6IRGINIAS #HIEF $EPUTY FOR 0UBLIC (EALTH IS SCHEDULED TO PRESENT TO THE -EDICAID -ANAGED#ARE /RGANIZATION -#/ 7ORKGROUP INFORMATION REGARDING INFANT MORTALITY AND 0LAN &IRST IN THE CONTEXT OF HEALTH EQUITY 4HE WORKGROUP IS MADE UP OF EXECUTIVE ADMINISTRATORS FROM THE STATES SIX CONTRACTED -#/S AND THEREFORE PROVIDES AN OPPORTUNITY FOR THE STATE TO REACH KEY PARTNERS TO ADDRESS RACIALAND ETHNIC DISPARITIES IN INFANT MORTALITY 4HIS PRESENTATION IS ANOTHER EXAMPLE OF HOW PUBLIC HEALTH AND

-EDICAID AGENCIES CAN COLLABORATE TO SHARE INFORMATION ABOUT EXISTING RACIAL AND ETHNIC DISPARITIES INHEALTH STATUS AND HEALTH CARE AND CREATE OPPORTUNITIES TO ADDRESS THEM

5SING $ATA TO %NGAGE #OMMUNITIES IN 0OLICY $EVELOPMENT IN .EW -EXICO

4HE .EW -EXICO $EPARTMENT OF (EALTH HAS INSTITUTED A NEW MODEL FOR HEALTH PLANNING TO CREATEA COMMON LANGUAGE ACROSS LOCAL 4RIBAL REGIONAL AND STATE POLICY 2EFERRED TO AS 4URN THE #URVETHIS MODEL FOR PLANNING AND DECISIONMAKING PROVIDES A FORUM FOR THE STATE AND COMMUNITIES TOWORK COLLABORATIVELY TO ADDRESS MUTUALLY IDENTIED POPULATION HEALTH NEEDS!S OF -AY THE$EPARTMENT HAD HELD FOUR PUBLIC 4URN THE #URVE MEETINGS ACROSS THE STATE %ACH MEETING ENABLEDMARGINALIZED COMMUNITY MEMBERS TO VOICE THEIR MOST CRITICAL POPULATION HEALTH NEEDS PROVIDE ACONSENSUS VOTE ON WHICH HEALTH NEEDS TO ADDRESS AND PROPOSE STRATEGIES TO DO SO 4HE $EPART

MENT STRATEGICALLY USED STATEWIDE DISPARITIES DATA TO IDENTIFY LOCATIONS FOR THE MEETINGS AS A WAYTO EMPOWER DISADVANTAGED COMMUNITY MEMBERS TO ADVOCATE FOR THEMSELVES IN HEALTH POLICY ANDAS PART OF THE HEALTH SYSTEM 4HE MEETINGS RESULTED IN A COMMITMENT TO FUTURE COLLABORATIVE WORKBETWEEN THE STATE AND COMMUNITIES ON DATA AND POLICY IMPROVEMENT #OMMUNITY FEEDBACK WILLINFORM THE $EPARTMENTS 3TATEWIDE (EALTH )MPROVEMENT 0LAN .EW -EXICOS USE OF DISPARITIES DATA TO ENGAGE VULNERABLE COMMUNITIES IN HEALTH AND HEALTH POLICY PLANNING IS A STRATEGYOTHER STATES COULD USE IN A VARIETY OF TOPIC AREAS TO ADVANCE HEALTH EQUITY


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2ECOMMENDATIONS BASED ON STATE ACTIONS TO ADVANCE HEALTH EQUITY USING QUALITY AND DELIVERY SYS

TEM STRATEGIES

"ASED ON PARTICIPATING STATES ACTIVITIES TO ADVANCE HEALTH EQUITY THROUGH QUALITY IMPROVEMENT AND DELIVERY SYSTEM REFORM STRATEGIES THE FOLLOWING RECOMMENDATIONS EMERGED

)NCORPORATE CULTURAL COMPETENCE 2%, DATA AND HEALTH EQUITY CONSIDERATIONS INTO HEALTH AND MEDI CAL HOMES THROUGH SELECTION CRITERIA PROVIDER TRAINING ANDOR CONSUMER ENGAGEMENT

7HERE POSSIBLE ESTABLISH STANDARDS FOR 2%, DATA COLLECTION AND USE IN !0#$S

%DUCATE MEDICAL PROVIDERS ABOUT CULTURAL COMPETENCY AND LINK PROVIDERS TO EXISTING RESOURCES THATWILL HELP THEM DELIVER CULTURALLYSENSITIVE CARE

5SE -EDICAID PURCHASING AND REGULATORY STRATEGIES TO REQUIRE OR ENCOURAGE MANAGED CARE ORGANIZATIONS AND PROVIDERS TO ADDRESS HEALTH DISPARITIES FOR HIGH QUALITY PATIENTCENTERED CARE AND

5SE -EDICAID HEALTH PLAN OR PROVIDER TRAININGS AND CONVENINGS TO SHARE TOOLS AND RESOURCES ABOUTDISPARITIES AND HEALTH EQUITY AND ENSURE PROVIDER CULTURAL COMPETENCE


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BS A NAL STEP IN THIS PROJECT .!3(0 HOSTED AN INPERSON MEETING OF STATE (EALTH %QUITY ,EARNING#OLLABORATIVE TEAM MEMBERS AND FEDERAL OFCIALS TO PROVIDE A FORUM FOR SHARING STATE AND FEDERALINITIATIVES TO ADVANCE HEALTH EQUITY THROUGH HEALTH REFORM AS WELL AS THE POLICY LEVERS AVAILABLE AT

THE STATE AND FEDERAL LEVELS TO FACILITATE THESE EFFORTS 4HE NEXT DAY STATE TEAM MEMBERS CONVENED AGAIN TOREECT ON THEIR EXPERIENCES PARTICIPATING IN THE #OLLABORATIVE AND TO IDENTIFY ACTION STEPS AND PROMISINGSTATE STRATEGIES FOR ADVANCING HEALTH EQUITY THROUGH HEALTH REFORM IMPLEMENTATION 4HIS SECTION DESCRIBESTHE THEMES THAT EMERGED FROM THE MEETINGS

&EDERAL DATA AND TOOLS CAN INFORM AND SUPPORT STATE EFFORTS

3TATES PLAY A CRUCIAL ROLE IN ENGAGING COMMUNITIES THAT IS NOT POSSIBLE AT THE FEDERAL LEVEL

#ROSSAGENCY COLLABORATION IS KEY TO ADVANCING EQUITY AND

&RAMING HEALTH EQUITY AS AN ISSUE OF QUALITY COST AND JUSTICE IS IMPORTANT IN GARNERING WIDESPREADINTEREST AND TAKING ADVANTAGE OF THE MOST OPPORTUNITIES TO ADVANCE CHANGE

&%$%2!, $!4! !.$ 4//,3 4/ 3500/24 34!4% %&&/243)N ADDITION TO SEEKING OUT !#! GRANT OPPORTUNITIES PARTICIPATING STATES HAVE USED OTHER FEDERAL NON!#! RESOURCES TO SUPPORT STATELEVEL ACTION TO ADVANCE HEALTH EQUITY /HIOS PUBLIC HEALTH DEPARTMENTFOR EXAMPLE REGULARLY REFERENCES DATA FROM THE !GENCY FOR (EALTHCARE 2ESEARCH AND 1UALITY !(21S.ATIONAL (EALTHCARE $ISPARITIES 2EPORTS AND .ATIONAL (EALTHCARE 1UALITY 2EPORTS TO PROVIDE A NATIONALCONTEXT FOR THE IMPORTANCE OF IMPROVING HEALTH CARE QUALITY AND ACCESS AS WELL AS TO MEASURE QUALITY ANDACCESS IN /HIO RELATIVE TO OTHER STATES AND THE NATION 4HE !(21 REPORTS TRACK MEASURES TO ASSESS TRENDSIN HEALTH CARE QUALITY EFFECTIVENESS SAFETY TIMELINESS ETC AS WELL AS ACCESS FOR VULNERABLE POPULATIONS4O HELP OTHER STATE AGENCIES INCORPORATE HEALTH EQUITY INTO IMPROVEMENT AND PRIORITYSETTING EFFORTS THE/HIO #OMMISSION ON -INORITY (EALTH CITES AS A TEMPLATE THE GOALS AND STRATEGIES RECOMMENDED IN THERST .ATIONAL 3TAKEHOLDER 3TRATEGY FOR !CHIEVING (EALTH %QUITY PUBLISHED BY THE 53 $EPARTMENT OF (EALTHAND (UMAN 3ERVICES ((3 /FCE OF -INORITY (EALTH IN 4HIS TYPE OF INFORMATION CAN BE INCLUDEDIN EDUCATIONAL WORKSHOPS FOR POLICYMAKERS GUIDING HEALTH REFORM IMPLEMENTATION TO PROVIDE COMPARATIVEINFORMATION AND ESTABLISH OR REINFORCE THE IMPORTANCE OF ADDRESSING RACIAL AND ETHNIC DISPARITIES IN HEALTHSTATUS AND HEALTH CARE

&EDERAL AGENCIES ARE IMPROVING COLLABORATION AND WEAVING DISPARITIES REDUCTION ACTIVITIES THROUGHOUT THEIREFFORTS WHICH LIKELY WILL HAVE A RIPPLE EFFECT IN STATES !S A RESULT OF !#! THERE ARE NOW NEW /FCES OF-INORITY (EALTH IN FOUR ((3 AGENCIES THE #ENTERS FOR -EDICARE -EDICAID 3ERVICES #-3 THE &OOD AND$RUG !DMINISTRATION &$! THE (EALTH 2ESOURCES AND 3ERVICES !DMINISTRATION (23! AND THE 3UBSTANCE!BUSE AND -ENTAL (EALTH 3ERVICES !DMINISTRATION 3!-(3! 4HERE ALSO IS A FEDERAL INTERAGENCY GROUPDEVOTED TO HEALTH EQUITY WHICH INCLUDES THE $EPARTMENTS OF *USTICE ,ABOR AND ((3

$URING THE MEETING STATES OFFERED A FEW SUGGESTED FEDERAL ACTIONS OR GUIDANCE THAT WOULD SUPPORT HEALTHEQUITY EFFORTS INCLUDING

2ECOMMENDING OR REQUIRING HEALTH DISPARITIES METRICS FROM STATE -EDICAID AGENCIES IN ORDER TODRAW FEDERAL MATCHING FUNDS FOR -EDICAID

0ROVIDING GUIDANCE FOR HOW NAVIGATORS WILL REACH DIVERSE AND VULNERABLE POPULATIONS THROUGH INSURANCE EXCHANGES AND IN -EDICAID AND


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2EFERENCING STRATEGIES TO REDUCE RACIAL AND ETHNIC DISPARITIES EG CULTURAL COMPETENCE LANGUAGEASSISTANCE OUTREACH TO OR INCLUSION OF DIVERSE COMMUNITIES IN FEDERAL GRANTS

4(% 2/,% /& 34!4%3 ). &!#),)4!4).' #/--5.)49 %.'!'%-%.4!LTHOUGH STATES OFTEN LOOK TO FEDERAL AGENCIES FOR GUIDANCE AND LEADERSHIP IN HEALTH AND HEALTH CAREREFORM FEDERAL OFCIALS RELY ON STATES FOR ASSISTANCE TOO -EETING PARTICIPANTS MADE CLEAR THAT ONE CRITICALPIECE OF HEALTH REFORM THAT THE FEDERAL GOVERNMENT CANNOT DOCOMMUNITY ENGAGEMENT AND EDUCATIONIS AN IMPORTANT PART OF ADVANCING HEALTH EQUITY &EDERAL AGENCIES DO NOT HAVE THE CAPACITY OR EXPERIENCETO REACH OUT TO LOCAL COMMUNITIES AND WHILE LOCAL ORGANIZATIONS AND COMMUNITIES THEMSELVES HAVE THEMOST EXPERTISE AND CAPACITY IN COMMUNITY ENGAGEMENT STATE AGENCIES ARE ABLE TO ENGAGE COMMUNITYMEMBERS IN POLICYMAKING AND AS PART OF STAKEHOLDER CONVENING

3EVERAL STATE MINORITY HEALTH OFCE OFCIALS NOTED THAT THEIR OFCES ROLES AND RESPONSIBILITIES INCLUDE COMMUNITY ENGAGEMENT AS SUCH THEY HAVE EXISTING NETWORKS OF COMMUNITY LEADERS AND REPRESENTATIVES AS WELLAS MECHANISMS TO ENGAGE COMMUNITIES EG VIA NEWSLETTERS OR REGULAR PUBLIC MEETINGS 3TATE POLICYMAKERSCAN FACILITATE THE PROCESS OF RAISING COMMUNITY AWARENESS AND EDUCATING THE PUBLIC ABOUT HEALTH REFORMAND HEALTH EQUITY &OR EXAMPLE THE !RKANSAS 3TATE (EALTH %QUITY #OLLABORATIVE !3(%# IS A COALITION OF

STAKEHOLDERS FROM MULTIPLE SECTORS WHO CONVENE QUARTERLY TO EXAMINE ISSUES OF HEALTH EQUITY WITHIN THESTATE 4HROUGH THE !3(%# THE STATE HAS BEEN ABLE TO DEVELOP AND DISTRIBUTE A MONTHLY NEWSLETTER FOR THEPUBLIC HIGHLIGHTING INFORMATION ABOUT HEALTH EQUITY EVENTS AND RESOURCES WITHIN THE COMMUNITY PARTICULARLY AS THEY RELATE TO HEALTH REFORM

0ARTICIPATING STATES EMPHASIZED THE IMPORTANCE OF A SECOND LEVEL OF ENGAGEMENT ENGAGING COMMUNITY MEMBERS IN THE POLICYMAKING PROCESS AS EVIDENCED IN -INNESOTA S EXCHANGE PLANNING #OMMUNITYMEMBER INSIGHT AND EXPERIENCE HELP SHAPE THE COURSE OF ACTION TO ENSURE PROGRAMS AND POLICIES MEET THENEEDS OF THE PUBLICTHOSE MOST DIRECTLY AFFECTED BY HEALTH AND HEALTH CARE POLICY

#2/33!'%.#9 #/,,!"/2!4)/.$URING THE INPERSON MEETING STATE TEAM MEMBERS FROM PUBLIC HEALTH MINORITY HEALTH AND -EDICAIDAGENCIES EMPHASIZED THE ROLE OF ONGOING COLLABORATION IN MOVING FORWARD POLICY RECOMMENDATIONS AND INRAISING INTERNAL AND EXTERNAL AWARENESS ABOUT HEALTH EQUITY 4HROUGH REGULAR MEETINGS AND COMMUNICATIONTEAM MEMBERS IDENTIED WAYS THAT THEY COULD HELP EACH OTHER BY POOLING THEIR RESPECTIVE EXPERTISE ANDDRAWING FROM EXISTING RESOURCES &OR EXAMPLE A NUMBER OF PARTICIPATING STATES USED DISPARITIES DATA FROMPUBLIC HEALTH DEPARTMENTS TO INFORM BROADER DISCUSSION OF HEALTH REFORM POLICY EXCHANGE DEVELOPMENTAND INITIATIVES MEDICAL HOMES AS WELL AS -EDICAID PROGRAMS ENROLLMENT PRIORITIZATION OF OUTREACH EFFORTS )N /HIO THE COLLABORATION OF THREE HIGHLEVEL DIRECTORS FROM THE -INORITY (EALTH #OMMISSION 0UBLIC(EALTH $EPARTMENT AND -EDICAID AGENCY WAS KEY TO ADVANCING RECOMMENDATIONS FOR DRAFT MANAGED CARECONTRACT LANGUAGE 4HIS PROJECT PROVIDED THE NECESSARY FORUM FOR CROSSAGENCY COLLABORATION TO LEVERAGE INTERNAL EXPERTISE AND RESOURCES TO PROPOSE THE LANGUAGE AT THE EXACT TIME OF AGENCYWIDE REVIEW OF

CONTRACTS

%15)49 !3 ! 15!,)49 #/34 !.$ *534)#% )335%!NOTHER THEME THAT EMERGED FROM MEETING DISCUSSION WAS THE NEED TO RECOGNIZE THAT STAKEHOLDERS COMETO THE TABLE TO ADDRESS HEALTH DISPARITIES FOR DIFFERENT REASONS USING DIFFERENT TERMS AND IT IS IMPORTANTTO SPEAK THE LANGUAGE OF EACH 7HEREAS SOCIAL JUSTICE AND EQUALITY ARE KEY PRINCIPLES FOR MINORITY HEALTHOFCES EFCIENCY AND COST CONTAINMENT ARE PARAMOUNT TO -EDICAID AGENCIES )N TIMES OF BUDGET CUTS FORPUBLIC HEALTH AND -EDICAID IDENTICATION OF POTENTIAL COST SAVINGS EG THROUGH IMPROVED PREVENTIVE


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CARE OR AVOIDED EMERGENCY DEPARTMENT USE CAN BE PERSUASIVE IN MAKING THE CASE FOR INVESTMENT IN NEWSTRATEGIES 3EVERAL STATE TEAMS FOUND THAT FRAMING HEALTH EQUITY AS AN ISSUE OF QUALITY IMPROVEMENT HELPEDGARNER INTEREST AND BUYIN &OR EXAMPLE LANGUAGE PERTAINING TO CULTURAL COMPETENCY OR DISPARITIES REDUCTION CAN FALL UNDER QUALITY IMPROVEMENT RESPONSIBILITIES IN MANAGED CARE CONTRACTS OR AS PART OF MEDICALHOME OR !#/ PROVIDER RESPONSIBILITIES

3TATE AND FEDERAL AGENCIES EMPHASIZED NDING POSSIBILITY AND OPPORTUNITY TO ADVANCE HEALTH EQUITY EVENWHEN NOT EXPLICITLY REFERENCED OR REQUIRED !T THE FEDERAL LEVEL THE #ENTER FOR -EDICARE AND -EDICAID)NNOVATION #--) HAS A STATUTORY RESPONSIBILITY TO ADDRESS COSTS THERE IS NO EXPLICIT REFERENCE TO DISPARITIES REDUCTION OR ADVANCING HEALTH EQUITY IN ITS MISSION OR PURPOSE 7ITH THE PREPONDERANCE OF EVIDENCEOF THE COSTS ASSOCIATED WITH DISPARITIES INITIATIVES THAT SEEK TO ADDRESS DISPARITIES AS PART OF COST CONTAINMENT EFFORTS WOULD T WITH #--)S MISSION )NTERESTINGLY IN *ULY #--) ANNOUNCED A NEW 3TATE)NNOVATION -ODELS 3)- INITIATIVE TO PROVIDE MILLION IN FUNDING FOR SELECTED STATES TO TEST PAYMENTAND SERVICE DELIVERY MODELS WITHIN THE CONTEXT OF LARGER HEALTH SYSTEM TRANSFORMATION 3TATES THAT APPLYARE ENCOURAGED TO INCLUDE CARE MODELS AND INTERVENTIONS THAT AIM TO REDUCE HEALTH DISPARITIES AND ADDRESS THE SOCIAL ECONOMIC AND BEHAVIORAL DETERMINANTS OF HEALTH


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TEVERAL OVERARCHING LESSONS EMERGE FROM PARTICIPATING STATES ACTIVITIES AND EXPERIENCES AS PART OF THE(EALTH %QUITY ,EARNING #OLLABORATIVE

!DVANCING HEALTH EQUITY DOES NOT DEPEND SOLELY ON !#! IMPLEMENTATION BUT !#! PROVIDES

A UNIQUE PLATFORM TO CATALYZE STATE EFFORTS !#!S NUMEROUS PROVISIONS RELATED TO REDUCTION OFDISPARITIES IN HEALTH AND CARE OFFER RARE OPPORTUNITIES TO ADVANCE HEALTH EQUITY !#! HAS PROVIDEDMOMENTUM IN STATES WHERE LEADERSHIP IS ACTIVELY PURSUING !#!RELATED GRANTS AND WORKING TOCOMPLY WITH THE !CTS PROVISIONS !T THE SAME TIME MANY OF THE POLICY LEVERS PARTICIPATING STATESARE LEVERAGINGTHROUGH REGULATION AND PURCHASING FOR EXAMPLEARE APPLICABLE REGARDLESS OF THESTATES SUPPORT FOR !#!

,ANGUAGE MATTERS QUALITY IMPROVEMENT POPULATION HEALTH PUBLIC HEALTH SYSTEMS CHANGE

AND PATIENTCENTEREDNESS ALL HAVE HEALTH EQUITY COMPONENTS 0ARTICIPATING STATES EXPERIENCE IS THAT THE WORK OF ADVANCING HEALTH EQUITY REQUIRES COLLABORATION AMONG STAKEHOLDERS AND

AGENCY REPRESENTATIVES WHO MAY SELDOM PARTNER WITH EACH OTHER AND WHO OFTEN SPEAK IN DIFFERENT TERMS BECAUSE THEY OPERATE IN DIFFERENT ENVIRONMENTS $ENING AND ENSURING COMMONUNDERSTANDING OF TERMS SUCH AS HEALTH EQUITY HEALTH DISPARITIES SOCIAL DETERMINANTS OF HEALTHAND EVEN COMMUNITY ARE A CRITICAL STEP !S ONE STATE OFCIAL NOTED IT IS EQUALLY IMPORTANT TOUNDERSTAND THE CULTURES OF PARTNERS BY IDENTIFYING AND NDING A WAY TO REECT BACK AND MEETTHEIR NEEDS AND PRIORITIES BE THEY ECONOMIC SOCIAL ANDOR MORAL 0OLICIES AND PROGRAMS LINKED TOQUALITY IMPROVEMENT POPULATION HEALTH PUBLIC HEALTH SYSTEMS CHANGE AND PATIENTCENTEREDNESSARE JUST A FEW EXAMPLES OF OPPORTUNITIES TO INCORPORATE AND TRANSLATE TO HEALTH EQUITY

3TATE AGENCIES WOULD LIKE MORE OPPORTUNITIES FOR PEERTOPEER LEARNING AROUND ISSUES OF

HEALTH EQUITY 4HROUGHOUT THIS PROJECT STATE TEAMS HAVE BEEN ENCOURAGED TO BUILD COLLABORA

TIVE PARTNERSHIPS ACROSS -EDICAID PUBLIC HEALTH AND MINORITY HEALTH AGENCIES AS THESE OFCESSHARE COMPLEMENTARY GOALS (OWEVER THE MOMENTUM TO COLLABORATE ON STRATEGIES TO ADVANCEHEALTH EQUITY CAN BECOME DIFCULT IN THE FACE OF DAYTODAY COMMITMENTS AND COMPETING PRIORITIES 3TATE OFCIALS IN THIS PROJECT EXPRESSED INTEREST IN CONTINUING THE RELATIONSHIPS THEY FORMEDTHROUGH THE (EALTH %QUITY ,EARNING #OLLABORATIVE AND ARE EAGER TO ENGAGE IN SIMILAR OPPORTUNITIES TO CONVENE ESPECIALLY INPERSON AROUND ISSUES OF HEALTH EQUITY

0ARTICIPATION IN MULTISTATE EFFORTS HELPS LEGITIMIZE EFFORTS TO ADVANCE HEALTH EQUITY 0RIORTO THE START OF THIS PROJECT STATE TEAMS PARTICIPATING IN THE LEARNING COLLABORATIVE WERE ALL IN THEPROCESS OF ADDRESSING HEALTH EQUITY IN THEIR STATES (OWEVER SEVERAL STATE TEAM MEMBERS AGREEDTHAT DEVELOPING A FORMAL STATE TEAMONE RECOGNIZED AS PARTICIPATING IN A MULTISTATE INITIATIVEWAS AN IMPORTANT STEP IN LEGITIMIZING AND FURTHERING WORK TO ADVANCE HEALTH EQUITY IN THEIR STATES

#OMMUNITIES NEED TO BE PARTNERS IN POLICY DEVELOPMENT AND IMPLEMENTATION 3TATE TEAMSREPEATEDLY EMPHASIZED THE NEED FOR AN ACTIVE COMMUNITY ROLE IN SHAPING REVIEWING RECOMMENDING AND HELPING TO IMPLEMENT HEALTH POLICY IF IT IS TO MEET THE NEEDS OF COMMUNITIES #OMMUNITYBASED ORGANIZATIONS AND CONSUMER GROUPS LEAD COMMUNITY ENGAGEMENT PROCESSES BUT STATEOFCIALS CAN ENSURE COMMUNITY REPRESENTATIVES AND INDIVIDUAL CONSUMERS NOT JUST CONSUMERADVOCATES ARE A PART OF HEALTH REFORM AND OTHER POLICYMAKING 0UBLIC HEALTH AND MINORITY HEALTH


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DEPARTMENTS OFTEN HAVE EXISTING NETWORKS AND ENGAGEMENT STRATEGIES TO ASSIST SISTER STATE AGENCIES

$ATA ARE POWER AND STATES CONTINUE TO WORK TO IMPROVE DATA COLLECTION AND USE TO ADVANCE

HEALTH EQUITY !S ONE STATE OFCIAL PUT IT 9OU CANNOT MANAGE WHAT YOU CANNOT MEASURE $ATAANALYSES AND TOOLS SUCH AS ')3 MAPPING CAN HELP IDENTIFY POPULATIONS AND LOCALITIES SUFFERINGFROM THE GREATEST HEALTH DISPARITIES AND INFORM PRIORITIZATION OF RESOURCES FOR NAVIGATORS HEALTHHOMES AND ACCOUNTABLE CARE ORGANIZATIONS 0ARTICIPATING STATES ARE AT DIFFERENT STAGES OF INVENTORYING AND ANALYZING 2%, DATA COLLECTION AND USE AND THEY ARE INTERESTED IN USING HEALTH EQUITYMEASURES AND METRICS TO ASSESS PROGRESS AND CREATE ACCOUNTABILITY FOR IMPROVEMENT /THER INTERESTS ARE SHARING 2%, DATA BETWEEN -EDICAID AND PUBLIC HEALTH AGENCIES AND INCORPORATING DATAON SOCIAL DETERMINANTS OF HEALTH INTO STATE DISPARITIES REPORTS


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UHE STATE TEAMS PARTICIPATING IN THE (EALTH %QUITY ,EARNING #OLLABORATIVE IDENTIED AND PURSUEDA NUMBER OF STRATEGIES TO ADVANCE HEALTH EQUITY THROUGH HEALTH REFORM IMPLEMENTATION 4HROUGHATTENTION TO ISSUES OF HEALTH CARE ACCESS QUALITY EFCIENCY AND POPULATION HEALTH AND NUMEROUS

PROVISIONS PERTAINING TO DISPARITIES REDUCTION !#! PROVIDES MOMENTUM AS WELL AS RESOURCES TO SPUR STATEAND FEDERAL ACTION IN ADVANCING HEALTH EQUITY FOR RACIALLY ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS4HE RECENT 3UPREME #OURT RULING ENABLES THE (EALTH %QUITY ,EARNING #OLLABORATIVE STATES IMPROVEMENTEFFORTS TO CONTINUE MOVING FORWARD 7ITH THE RULING ALL STATES NOW HAVE CRITICAL DECISIONS TO MAKE ABOUTTHE INSURANCE EXCHANGE AND -EDICAID EXPANSION

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NASHP Advancing Equity Health Reform