5 suggestions for improving health care equity
AHIP offers its recommendation for Medicaid to help advance health equity for the disadvantaged.
Policymakers have long wrestled with how to provide greater access to essential health care for disadvantaged Americans. Expanding and revising Medicaid may be part of the solution, according to a new report from America’s Health Insurance Plans.
“As the federal-state program providing access to essential health care to over 77 million low-income adults, children, pregnant women, elderly adults and people with disabilities, Medicaid has a unique opportunity to address the social risk factors that disproportionately impact these vulnerable populations,” the report said.
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These socioeconomic barriers or social determinants of health include inadequate access to nutritious food, lack of affordable housing, lack of convenient and efficient transportation options, limited opportunities for quality education and meaningful employment, limited broadband access and more. These barriers affect a person’s ability to live a healthy life, achieve their fullest potential and access quality health care, and they can put them at greater risk of developing chronic conditions. The results often can be poorer health outcomes, more hospital admissions and higher costs.
“For example, an individual may have diabetes-related hospital admissions due to food insecurity, develop asthma due to poor housing conditions, frequently visit an emergency department because of homelessness or develop a stress-related illness like hypertension due to unemployment,” the report said. “There is a growing body of evidence that indicates that these challenges not only lead to poorer health outcomes for beneficiaries and higher Medicaid costs but can exacerbate health disparities for a broad range of populations as well, particularly for racial and ethnic minorities.”
The pandemic has further exposed the health disparities and inequities that exist in the United States and demonstrated the crucial link between socioeconomic circumstances and health outcomes. It also has highlighted the important role Medicaid and policy flexibilities play in the ability of states, Medicaid managed care organizations and other stakeholders to address these socioeconomic risk factors of Medicaid populations. This could lead to more appropriate services that help address the needs of individuals, promote greater health equity and lower total costs of care by reducing unnecessary hospital admissions and routine emergency department visits.
The organization offers several policy recommendations:
- Increase flexibility in Medicaid waivers.
- Create a pathway for interdisciplinary and interagency waivers.
- Broaden the interpretation of quality improvement activities for purposes of calculating Medicaid plan medical loss ratios to include expenditures for interventions that address social determinants of health so these activities are treated as health-related instead of being categorized as administrative costs.
- Permit greater latitude in the use of “in lieu of services.”
- Extend flexibilities to allow Medicaid MCO providers to participate in pooled funding arrangements with others in the community.
“Medicaid is an essential safety net and has unique opportunities to address the health-related social needs of vulnerable populations,” the report concluded. “Medicaid MCOs are committed to working with CMS and state Medicaid agencies to address the underlying root causes of poor health for those most in need.
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