Toolkit
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02-12-21

State Policy and Program Strategies to Advance Health and Racial Equity

The impact of COVID-19 has highlighted racial and ethnic disparities in the United States. With systemic racism driving these inequities, states are addressing the root causes and advancing racial and health equity with cross-agency collaboration, effective use of data, and improved community input and staff diversity. They are also leveraging Medicaid managed care and making hospital community investment more effective in reducing disparities. For more information about these strategies, explore this chart and NASHP’s Resources for States to Address Health Equity and Disparities. Contact Allie Atkeson for more information or to add your state’s initiatives to this chart.

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Indiana	Gov. Eric Holcomb appointed the state’s first Chief Equity, Inclusion, and Opportunity Officer in November 2020. The officer will report directly to the governor and “focus on improving state government operations as well as drive systemic change to remove hurdles in the government workplace and services the state provides.” The Indiana Office of Healthy Opportunities’ mission is to reduce barriers that impede Hoosiers from achieving optimal individual health outcomes. Partnership between Department of Health, Transportation, Housing and Community Development Authority and Workforce Development.
Louisiana	Louisiana’s Office of Community Partnerships and Health Equity works to address health disparities and implement agency-wide health equity plans, protocols, and tools. Local health departments have health equity action teams that help create Louisiana’s Health Equity Action Plan.
Minnesota	Minnesota’s Chief Inclusion Officer “provides structure and strategic direction for enterprise-wide inclusion and equity efforts. This includes developing a statewide vision providing strategic direction, advice and consultation to state agency partners to advance integration of inclusion and equity principles into state agency culture.”
Rhode Island	The Rhode Island Department of Health and Human Services issued a clear statement of equity as a priority, and is developing a plan to avoid perpetuating internal inequity. Rhode Island COVID-19 Equity Council is “an advisory council that was created to ensure that the state’s emergency response and recovery strategies address the specific needs of the communities most impacted by the pandemic.”
Virginia	The Chief Diversity Officer, a member of the governor’s administration works to implement One Virginia, “a state-wide effort to increase diversity, equity, and inclusion across more than 100 state agencies in the Commonwealth.” Equity Leadership Taskforce: COVID-19 Response uses “data to inform the COVID-10 Unified Command about at-risk populations and geographic areas of increased risk.”
Washington	HB 1783 to establish the Office of Equity within the governor’s office was passed June 2020. Gov. Jay Inslee’s 2021 legislative session equity policy package includes $365 million for equity initiatives. The Equity Office will consist of eight staff to “develop and implement a five-year equity plan for the state and assist agencies in developing their own diversity, equity and inclusion plans.”

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California	California uses an equity metric for its COVID-19 recovery. In California, a county with a population greater than 106,000 cannot reopen its economy if the test positivity rates in its most disadvantaged neighborhoods, referred to as the Health Equity Quartile of the Healthy Places Index census tracts, significantly lags behind its overall county test positivity rate.
Connecticut	Connecticut supports primary care practices in collecting more granular race and ethnicity data to identify gaps in outcomes for subpopulations. The state offered technical assistance to participating providers to implement a consensus set of granular race/ethnic categories. It also implemented infrastructure and workflows in order to collect Sexual Orientation and Gender Identity (SOGI) data in its electronic health records.
Massachusetts	Massachusetts combined 30 different databases under a project focused on the opioid epidemic to identify at-risk population and examine services people receive. Identified populations include: pregnant and post-partum women, communities of color, those with a history of substance use disorder, those experiencing homelessness or housing insecurity, and those with chronic illness.

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Delaware	Delaware’s contact tracing program includes creating linkages between those who test positive for COVID-19 and community health workers (CHW), who may be uniquely positioned to build trust and address barriers traditionally underserved communities face to seeking care. The state hired 200 CHWs to assist in COVID-19 recovery.
New Mexico	New Mexico leverages community health workers (CHWs) who understand the lived experiences of individuals from traditionally underserved communities and can serve as links between providers and community members with chronic health conditions. The state finances CHWs through Medicaid managed care capitated rates.
Minneapolis and St. Paul	The Twin Cities Boards and Commissions Leadership Institute is a “seven-month program that identifies, trains, and supports placement of communities of color and other underrepresented communities in publicly appointed boards and commissions in support of an equity agenda.”
Minnesota	The Minnesota Office of State Procurement (OSP) created an Office of Equity in Procurement and Diversity and Inclusion Council. The OSP also partnered with the NAACP to evaluate its programs.
Multnomah County, Oregon	The county created a guidance document, Minimum Qualifications: Best Practices in Recruitment and Selection, in an effort to achieve racial equity through transforming hiring practices.
North Carolina	The state is seeking to ensure that communities and historically underutilized businesses understand state procurement processes, so that they can successfully bid on contracts.
Virginia	The Department of Medical Assistance Services has a staff-led Diversity and Equity Council. The council is “re-examining how their existing policies might hamper equity among staff and is working to identify potential policy changes to move forward in a more equitable way.”
Wisconsin	Wisconsin Medicaid created an equity advisor position to support Black, Native American, and other people of color staff members. The state is also working with consultants to “create and provide training to improve cultural competency and ensure that program policies and practices adhere to Culturally and Linguistically Appropriate Services standards.”

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Colorado	Colorado passed a tobacco tax in November 2020. In its first year, it is estimated that the new tax could reap $176 million for state coffers, increasing to $275 million by 2028. From these funds, $33.5 million would go to a state-administered grant program for affordable housing development and $1.5 million would go to the Colorado eviction defense fund. It would also raise $375 million for schools by 2023, $2 billion for a universal preschool program over 10 years, and $110 million for tobacco-vape cessation and public health programs, according to the Yes on EE campaign.
Connecticut	Connecticut’s Health Enhancement Communities are multisector collaboratives that “implement community health, health equity, and prevention strategies in their communities and reduce costs and cost trends for critical health priorities.” These initiatives are financed through grants, loans, tax credits and public health insurance programs in the near term and incentivized and rewarded for outcomes in the long term.
Rhode Island	Rhode Island’s Health Equity Zones use a braided funding model to direct public health resources towards community-led initiatives “to build healthier, more resilient communities, while building community power to sustain the work.”

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Colorado	Colorado has a Member Experience Council for Medicaid enrollees to share their perspectives and participate in programmatic and policy changes and serve as ambassadors for the program in their communities. Gift cards and childcare are available for participants.
Oregon	Oregon’s Coordinated Care Organizations (CCOs) are required to have community advisory councils (CAC) that “make recommendations about how to improve health care quality and services in their community.” They also contribute to hospital community health needs assessments and strategic plans to address identified health disparities, and they play a role in directing CCOs investments. CCOs are required to include social determinants of health and equity partners and organizations’ in the development of both community assessments and improvement plans.
Virginia	Virginia’s Medicaid Member Advisory Committee provides “a formal method for enrollees’ voices to be included in the Department of Medical Assistance Services (DMAS) decision-making proves and to inform DMAS change management strategies.”

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Boulder, Colorado	Boulder, Colorado uses a Racial Equity Assessment to apply a racial equity focus when assessing city budgets, programs, policies and practices. The city has formatted the questions for the current COVID-19 context.
Oregon	The Oregon Health Policy Board utilizes health equity impact assessments to make recommendations for their coordinated care organizations (CCOs).

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Illinois	Illinois requires Medicaid MCOs to have a community liaison who connects enrollees with community-based services.
Kansas	Kansas requires MCOs to have a housing coordinator to assist enrollees with accessing affordable housing and housing programs.
Louisiana	Louisiana requires MCOs to stratify performance measures across geography, race, ethnicity, and disability status.
Michigan	The Michigan Health Equity Project is the state’s strategy to identify and reduce health disparities in Medicaid. MCOs are required to participate to help identify health disparities. Health plans agree on a set of measures and submit data for analysis of racial and ethnic disparities. A list of reports can be found here.
North Carolina	North Carolina is implementing Healthy Opportunities Pilots to address Medicaid enrollees unmet social needs. The North Carolina Department of Health and Human Services in collaboration with stakeholders, developed a fee schedule that defines and prices these evidence-based interventions.
Oregon	Coordinated care organizations (CCOs) must spend a portion of their previous years net income or reserves on services to address health disparities and SDOH in line with community health improvement plan.
Pennsylvania	Requires MCOs to meet the National Committee for Quality Assurances multicultural distinction in healthcare and created a new pay for performance requirement for reducing racial disparities in prenatal and postpartum care and well child visits in new contracts.
Washington	Washington’s managed care workgroup on disparities is a partnership between Community Health Plan of Washington, the Washington Health Authority, and Advancing Health Equity to develop Medicaid models to reduce health disparities.

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Massachusetts	Massachusetts reformed its determination-of-need process to include a focus on population health and health equity, and reformed its community health investment guidelines so that health systems must be accountable for spending on upstream prevention activities.
Maryland	Maryland enacted legislation requiring its Health Services Cost Review Commission to establish a Community Benefit Reporting Workgroup that includes people impacted by hospital community benefit spending. Maryland requires hospitals’ community health needs assessments to describe a hospital’s effort to track and reduce disparities in its community.

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Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation. The author also wishes to thank state officials in the Public and Population Health Advisory Group, and Jill Rosenthal, Rebecca Cooper, and Elinor Higgins at NASHP for their contributions to this analysis.

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