February 16 Update

In This Week’s Update:

  • COVID-19 Health Equity Task Force Additions
  • SHVS Resources
  • COVID-19 State Updates: CT, MN, NC, OR, VT, WI
  • Other State Updates: CA, KS, NJ, OR, PA
  • Webinar: Analyzing Health Disparities in Medicaid Managed Care
  • Awareness of Coverage Options for Uninsured Adults
  • Payment Reform and SDOH
  • Screening for Social Needs in Pediatrics

 

COVID-19 Health Equity Task Force Additions

Last week, President Joe Biden and Vice President Kamala Harris announced individuals to serve as nonfederal members of the Biden-Harris COVID-19 Health Equity Task Force. The Task Force is charged with issuing a range of recommendations to help inform the COVID-19 response and recovery. This includes recommendations on equitable allocation of COVID-19 resources and relief funds, effective outreach and communication to disproportionately affected populations, and improving cultural proficiency within the federal government.

 

SHVS Resources

State Health and Value Strategies (SHVS) has several new resources on its Health Equity resource page, which serves as an accessible one-stop source of health equity information for states. In particular, SHVS published an issue brief that explores the impediments and accelerants states face to advancing health equity as well as an expert perspective highlighting what data states are currently publicly reporting related to vaccine administration, as several states are now publishing data on vaccine distribution by race and ethnicity. SHVS also recently published an expert perspective that provides an overview of the TennCare III Demonstration and discusses its implications for states.

 

COVID-19 State Updates: CT, MN, NC, OR, VT, WI

  • Connecticut and Vermont – These states announced enrollment periods to provide residents affected by the COVID-19 pandemic the opportunity to enroll in coverage, mirroring recent action by the Biden administration.
  • Minnesota – The state published a bulletin announcing that it is extending eligibility for Refugee Cash Assistance to a maximum of 25 months for qualifying participants during the COVID-19 public health emergency.
  • North Carolina – As part of its partnership with the North Carolina Department of Health and Human Services to research public attitudes toward COVID-19, a new study from the North Carolina Central University Advanced Center for COVID-19 Related Disparities shows communication about the safety and effectiveness of COVID-19 vaccines, coupled with local access to COVID-19 vaccination sites, can significantly reduce vaccine hesitancy among communities that have been marginalized. 
  • Oregon – The Oregon Health Authority piloted and launched a new “Get Vaccinated Oregon” tool as part of a multipronged effort to provide older adults information about COVID-19 vaccinations. With the new tool, older adults in Oregon have four primary ways to get linked to local vaccine information.
  • Wisconsin – The Wisconsin Department of Health Services released a new data dashboard on its COVID-19 vaccine data page. The new dashboard is designed to provide a comprehensive overview of COVID-19 vaccine administration in Wisconsin. It consolidates previous visualizations regarding vaccine series completion and administration data by sex and age and also adds new metrics, including vaccines administered by race and ethnicity.

 

Other State Updates: CA, KS, NJ, OR, PA

  • California – The California Department of Health Care Services (DHCS) has proposed making certain telehealth flexibilities permanent and expanding others. The flexibilities, which were put in place during the COVID-19 pandemic, include payment parity, expanded coverage for services delivered by federally qualified health centers and rural health centers, and some coverage for audio-only telehealth. DHCS hopes to enact some of the proposals by July 1.
  • Kansas – Gov. Laura Kelly announced legislation to expand Medicaid (Kancare) and provide health insurance for 165,000 Kansans. This Medicaid expansion bill includes the same components as compromise legislation from last year but with a few revisions, including the removal of the Medicaid Expansion Surcharge to be paid by Kansas hospitals to offset the state general fund costs of expanding Medicaid and the addition of a proposed medical marijuana bill. 
  • New Jersey – Gov. Phil Murphy announced that health insurance signups through New Jersey’s new state-based marketplace surpassed the open enrollment period (OEP) for the previous two years. Plan selections for 2021 coverage increased 9.4 percent over last year’s OEP.
  • Oregon – The Oregon Health Authority convened the Social Determinants of Health (SDOH) Measurement Workgroup with the objective of recommending a measure related to the social determinants of health for consideration by Oregon’s Metrics and Scoring Committee and Health Plan Quality Metrics Committee. The SDOH Measurement Workgroup issued a final report recommending a measure to incentivize screening for individual, health-related social needs.
  • Pennsylvania – Department of Human Services (DHS) Secretary Teresa Miller outlined the Medicaid Work Supports system, a program designed to connect people whose health care is covered through Medicaid to local employment and training resources, with a goal of supporting people in finding long-term employment. DHS worked with partners across the state to implement a systematic identification and connection framework to increase workforce participation and long-term employment outcomes.

 

Webinar: Analyzing Health Disparities in Medicaid Managed Care

Wednesday, Feb. 24, 2:00 p.m. to 3:00 p.m. EST

On Wednesday, Feb. 24, SHVS is hosting 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 will discuss 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. Attendees will also hear from Dr. Lisa Albers at the California Department of Health Care Services about California’s experience analyzing Medi-CAL HEDIS (Healthcare Effectiveness Data and Information Set) data to identify health care disparities and establish performance improvement expectations for Medi-CAL plans. To request accommodations due to disability for this event, please contact Stephanie Benjamin (stephanie.benjamin@princeton.edu) at least 48 hours in advance.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=e6927c49688205bc92c6f293e0c180b3d

 

Many Uninsured Adults Have Not Tried to Enroll in Medicaid or Marketplace Coverage

With support from the Robert Wood Johnson Foundation, the Urban Institute released findings from a survey assessing awareness of and experiences with publicly subsidized coverage options among adults who were uninsured in September 2020. The authors analyzed data from the second wave of the Urban Institute’s Coronavirus Tracking Survey, fielded Sept. 11-28, 2020, and found that though some uninsured adults were aware of publicly subsidized coverage options, critical knowledge gaps remained, and many uninsured people had not attempted to enroll in coverage for which they may be eligible. The brief also notes that perceptions of Marketplace affordability and eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) may keep some people from enrolling. For example, just 29.3 percent of uninsured adults tried to obtain Medicaid or CHIP coverage. Most commonly, those who did not try did not think they would qualify. Nearly half of all uninsured adults (47.0%) did not look for information on Marketplace coverage, nor tried to obtain Medicaid or CHIP coverage. About half of uninsured adults (53.9%) heard a lot or some about the Marketplaces; just under two-thirds (64.9%) heard nothing or only a little about financial assistance for Marketplace coverage. And almost half of uninsured adults familiar with Marketplace plans did not look for information on them, most commonly because of cost concerns. As the COVID-19 recession continues, this research demonstrates the urgency of raising awareness about available coverage options among uninsured people, educating them about eligibility rules and affordability, and helping them enroll in coverage.

 

How Are Payment Reforms Addressing Social Determinants of Health? Policy Implications and Next Steps

The movement toward value-based care provides a significant opportunity to address social determinants of health (SDOH) while improving value and quality of care. Although federal, state, and commercial payers are launching innovative new payment models addressing SDOH, questions remain regarding best practices for implementation, impact on cost and outcomes, and ability to scale and spread across different contexts under current policies. A new issue brief by the Milbank Memorial Fund and the Duke Margolis Center for Health Policy summarizes the current landscape of payment reform initiatives addressing SDOH, drawing on results from a systematic review of peer-reviewed and gray literature supplemented with scans of state health policies and proposed payment reform models. It also discusses challenges and opportunities related to implementation—data collection and sharing, social risk factor adjustment (statistical methods for accounting for adverse social conditions associated with poor health), cross-sector partnerships, and organizational competencies—as well as policy implications and next steps so that states and payers can use value-based payment to encourage and promote addressing social needs.

 

Screening for Social Needs in Pediatrics: How Can We Ensure it is Family-centered and Effective?

As health care systems and payers are increasingly focused on the social needs of patients, there has been an emphasis on screening in the health care setting as a way to understand the support families require. However, there is a lack of a robust, evidence-based means of determining and addressing patients’ immediate social needs at the point of care, which can lead to numerous unintended consequences. A new issue brief authored by experts from the Children’s Hospital of Philadelphia (CHOP) offers guidance on strategies pediatric health care systems and providers can adopt to effectively implement screening and support families in meeting their social needs. The recommendations offered are based upon extensive evidence from a wide-range of academic institutions (including CHOP), lived experiences of patients and families, and policy expertise. The authors highlight the need for a family-centered approach to social needs screening, which is also illustrated in this related blog post.