NASHP Advancing Equity Health Reform

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National Academy for State Health Policy
Port|and, Maine Ofhce:
! Iree Street, 2nd I|oor
Port|and, M 4!!
Phone: [27] 874-6524
washington, DC Ofhce:
!233 2th Street, Nw, Suite 33
washington, DC 236
Phone: [22] 93-!!
&OR MORE INFORMATION ABOUT .!3(0 AND ITS WORK VISIT WWWNASHPORG
I I
1be Naflonal Acadeuy For Sfafe Healfb Pollcy
(NASHP) ls an lndependenf acadeuy oF sfafe
bealfb pollcyualers. we are dedlcafed fo belp-
lng sfafes acbleve excellence ln bealfb pollcy
and pracflce. A non-proFf and non-parflsan
organlzaflon, NASHP provldes a Foruu For con-
sfrucflve worl across brancbes and agencles oF
sfafe governuenf on crlflcal bealfb lssues. Our
Funders lnclude bofb publlc and prlvafe organl-
zaflons fbaf confracf For our servlces.
1o accoupllsb our ulsslon we.
Convene sfafe leaders fo solve probleus -
and sbare soluflons
Conducf pollcy analyses and researcb -
Dlsseulnafe lnForuaflon on sfafe pollcles -
and prograus
Provlde fecbnlcal asslsfance fo sfafes -
1be responslblllfy For bealfb care and bealfb
care pollcy does nof reslde ln a slngle sfafe
agency or deparfuenf. Af NASHP, we provlde a
unlque Foruu For producflve lnfercbange across
all llnes oF aufborlfy, lncludlng execuflve oFFces
and fbe leglslaflve brancb.
we worl across a broad range oF bealfb pollcy
foplcs lncludlng.
AFFordable Care Acf and Sfafe Healfb -
Care keForu
Coverage and Access -
Vedlcald -
Quallfy, Cosf, and Healfb Sysfeu Per- -
Foruance
Long 1eru and Cbronlc Care -
Quallfy and Paflenf SaFefy -
Populaflon and Publlc Healfb -
lnsurance Coverage and Cosf Confaln- -
uenf
Our sfrengfbs and capablllfles lnclude.
Acflve parflclpaflon by a large nuuber -
oF volunfeer sfafe oFFclals
Developlng consensus reporfs fbrougb -
acflve lnvolveuenf ln dlscusslons auong
people wlfb dlsparafe pollflcal vlews
Plannlng and execuflng large and suall -
conFerences and ueeflngs wlfb subsfan-
flal user lnpuf ln deFnlng fbe agenda
Dlsfllllng fbe llferafure ln language use- -
able and useFul For pracflfloners
ldenflFylng and descrlblng euerglng and -
proulslng pracflces
Developlng leadersblp capaclfy wlfbln -
sfafes by enabllng couuunlcaflon wlfbln
and across sfafes
Io||ow us nashphea|th on Twitter
Copyrlgbf 2u12 Naflonal Acadeuy For Sfafe Healfb Pollcy. lor reprlnf perulsslon, please confacf NASHP af (2u7) 874-6524.
1bls publlcaflon ls avallable on fbe web af. www.nasbp.org
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State lo||cjma|ers' Ca|de lor /danc|ng ea|tn Lqa|tj 1nroagn ea|tn kejorm |mp|ementat|on
Ubcmf!pg!Dpoufout
Acknow|edgements !
xecutive Summary 2
Introduction 4
Couuon DeFnlflons 4
Sfafe Opporfunlfles fo Advance Healfb Lqulfy fbrougb Healfb keForu lupleuenfaflon 5
1ab|e !. Se|ect /C/ lro|s|ons tnat Can /dance ea|tn Lqa|tj* S
lnsurance Coverage 6
Healfb Care Dellvery keForu 7
Dafa 8
Populaflon Healfb 9
1be NASHP Sfafe Healfb Lqulfy Learnlng Collaboraflve 9
Sfafe Selecflon Process 1u
1ab|e 2. ea|tn Lqa|tj Learn|ng Co||aborat|e States' wor|p|an lr|or|tj /reas !!
State Action to Advance Hea|th quity using Se|ect ACA and State Po|icy levers !3
Sfafe Acflon kelafed fo Coverage and Access 13
Lxcbange plannlng and leadersblp 13
Connect|cat !3
V|nnesota !3
1ab|e 3. State /ct|on tnroagn tne ea|tn Lqa|tj Learn|ng Co||aborat|e to /dance ea|tn
Lqa|tj as|ng Se|ect /C/ and State lo||cj Leers !4
Consuuer asslsfance and oufreacb ln navlgafor prograus 15
/r|ansas !S
Dafa agreeuenfs and analysls fo lnForu Vedlcald enrolluenf and servlce provlslon 15
v|rg|n|a !6
kecouuendaflons based on sfafe acflons fo advance bealfb equlfy fbrougb coverage and
access sfrafegles 16
Sfafe Acflon kelafed fo Quallfy and Dellvery keForu 16
Healfb and uedlcal boues 17
On|o !7
V|nnesota !7
aaa|| !7
kLL dafa collecflon guldellnes and recouuendaflons 18
V|nnesota !8
Connect|cat !9
Culfural coupefency fralnlng For Vedlcald provlders 19
v|rg|n|a !9
Vedlcald uanaged care confracflng and educaflon 19
On|o 20
v|rg|n|a 20
Uslng Dafa fo Lngage Couuunlfles ln Pollcy Developuenf ln New Vexlco 2u
kecouuendaflons based on sfafe acflons fo advance bealfb equlfy uslng quallfy and
dellvery sysfeu sfrafegles 21
Sustaining State fforts to Advance Hea|th quity 22
I V
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lederal Dafa and 1ools fo Supporf Sfafe LFForfs 22
1be kole oF Sfafes ln laclllfaflng Couuunlfy Lngageuenf 23
Cross-agency Collaboraflon 23
Lqulfy as a Quallfy, Cosf and [usflce lssue 23
lessons 25
Conc|usion 27
Appendix: Hea|th quity learning Co||aborative In-Person Meeting Participants 29
ndnotes 3!
1
Bdlopxmfehfnfout
U
be aufbors wlsb fo fbanl fbe Aefna loundaflon For lfs supporf oF fbls projecf, speclFcally Dr. Gllllan
8arclay, \lce Presldenf oF Prograus, and Velenle Vagnoffa, Granfs Vanager. we also fbanl fbe
uany sfafe oFFclals wbo gave generously oF fbelr flue fo parflclpafe ln fbe projecf's learnlng collab-
oraflve, affend fbe ln-person ueeflng (see appendlx For all ueeflng affendees), and/or provlde subsfanflve
couuenfs and guldance For fbls reporf, especlally.
/r|ansas 1eam Vembers - . Varqulfa Llffle, Deparfuenf oF Huuan Servlces, Dr. Cresbelle Nasb, lay w.
8oozuan College oF Publlc Healfb, Dr. Vlcbelle Sulfb, Deparfuenf oF Healfb,
Connect|cat 1eam Vembers - . Dr. Vargaref Hynes and Leonard Lee, Deparfuenf oF Publlc Healfb, kod-
erlcl 8reuby and Sylvla GaFFord-Alexander, Deparfuenf oF Soclal Servlces, Vaff Salner, OFFce oF
Healfb keForu and lnnovaflon, Dr. kaja Sfaggers-Hallu, Connecflcuf Couulsslon on Healfb Lqulfy,
aaa|| 1eam Vembers - . Dr. Cbrlsflan (Kluo) Alaueda, Karen Krabn, and Dr. Davld Salauofo, Deparf-
uenf oF Healfb, Dr. Curfls 1oua and Dr. Kennefb llnl, Deparfuenf oF Huuan Servlces,
V|nnesota 1eam Vembers - . [eanne Ayers, [os Gonzalez, and Davld Sfroud, Deparfuenf oF Healfb,
Anfonla Apollnarlo-wllcoxon, Lauren Gllcbrlsf, and Davld GodFrey, Deparfuenf oF Huuan Servlces,
Nea Ve\|co 1eam Vembers - . 8efb Leopold and [eFF Lara, Deparfuenf oF Healfb,
On|o 1eam Vembers - . [obnnle (Cblp) Allen, Deparfuenf oF Healfb, Angela Dawson, Oblo Couulsslon
on Vlnorlfy Healfb, Carol ware, Deparfuenf oF [ob and laully Servlces,
v|rg|n|a 1eam Vembers - . Dr. Vlcbael koysfer and Dr. Dlane Helenfjarls, Deparfuenf oF Healfb, kebec-
ca Vendoza and Asblee Harrell, Deparfuenf oF Vedlcal Asslsfance Servlces,
1be Followlng projecf advlsory couulffee ueubers provlded belpFul guldance and experflse fbrougbouf fbls
projecf. Dr. Dennls Andrulls, 1exas Healfb lnsflfufe and Unlverslfy oF 1exas, [obn Auerbacb, Vassacbuseffs
Deparfuenf oF Publlc Healfb, Dr. [udyAnn 8lgby, Vassacbuseffs Lxecuflve OFFce oF Healfb and Huuan
Servlces, Carrle 8rldges, kbode lsland Deparfuenf oF Healfb, Dr. kosanna CoFFey, 1bouson keufers, Scoff
Lelfz, Vlnnesofa Deparfuenf oF Huuan Servlces, Dr. Dena Ned, Unlverslfy oF Ufab, Dr. Lrnesf Voy, Agency
For Healfbcare kesearcb and Quallfy, Cberyl koberfs, \lrglnla Deparfuenf oF Vedlcal Asslsfance Servlces,
and Dr. George kusf, Vorebouse Scbool oF Vedlclne.
llnally, fbls reporf beneFfed Frou fbe fbougbfFul lnpuf oF and/or revlew by [lll kosenfbal, Alan well, Neva
Kaye and Dlane [usflce oF NASHP.
Any errors or oulsslons are fbose oF fbe aufbors.
2
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D
oupared fo ofber populaflons, raclal and efbnlc ulnorlfles suFFer Frou poorer bealfb sfafus, bealfb
oufcoues, bealfb care quallfy, bealfby llFesfyle opflons and access fo bealfb care.
1
1be Paflenf
Profecflon and AFFordable Care Acf (ACA)
2
oFFers sfafes uulflple pollcy levers fo luprove fbe bealfb
sfafus oF and quallfy oF care For raclal and efbnlc ulnorlfy populaflons fbrougb broad dellvery sysfeu reForus,
fargefed publlc bealfb and couuunlfy lnfervenflons and expanded bealfb lnsurance coverage and access, as
well as provlslons speclFc fo raclal and efbnlc ulnorlfles. 1bls reporf draws Frou fbe experlences oF feaus
oF sfafe oFFclals ln seven sfafes fbaf parflclpafed ln fbe Healfb Lqulfy Learnlng Collaboraflve, sponsored by
fbe Aefna loundaflon and adulnlsfered by fbe Naflonal Acadeuy For Sfafe Healfb Pollcy. lf blgbllgbfs selecf
pollcy levers fbaf can advance bealfb equlfy, opporfunlfles For sfafe and Federal agency collaboraflons fo
sfrengfben fbese eFForfs, and luporfanf lessons and conslderaflons For advanclng bealfb equlfy.
1bls reporf Frsf dlscusses selecf ACA provlslons and pollcy levers ln Four broad cafegorles fbaf can be used
fo advance bealfb equlfy For raclal and efbnlc ulnorlfles.
lnsurance coverage provlslons, parflcularly fbe Vedlcald expanslon and developuenf oF lnsurance -
excbanges, fo luprove raclal and efbnlc ulnorlfy populaflons' access fo needed bealfb care servlces,
as well as culfurally and llngulsflcally coupefenf ellglblllfy and enrolluenf servlces.
Healfb care dellvery reForu provlslons relafed fo fbe developuenf and lupleuenfaflon oF uedlcal -
and bealfb boues, Federal opporfunlfles fo supporf dellvery lnnovaflons, and supporf For developlng
a uore dlverse bealfb care worlForce.
Provlslons relafed fo dafa collecflon and sfandardlzaflon fo analyze bealfb care access and uflllzaflon -
by race, efbnlclfy and language.
Provlslons fo luprove populaflon bealfb fbrougb couuunlfy-based prevenflve bealfb prograus, -
supporf For publlc bealfb lnFrasfrucfure, saFefy-nef capaclfy, and couuunlfy bealfb needs assess-
uenfs fo approprlafely plan For bealfb servlces ln underserved couuunlfles and auong populaflons
oF color.
Nexf, fbls reporf synfbeslzes fbe worl oF and recouuendaflons Frou Arlansas, Connecflcuf, Hawall, Vln-
nesofa, New Vexlco, Oblo, and \lrglnla, fbe sfafes fbaf parflclpafed ln fbe NASHP Healfb Lqulfy Learnlng
Collaboraflve. 1bese sfafes pursued a nuuber oF sfrafegles fo address raclal and efbnlc dlsparlfles ln cover-
age or access fo care and bealfb care quallfy/dellvery fbrougb lupleuenfaflon oF bealfb reForu. wlfb regard
fo coverage and access, fbe sfafe feaus lnfegrafed bealfb equlfy lnfo.
Oufreacb and enrolluenf sfrafegles fo creafe and provlde culfurally senslflve educaflonal uaferl- -
als fo fbe publlc, lncorporafe bealfb equlfy conslderaflons lnfo consuuer asslsfance and oufreacb
fbrougb navlgafor prograus, and, develop dafa sbarlng agreeuenfs fo analyze enrolluenf and prlorl-
flze areas For oufreacb and enrolluenf eFForfs, and
Lxcbange plannlng by developlng guldellnes For collecflng race/efbnlclfy/language (kLL) dafa, ana- -
lyzlng bealfb equlfy dafa and provldlng educaflon For excbange plannlng and advlsory board ueu-
bers, and ensurlng dlverse sfalebolder represenfaflon on plannlng and advlsory boards.
3
ln ferus oF addresslng quallfy and bealfb care dellvery reForu, parflclpaflng sfafes pursued.
New provlder fralnlng and expecfaflons by developlng culfural coupefency fralnlng and/or provldlng -
anfl-oppresslon assessuenfs For Vedlcald provlders, and Faclllfaflng uanaged care confracf language
cbanges fo lncrease accounfablllfy fo dellver culfurally senslflve care and/or reduce bealfb dlsparl-
fles, and
Healfb and uedlcal boues wlfb an eupbasls on bealfb equlfy by conducflng oufreacb fo dlverse -
couuunlfles fo lnForu bealfb boue plannlng, uedlcal boue rollouf ln raclally/efbnlcally dlverse
couuunlfles, developlng and conducflng culfural coupefency fralnlng For uedlcal boue provlders,
and pursulng Federal supporf opporfunlfles fo luprove payuenf and care dellvery.
1bls reporf fben oFFers luporfanf bealfb equlfy conslderaflons and fbeues Frou an ln-person ueeflng oF fbe
Healfb Lqulfy Learnlng Collaboraflve and Federal oFFclals. Key lessons Frou fbls ueeflng lnclude. fbe value oF
Federal dafa and fools ln supporflng parflclpaflng sfafes' eFForfs, fbe role oF sfafes ln engaglng couuunlfles
and sfalebolders ln pollcy developuenf, fbe luporfance oF cross-agency collaboraflon fo advanclng bealfb
equlfy, and fbe need fo Fraue bealfb equlfy.
Overall, fbe Followlng lessons euerged Frou fbe acflvlfles oF Healfb Lqulfy Learnlng Collaboraflve sfafe
feaus.
Advanclng bealfb equlfy does nof depend solely on ACA lupleuenfaflon, buf ACA provldes a -
unlque plafForu fo cafalyze sfafe eFForfs.
Language uaffers. quallfy luproveuenf, populaflon bealfb, publlc bealfb sysfeus cbange, and -
paflenf-cenferedness all bave bealfb equlfy couponenfs.
Sfafe agencles would llle uore opporfunlfles For peer-fo-peer learnlng around lssues oF bealfb -
equlfy.
Parflclpaflon ln uulfl-sfafe eFForfs belps leglflulze eFForfs fo advance bealfb equlfy. -
Couuunlfles need fo be parfners ln pollcy developuenf and lupleuenfaflon. -
Dafa are power, and sfafes conflnue fo worl fo luprove kLL dafa collecflon fo advance bealfb -
equlfy.
Parflclpaflng sfafe feaus ldenflFed and pursued a nuuber oF sfrafegles fo advance bealfb equlfy fbrougb
bealfb reForu lupleuenfaflon. 1be recenf Supreue Courf rullng enables fbe Healfb Lqulfy Learnlng Collab-
oraflve sfafes' luproveuenf eFForfs fo conflnue uovlng Forward. wlfb fbe rullng, all sfafes now bave crlflcal
declslons fo uale fbaf can address dlsparlfles, fbe sfrafegles oF parflclpaflng sfafes oFFer exauples oF bow
pollcy ualers can advance bealfb equlfy uslng ACA and sfafe-level pollcy levers.
4
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D
oupared fo ofber populaflons, raclal and efbnlc ulnorlfles suFFer Frou poorer bealfb sfafus,
bealfb oufcoues, bealfb care quallfy, bealfby llFesfyle opflons and access fo bealfb care.
3
1be
Paflenf Profecflon and AFFordable Care Acf (ACA)
4
oFFers sfafes uulflple pollcy levers fo lu-
prove fbe bealfb sfafus oF and quallfy oF care For raclal and efbnlc ulnorlfy populaflons fbrougb broad
dellvery sysfeu reForus, fargefed publlc bealfb and couuunlfy lnfervenflons, and expanded bealfb lnsur-
ance coverage and access, as well as provlslons speclFc fo raclal and efbnlc ulnorlfles. Slnce lndlvlduals
Frou raclal and efbnlc ulnorlfy couuunlfles are projecfed fo couprlse 54 percenf oF fbe U.S. populaflon
by 2u5u,
5
sfafe bealfb pollcyualers are ln a prlue poslflon fo uflllze fools ln fbe ACA fo advance bealfb
equlfy- affalnuenf oF fbe blgbesf level oF bealfb-For fbelr uosf vulnerable ulnorlfy populaflons.
6
lrou
Ocfober 2u11 fbrougb [une 2u12, feaus Frou seven sfafes parflclpafed ln fbe Healfb Lqulfy Learnlng
Collaboraflve, wblcb was supporfed by fbe Aefna loundaflon and adulnlsfered by fbe Naflonal Acadeuy
For Sfafe Healfb Pollcy (NASHP). Parflclpaflng sfafes engaged ln fecbnlcal asslsfance acflvlfles and peer-
fo-peer learnlng fo plan and carry ouf coordlnafed approacbes fo advance bealfb equlfy fbrougb ACA
lupleuenfaflon. 1bls reporf draws Frou fbe experlences oF fbe Healfb Lqulfy Learnlng Collaboraflve fo
blgbllgbf selecf ACA and sfafe pollcy levers fbaf can advance bealfb equlfy, opporfunlfles For sfafe and
Federal agency collaboraflons fo sfrengfben fbese eFForfs and luporfanf lessons and conslderaflons For
advanclng bealfb equlfy.
Common Dehnitions
Acblevlng bealfb equlfy For raclal and efbnlc ulnorlfles requlres a worllng undersfandlng oF fbe Fac-
fors lnFuenclng fbe bealfb oF fbese populaflons, soue oF wblcb reFer fo Facfors beyond fbe scope
oF fbe bealfb care sysfeu. 8elow are a Few couuon deFnlflons.
7
Hea|th equity - . Affalnuenf oF fbe blgbesf level oF bealfb For all people. Acblevlng bealfb equlfy
requlres valulng everyone equally wlfb ongolng eFForfs fo address avoldable lnequallfles and
lnjusflces, and ellulnafe dlsparlfles.
Hea|th inequity: - A dlFFerence or dlsparlfy ln bealfb oufcoues fbaf ls sysfeuaflc, avoldable,
and unjusf.
Hea|th inequa|ity - . DlFFerence, varlaflon, and dlsparlfy ln fbe bealfb acbleveuenfs oF lndlvldu-
als and groups oF people.
Hea|th disparity - . A fype oF dlFFerence ln bealfb oufcoue fbaf ls closely llnled wlfb soclal or
econoulc dlsadvanfage.
8
Healfb dlsparlfles negaflvely aFFecf groups oF people wbo bave sys-
feuaflcally experlenced greafer soclal or econoulc obsfacles fo bealfb. 1bese obsfacles sfeu
Frou cbaracferlsflcs blsforlcally llnled fo dlscrlulnaflon or excluslon sucb as race or efbnlclfy,
rellglon, socloeconoulc sfafus, gender, uenfal bealfb, sexual orlenfaflon, or geograpblc loca-
flon. Ofber cbaracferlsflcs lnclude cognlflve, sensory, or pbyslcal dlsablllfy.
Socia| determinants of hea|th - . 1be couplex, lnfegrafed, and overlapplng soclal sfrucfures
and econoulc sysfeus fbaf are responslble For uosf bealfb lnequlfles. 1bese soclal sfrucfures
and econoulc sysfeus lnclude fbe soclal envlronuenf, pbyslcal envlronuenf, bealfb servlces,
and sfrucfural and soclefal Facfors. Soclal deferulnanfs oF bealfb are sbaped by fbe dlsfrlbu-
flon oF uoney, power, and resources fbrougbouf local couuunlfles, naflons, and fbe world.
9
5
STAT OPPORTUNITIS TO ADvANC HAlTH QUITY THROUGH HAlTH RIORM IMPlMNTATION
1bls secflon explores provlslons and pollcy levers ln fbe ACA fbaf can advance bealfb equlfy For raclal and
efbnlc ulnorlfles. 1bese pollcy uecbanlsus Fall under Four broad cafegorles. coverage, dellvery sysfeu
reForu, dafa, and populaflon bealfb. 1able 1 (below) provldes an overvlew oF ley ACA provlslons fbaf
expllclfly reFerence care or access For raclal or efbnlc ulnorlfy populaflons or are broader buf can be used
fo advance bealfb equlfy.
TAl !: SlCT ACA PROvISIONS THAT CAN ADvANC HAlTH QUITY*
ACA Provision Topic and
Sections)
rief Description
C
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A
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Vedlcald Lxpanslon
(11u1, 1311, 1322,
1421, 15u1, 1513,
2uu1, 2uu5, 1u1u4)
Creafes opflon fo cover adulfs under age 65 wlfb lncoues af or below 138% -
oF fbe Federal poverfy level, lncludlng adulfs wlfbouf cusfodlal cblldren
lrou 2u14-2u16,oFFers sfafes 1uu% lVAP (pbaslng down fo 9u% lVAP -
by 2u2u) For coverlng fbe newly ellglble under fbe above opflon
Sefs new sfandards For slupllFylng bealfb lnsurance ellglblllfy and enrolluenf -
processes
lnsurance Lxcbanges
(13u1, 13u2, 13u3,
13u4, 1311, 1312,
1313, 1321, 1322,
1324, 1411, 1412,
1413)
8eglnnlng 2u14, creafes a uarlefplace For legal resldenfs and suall euploy- -
ers fo sbop For aFFordable prlvafe bealfb lnsurance plans and uale lnForued
declslons abouf fbelr plan opflons
OFFers slldlng scale Federal fax credlfs For lndlvlduals befween 138% and -
4uu% oF fbe Federal poverfy llne fo purcbase plans (or befween 1uu% and
4uu% ln sfafes fbaf do nof expand Vedlcald)
kequlres parflclpaflng plans fo provlde cerfaln bealfb servlces (essenflal -
bealfb beneFfs') For beneFclarles
kequlres parflclpaflng plans fo confracf wlfb provlders fbaf lnclude couuu- -
nlfy bealfb cenfers and saFefy-nef provlders
kequlres excbange plans fo develop consuuer asslsfance Navlgafor prograus -
fbaf oFFer culfurally and llngulsflcally approprlafe servlces
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S
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R
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f
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m
Healfb Houes
(27u3)
Creafed Sfafe Plan Auenduenf opflon fo serve Vedlcald enrollees wlfb 2 or -
uore cbronlc condlflons, 1 condlflon and fbe rlsl oF developlng anofber, or
af leasf 1 serlous and perslsfenf uenfal bealfb condlflon
1u
OFFers sfafes 9u% lVAP For 2 years For provldlng bealfb boues servlces -
(e.g., care uanageuenf, care coordlnaflon, bealfb prouoflon, reFerrals fo
couuunlfy and soclal supporfs, and use oF bealfb lnForuaflon fecbnology)
11
Cenfer For Vedlcare
and Vedlcald
lnnovaflon (3u21)
Creafed a Cenfer deslgned fo fesf bealfb care payuenf and servlce dellvery -
uodels fbaf lower Vedlcare, Vedlcald and CHlP spendlng, wblle ualnfalnlng
or luprovlng quallfy care
12
Accounfable Care
Organlzaflons (ACOs)
(3u22, 1u3u7)
Lsfabllsbed fbe - Medicare Shared Savings Program, fbrougb wblcb nefworls
oF provlders agree fo serve as ACOs fo coordlnafe fbe Full conflnuuu oF care
For beneFclarles For af leasf 3 years and be beld accounfable For care quallfy
and cosf
worlForce Dlverslfy
(54u2, 54u4)
Provldes supporf fo lncrease dlverslfy oF prluary care and long-feru care -
provlders, recrulf and fraln couuunlfy bealfb worlers fo provlde educaflon
and oufreacb fo dlverse couuunlfles, and develop sfrafegles fo provlde cul-
furally and llngulsflcally approprlafe servlces ln bealfb care sefflngs.
13
6
ACA Provision Topic and
Sections)
rief Description
D
a
t
a
Dafa Collecflon
Sfandards
(43u2)
kequlres all naflonal populaflon bealfb surveys fo lnclude dafa on race, efb- -
nlclfy, sex, prluary language, and dlsablllfy sfafus
14
kequlres dafa collecfed under a Vedlcald or CHlP plan fo ueef fbese sfan- -
dards
kequlres fbese dafa fo be selF-reporfed -
P
o
p
u
|
a
t
i
o
n
H
e
a
|
t
h
Prevenflon and Publlc
Healfb lund (4uu2)
Lsfabllsbed and allocafed uoney For fbe - Prevention and Pub|ic Hea|th Iund
fo creafe a regular source oF Fundlng For prograus addresslng presslng publlc
bealfb prlorlfles sucb as prevenflve bealfb care and dlsease prevenflon.
Couuunlfy
1ransForuaflon Granfs
(42u1)
Supporfed by fbe Prevenflon and Publlc Healfb lund, fbese granfs are -
deslgned fo belp sfafe and local agencles, nonproFf organlzaflons, nefworls
oF couuunlfy-based organlzaflons, and lndlan frlbes engage couuunlfles ln
local cbronlc dlsease prevenflon sfrafegles
Couuunlfy Healfb
Cenfers and fbe SaFefy
Nef (56u1, 1u5u3,
23u3)
15
Lsfabllsbed fbe - Hea|th Center Program xpansion fo expand operaflonal
capaclfy, luprove exlsflng Faclllfles, and enbance bealfb servlces
1be - Nationa| Hea|th Service Corps wlll recelve $1.5 bllllon over fbe nexf
Fve years fo decrease prluary care provlder sborfages ln underserved cou-
uunlfles
Developed Couuunlfy-8ased Collaboraflve Care Nefworls fo organlze cou- -
uunlfy bealfb cenfers and ofber saFefy nef provlders fo dellver coordlnafed
care fo vulnerable couuunlfles ln fargefed geograpblc areas
kequlres excbange bealfb plans fo confracf wlfb essenflal couuunlfy provld- -
ers (lncludlng saFefy nef provlders)
16
lkS Couuunlfy 8eneFf
(9uu7)
kequlres nonproFf bosplfals fo perlodlcally conducf couuunlfy bealfb needs -
assessuenfs fbaf lncorporafe couuunlfy Feedbacl and lupleuenf sfrafe-
gles fo address ldenflFed couuunlfy bealfb needs fo recelve exeupflon Frou
Federal faxes.
*A couprebenslve llsf oF provlslons ls avallable ln fbe Followlng docuuenf, Frou wblcb fbls fable was adapfed. Andrulls D, Slddlqul
N, Purfle [ and Ducbon L. lat|ent lrotect|on and /jjordab|e Care /ct oj 20!0. /danc|ng ea|tn Lqa|tj jor kac|a||j and Ltnn|ca||j u|-
erse lopa|at|ons. [olnf Cenfer For Pollflcal and Lconoulc Sfudles, [uly 2u1u. Avallable onllne. bffp.//www.jolnfcenfer.org/bpl/slfes/
all/Fles/PaflenfProfecflon_PkLP_u.pdF
ln [une 2u12, fbe Unlfed Sfafes Supreue Courf upbeld fbe consflfuflonallfy oF fbe ACA, excepf For fbe
uandafe fbaf sfafes expand Vedlcald ellglblllfy fo Auerlcans under age 65 wlfb lncoues af or below
138 percenf oF fbe Federal poverfy level or run fbe rlsl oF loslng all Federal Vedlcald Fundlng.
17
INSURANC COvRAG
Access fo lnsurance coverage ls an luporfanf deferulnanf oF poslflve bealfb oufcoues, and a lacl oF
bealfb lnsurance ls assoclafed wlfb underuflllzaflon oF prevenfaflve servlces and uedlcal freafuenf auong
raclal and efbnlc ulnorlfles.
18
ln 2u1u, abouf 33 percenf oF Hlspanlcs and 23 percenf oF AFrlcan Auerl-
cans were unlnsured, coupared fo only 14 percenf oF wblfe Auerlcans.
19
1brougb provlslons fo expand
fbe Vedlcald prograu and creafe bealfb lnsurance excbanges (blgbllgbfed ln 1able 1), fbe ACA bolds
opporfunlfles fo lncrease bealfb lnsurance coverage and access fo bealfb care For ulnorlfy populaflons.
TAl !: SlCT ACA PROvISIONS THAT CAN ADvANC HAlTH QUITY CONTINUD)
7
SpeclFcally.
Sfafes fbaf cboose fo parflclpafe ln fbe ACA Vedlcald expanslon wlll provlde crlflcal coverage fo -
fbe unlnsured, a group dlsproporflonafely couprlsed oF raclal and efbnlc ulnorlfles.
Sfafe Vedlcald prograus need fo be prepared fo provlde educaflon abouf fbe prograu, ad- -
equafely couuunlcafe enflfled bealfb beneFfs and euploy sfrafegles fo refaln fbe newly ellglble,
all ln culfurally and llngulsflcally approprlafe ways.
1be ACA's eupbasls on slupllFylng bealfb lnsurance ellglblllfy and enrolluenf processes wlll be -
especlally luporfanf For sfafes wlfb bard fo reacb Llulfed Lngllsb ProFclency (LLP) populaflons
fbaf oFfen experlence franslaflonal dlFFculfles wben seellng coverage.
Sfafes bave fbe Fexlblllfy fo lncorporafe bealfb dlsparlfles fracllng ueasures and culfural coupe- -
fency requlreuenfs lnfo fbelr Vedlcald uanaged care organlzaflons, wblcb wlll be an luporfanf
conslderaflon For Vedlcald uanaged care prograus fbaf confracf wlfb couuunlfy bealfb and
saFefy nef provlders, as 84 percenf oF Federally quallFed bealfb cenfers provlde cllnlcal servlces fo
LLP populaflons eacb day.
2u
Lxcbanges wlll provlde a uarlefplace fo sbop For aFFordable prlvafe bealfb lnsurance plans. -
1be excbange populaflon ls expecfed fo be uore raclally and efbnlcally dlverse fban prlvafely
lnsured populaflons, wlfb 58 percenf oF enrollees belng wblfe, 11 percenf blacl, and 25 percenf
Hlspanlc.
21
Sfafes uay requlre fbelr QuallFed Healfb Plans (QHPs)-deFned as bealfb plans parflclpaflng -
ln fbe excbange uarlefplace-fo provlde servlces beyond fbose fbaf are Federally requlred fo
ueef fbe speclFc needs oF dlverse populaflons and sfrafeglcally cboose plans fbaf advance bealfb
equlfy.
Af fbe governance level, sfafes bave fbe opporfunlfy fo ensure parflclpaflon oF ulnorlfy couuunl- -
fles by prlorlflzlng couuunlfy represenfaflves as ueubers oF excbange advlsory boards and by
Faclllfaflng opporfunlfles For publlc educaflon and couuenf on excbange pollcy developuenfs.
HAlTH CAR DlIvRY RIORM
Alfbougb coverage expanslons creafed by fbe ACA bold slgnlFcanf opporfunlfles For sfafes fo advance
bealfb equlfy, fbe ACA also addresses care coordlnaflon, payuenf reForu, and dellvery sysfeu lnnovaflon.
1be ACA can supporf sfafes seellng fo luprove raclal and efbnlc ulnorlfles' bealfb oufcoues and fbelr
experlences wlfbln fbe bealfb sysfeu. lor exauple.
kaclal and efbnlc ulnorlfles are dlsproporflonafely burdened by cbronlc dlsease and lllness. -
22
Lsfabllsbed as a sfafe opflon ln ACA, bealfb boues are deslgned fo serve cbronlcally lll Vedlcald
enrollees.
23
ACA speclFcally deFnes cbronlc condlflons served by a bealfb boue as lncludlng a
uenfal bealfb condlflon, a subsfance use dlsorder, asfbua, dlabefes, bearf dlsease, and obeslfy.
24
1be laffer fbree condlflons represenf serlous uorbldlfy rlsl Facfors For ulnorlfy populaflons.
25
Healfb boues bave an eupbasls on paflenf-cenfered care. All bealfb boue servlces uusf be oF- -
Fered by a bealfb boue provlder arrangeuenf cbosen by beneFclarles. As sfafes develop bealfb
boue servlce dellvery uodels, fbey can conslder bealfb boue deslgn eleuenfs fo decrease bealfb
dlsparlfles and luprove bealfb oufcoues For ulnorlfy couuunlfles dlsproporflonafely burdened
by cbronlc dlsease.
8
Sfafes can lool fo fbe Cenfer For Vedlcare and Vedlcald lnnovaflon as a ueans For explorlng -
dellvery sysfeu reForu uodels fo advance bealfb equlfy For ulnorlfy populaflons. lor sfafes fbaf
wlll experlence a large lnFux oF raclal and efbnlc ulnorlfy Vedlcald enrollees ln 2u14, fallng ad-
vanfage oF fbe lessons learned Frou Cenfer lnlflaflves can belp pollcyualers lncenflvlze Vedlcald
lnnovaflon and prograu advances, as well as lncrease fbe parflclpaflon oF ulnorlfles ln prluary
care servlces fbaf reduce bealfb dlsparlfles and advance bealfb equlfy.
Developlng and supporflng a dlverse bealfb care worlForce wlll be essenflal For sfafes fo engage -
and refaln ulnorlfy populaflons ln fbe bealfb care sysfeu. Voreover, researcb suggesfs fbaf
raclally and efbnlcally dlverse pracflfloners are uore lllely fo serve ln underserved areas and freaf
unlnsured or underlnsured paflenfs oF color.
26
kaclal and efbnlc ulnorlfy populaflons also could greafly beneFf Frou Accounfable Care Organlzaflons
(ACOs), wblcb are supporfed by ACA as a uecbanlsu fo lncenflvlze provlders fo dellver quallfy-drlven
care fbaf prouofes cosf-savlngs.
CVS regulaflon dlrecfs ACOs fo conslder fbe needs oF fbese populaflons ln plannlng, developlng, -
and susfalnlng fbese uodels.
27
Provlders applylng as an ACO uusf ueef elgbf paflenf-cenferedness crlferla,' wblcb lncludes a -
process For evaluaflng fbe bealfb needs oF fbe ACO's asslgned populaflon, lncludlng conslderaflon
oF dlverslfy ln lfs paflenf populaflons, and a plan fo address fbe needs oF lfs populaflon.' Apply-
lng ACOs uusf descrlbe fbls process For addresslng paflenf dlverslfy ln fbelr appllcaflons, as well
as bow fbe ACO would conslder dlverslfy ln ]lfs] paflenf populaflon.'
28
Sfafes uusf be aware oF fbe geograpblc concenfraflons oF ACOs, and ensure fbaf ACOs are -
developed ln geograpblcally and lncoue-dlverse areas fo ensure equal access For raclal and efbnlc
ulnorlfy couuunlfles.
29
CVS granfs ACOs fbe Fexlblllfy fo declde fbe uosf eFFecflve ueasures fo address fbe bealfb -
needs oF fbelr dlverse populaflons, wblcb uay be an opporfunlfy For sfafes fo uonlfor bow ACOs
are decreaslng bealfb dlsparlfles auong ulnorlfy Vedlcare populaflons.
As a ueans fo plan and address populaflon bealfb needs, CVS encourages ACOs fo parfner wlfb -
sfafes or local bealfb deparfuenfs fbaf perForu couuunlfy bealfb assessuenfs.
3u
DATA
Collecflng fluely, rellable, and sfandardlzed dafa on bealfb care access and uflllzaflon by race, efbnlc-
lfy and language can belp sfafes sfrafeglcally assess and reFne fbelr bealfb sysfeus fo ellulnafe bealfb
dlsparlfles and prouofe bealfb equlfy. 8ulldlng upon fbe OFFce oF Vanageuenf and 8udgef sfandards For
race and efbnlclfy dafa collecflon, Secflon 43u2 oF fbe ACA requlres fbaf all naflonal populaflon bealfb
surveys lnclude dafa on race, efbnlclfy, sex, prluary language, and dlsablllfy sfafus.
31
1brougb fbls parf oF
ACA.
Sfafes are perulffed fo Furfber granulafe fbe ulnluuu dafa sfandards lF fbese ueasures are repre- -
senfaflve oF a sauple slze oF fbe fargef populaflon.
32
Sfafes can worl fo sfandardlze race/efbnlclfy/language (kLL) dafa collecflon and reporflng uore -
broadly, e.g., as parf oF all-payer clalus dafabases fo assess cosf, quallfy and access (see page 19
For uore on all-payer clalus dafabases). As a resulf, sfafes wlll be beffer equlpped fo fracl bealfb
dlsparlfles, jusflFy pollcy lnlflaflves fo advance bealfb equlfy, and adopf payuenf reForus fbaf use
dafa-drlven equlfy perForuance ueasures.
9
POPUlATION HAlTH
luprovlng populaflon bealfb uay requlre lupleuenflng sfrafegles fbaf address larger soclal deferulnanfs
oF bealfb beyond fbe scope oF fbe bealfb care dellvery sysfeu. Addlflonally, fbese sfrafegles uay address
fbe underlylng soclefal Facfors lnFuenclng bealfb dlsparlfles auong raclal and efbnlc ulnorlfy populaflons.
Several ACA provlslons address dlsparlfles fbrougb couuunlfy and populaflon bealfb lnfervenflons. lor
exauple.
1be ACA allocafes Fundlng fo fbe Prevenflon and Publlc Healfb lund fo supporf publlc bealfb -
lnlflaflves af local, sfafe, and Federal levels. ln lY2u11, fbese Funds were used fo supporf couuu-
nlfy-based prevenflve bealfb prograus, cllnlcal prevenflon servlces, bulldlng publlc bealfb lnFra-
sfrucfure, and publlc bealfb researcb and dafa collecflon eFForfs.
33
Sfafes can lncorporafe kLL dafa
luproveuenf and address publlc bealfb lssues dlsproporflonafely aFFecflng ulnorlfles.
Couuunlfy 1ransForuaflon Granfs, supporfed by fbe Prevenflon and Publlc Healfb lund, are an -
luporfanf resource For sfafes and locallfles loollng fo expllclfly address bealfb dlsparlfles auong
raclally and efbnlcally dlverse populaflons. ln 2u11, fbe prograu awarded $1u3 ullllon ln luple-
uenfaflon granfs fo 61 sfafe and local agencles, frlbes and ferrlforles, and nonproFf organlzaflons
fo supporf couuunlfy bealfb and wellness. 1bese awardees wlll engage ln acflvlfles fo address
couuunlfy fobacco-Free llvlng, acflve llFesfyles and bealfby eaflng, and supporf blgb-quallfy
cllnlcal prevenflons. 1be prograu ls expecfed fo run For Fve years and lupacf approxluafely 12u
ullllon Auerlcans.
34
An esfluafed 23 ullllon lndlvlduals wlll reualn unlnsured aFfer uosf oF fbe laws' provlslons are -
lupleuenfed. OF fbls group, approxluafely one-fblrd wlll be luulgranf populaflons lnellglble For
Vedlcald or excbange prograus, ln addlflon fo fbe quarfer oF lndlvlduals fbaf wlll be ellglble For
Vedlcald buf unenrolled.
35
Couuunlfy bealfb cenfers wlll be an luporfanf polnf oF access fo care
For unlnsured and newly lnsured populaflons. 1brougb coordlnafed approacbes fo supporflng
couuunlfy bealfb cenfers and sysfeu capaclfy, fbe ACA aFFords sfafes opporfunlfles fo bulld a
susfalnable saFefy nef and publlc bealfb lnFrasfrucfure fo address fbe bealfb care needs oF raclally
and efbnlcally dlverse populaflons.
8eglnnlng wlfb faxable years aFfer Varcb 2u12, fbe ACA requlres nonproFf bosplfals fo perlodl- -
cally conducf couuunlfy bealfb needs assessuenfs and lupleuenf sfrafegles fo address ldenfl-
Fed couuunlfy bealfb needs lF fbe bosplfals are fo recelve exeupflon Frou Federal faxes. 1be
couuunlfy bealfb needs assessuenfs are fo lncorporafe Feedbacl Frou couuunlfles, wblcb wlll
lnclude fbe underserved and populaflons oF color as well as local bealfb deparfuenfs.
36, 37
Vany
local bealfb deparfuenfs nof only bave experlence conducflng fbese assessuenfs, buf also oFfen
worl wlfb sfafe bealfb deparfuenfs fo couplle dafa For sfafewlde publlc bealfb reporfs, wblcb
oFfen lnclude kLL dafa. Sfafes can belp local bealfb deparfuenfs sbare kLL and cruclal dlsparlfles
dafa wlfb non-proFf bosplfals.
TH NASHP STAT HAlTH QUITY lARNING COllAORATIv
Acblevlng bealfb equlfy For fbe naflon's raclal and efbnlc ulnorlfy populaflons bas becoue a prlorlfy af
bofb fbe Federal and sfafe levels. However, sfafes are ln a unlque poslflon fo develop and adapf bealfb
equlfy agendas fbaf ueef fbe speclFc needs oF fbelr couuunlfles. ln Facf, all 5u sfafes bave esfabllsbed a
ulnorlfy bealfb or bealfb equlfy oFFce or enflfy.
38
lupleuenfaflon oF fbe ACA provldes a veblcle For uov-
lng bealfb dlsparlfles lssues ouf oF fbe sllos oF oFFce oF ulnorlfy bealfb and lnfo fbe larger confexf oF sfafe
10
bealfb pollcy. Sfafe pollcyualers bave an opporfunlfy fo worl across agencles, sysfeus, and secfors fo
develop susfalnable and couprebenslve sfafe-based approacbes fo advance bealfb equlfy For fbelr ulnor-
lfy populaflons.
1o belp sfafe pollcyualers ualnfaln uouenfuu fowards acblevlng bealfb equlfy ln a couplex lupleuen-
faflon envlronuenf, NASHP, wlfb Fundlng Frou fbe Aefna loundaflon, developed fbe Sfafe Healfb Lqulfy
Learnlng Collaboraflve For feaus oF sfafe oFFclals. 1be purpose oF fbls Learnlng Collaboraflve was fo pro-
vlde concrefe asslsfance fo seven sfafes fbrougb access fo experf consulfaflon, lupleuenfaflon resources,
and nefworllng wlfb ofber sfafe oFFclals fo supporf sfafes ln sluulfaneously acblevlng bealfb reForu and
bealfb equlfy goals. NASHP anflclpafed fbe Followlng oufcoues For parflclpaflng sfafes.
Imp|ementation of the ACA with a conscious consideration of the impact of state po|icy -
decisions on diverse popu|ations, and fbe ablllfy fo ldenflFy opporfunlfles fo prouofe bealfb
equlfy as fbey carry ouf requlred ACA roles and pollcles.
|evation of hea|th equity agendas. - Hlsforlcally, lnlflaflves fbaf prouofe bealfb equlfy bave been
slloed and vulnerable fo pollflcal and Fnanclal sblFfs. lncorporaflng bealfb equlfy lnfo fbe broader
scope oF bealfb sysfeus wlll Focus greafer affenflon on fbe needs oF dlverse populaflons.
Integration of hea|th equity initiatives across state programs. - luprovlng fbe bealfb oF dlverse
populaflons ls an objecflve oF uulflple sfafe agencles and brancbes oF governuenf. 1o be suc-
cessFul and bave fbe greafesf lupacf, Vedlcald, ulnorlfy bealfb, publlc bealfb and ofber agencles
sbould bulld susfalnable parfnersblps and prouofe cross-cufflng bealfb equlfy agendas.
State Se|ection Process
ln Augusf 2u11, NASHP sollclfed a naflonal requesf For appllcaflons For sfafes lnferesfed ln parflclpaf-
lng ln fbe Healfb Lqulfy Learnlng Collaboraflve. NASHP sougbf appllcaflons Frou sfafes fbaf bad Fruly
couulffed fo advanclng bealfb equlfy and wanfed fo leverage fbe opporfunlfles presenfed ln bealfb care
reForu. Sfafe appllcaflons were assessed based on fbe Followlng crlferla.
Partnerships - . Couulfuenf Frou Vedlcald, publlc bealfb, and ulnorlfy bealfb agencles fo par-
flclpafe ln a core projecf feau, as well as engage ofber relevanf sfafe agencles and sfalebolder
organlzaflons.
Re|evant hea|th reform activity - . Lvldence oF core feau ueuber engageuenf ln sfafe bealfb care
reForu eFForfs.
Reasonab|e objectives - . Lvldence fbaf fbe core feau wlll esfabllsb Feaslble objecflves For fbe
elgbf-uonfb projecf perlod, parflcularly by bulldlng upon exlsflng coupleuenfary eFForfs.
Potentia| impact of technica| assistance - . Lvldence fbaf parflclpaflon would sfrengfben fbe
sfafe's (and lnForu ofber sfafes') bealfb equlfy and bealfb reForu agendas.
8ased on fbe above crlferla, and aFfer consulflng wlfb a NASHP projecf advlsory couulffee couprlsed
oF naflonal and Federal bealfb equlfy experfs, NASHP selecfed Arlansas, Connecflcuf, Hawall, Vlnnesofa,
New Vexlco, Oblo, and \lrglnla fo parflclpafe ln fbe Healfb Lqulfy Learnlng Collaboraflve.
Selecfed sfafes were expecfed fo.
Iorm a core |eadership team - oF sfafe oFFclals Frou Vedlcald, ulnorlfy bealfb, and publlc bealfb
agencles fo Faclllfafe lnfer-agency collaboraflon.
11
Deve|op a workp|an and achieve reasonab|e progress towards workp|an objectives - wlfbln
fbree pollcy prlorlfy areas For advanclng bealfb equlfy fbrougb bealfb reForu lupleuenfaflon.
8ased on bealfb care reForu lupleuenfaflon prlorlfles ldenflFed by NASHP's Lxecuflve Couulffee and
Feedbacl Frou fbe projecf advlsory couulffee, NASHP provlded a llsf fo selecfed sfafes oF areas (See
1able 2) Frou wblcb fbey ldenflFed fbree prlorlfles as fbe Focus oF fbelr eFForfs over fbe elgbf-uonfb
fecbnlcal asslsfance perlod oF fbe Healfb Lqulfy Learnlng Collaboraflve.
39
TAl 2: HAlTH QUITY lARNING COllAORATIv STATS' wORkPlAN PRIORITY ARAS
Po|icy Area Samp|e Actions to Advance Hea|th quity
C
o
v
e
r
a
g
e
a
n
d
A
c
c
e
s
s 8e Sfrafeglc wlfb lnsurance
Lxcbanges
Develop descrlpflons oF plans and subsldles fbaf are culfurally and -
llngulsflcally approprlafe
Conducf fargefed oufreacb fo raclal and efbnlc ulnorlfy couuunl- -
fles fo lncrease fbelr awareness oF lnsurance subsldles
SlupllFy and lnfegrafe
Lllglblllfy Sysfeus
Adopf fesfed oufreacb enrolluenf and refenflon sfrafegles fo -
uaxlulze parflclpaflon oF underserved populaflons ln Vedlcald and
Lxcbanges
keduce docuuenfaflon burden oF clflzen verlFcaflon -
lncrease franslaflon and lnferprefaflon servlces -
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Lupbaslze Coordlnaflon oF
Care
Lsfabllsb bealfb boues ln raclal and efbnlc ulnorlfy couuunlfles -
fargefed fo people wlfb uulflple cbronlc condlflons
lnfegrafe dellvery sysfeu oF bebavloral and pbyslcal bealfb For Ved- -
lcald reclplenfs fbrougb saFefy nef provlders
Prouofe Quallfy and
LFFclency Frou fbe Healfb
Care Sysfeu
Adopf payuenf reForu deuonsfraflons fo luprove care For persons -
wlfb cbronlc dlseases and concenfrafe publlc resources For pllof
prograus ln raclal and efbnlc ulnorlfy couuunlfles
luprove Provlder and Healfb
Sysfeu Capaclfy
Sfrengfben fbe ablllfy oF saFefy nef provlder fo servlce persons newly -
ellglble For Vedlcald lnsurance beneFfs, uany oF wbou wlll lllely be
efbnlc ulnorlfles wlfb cbronlc condlflons
Develop Federal granf proposals fo supporf lncreased worlForce -
dlverslfy and expanded provlder capaclfy ln underserved areas
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Lngage fbe Publlc ln
Pollcy Developuenf and
lupleuenfaflon
Develop sfrafegles fo eupower raclal and efbnlc couuunlfles fo -
welgb ln on pollcy opflons beFore fbaf are adopfed and fo provlde
Feedbacl on bow fbaf are belng luplanfed so fbey can be luproved
Use Your Dafa
Develop sfrafegles fo analyze fbe uyrlad new dafa eleuenfs uandaf- -
ed For collecflon ln order fo ldenflfy and drlve needed luproveuenfs
ln bealfb equlfy
Use dafa fo esfabllsb provlder perForuance ueasures For reduclng -
bealfb dlsparlfles and cbronlc dlsease
Pursue Populaflon Healfb
Goals
kevlfallze publlc bealfb sfrafegles fbaf Focus on dlsease prevenflon -
and bealfb prouoflon
Develop Federal granf proposals fo access opporfunlfles provlded by -
fbe Prevenflon and Publlc Healfb lund
Lxpand fbe supply and scope oF couuunlfy bealfb worlers -
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Sfafes' prlorlfy areas were fbe basls For uonfbly experf fecbnlcal asslsfance acflvlfles and ongolng peer-
learnlng opporfunlfles, wblcb Focused on fbe Followlng slx foplcs.
Sfrafegles fo ensure parflclpaflon oF dlverse populaflons ln Vedlcald and excbange plans -
Lngaglng raclal and efbnlc ulnorlfy couuunlfles ln pollcy developuenf and lupleuenfaflon, -
Healfb and uedlcal boue deslgn conslderaflons For bealfb equlfy, -
Vedlcald uanaged care confracf opflons For advanclng bealfb equlfy, -
Culfural coupefency fralnlng For provlders and pollcy ualers, and -
Dafa collecflon and use fo advance bealfb equlfy. -
1be projecf cululnafed wlfb an ln-person sfafe-Federal ueeflng, Followed by a sfafe-only ueeflng oF
Healfb Lqulfy Learnlng Collaboraflve feau ueubers. 1bls reporf Focuses on fbe experlences oF fbe parflcl-
paflng sfafes and fbelr sfrafegles fo advance bealfb equlfy fbrougb bealfb reForu as parf oF fbls projecf.
13
Tubuf!Bdujpo!up!Bewbodf!Ifbmui!Frvjuz!vtjoh!Tfmfdu!BDB!!
boe!Tubuf!Qpmjdz!Mfwfst
T
fafes parflclpaflng ln fbe Healfb Lqulfy Learnlng Collaboraflve bave used selecf ACA sfafe pollcy
levers fo advance bealfb equlfy by bulldlng on exlsflng lnlflaflves and parfnersblps. 1bls secflon Frsf
descrlbes sfafes' acflon fo advance bealfb equlfy relafed fo bealfb coverage and access, and fben
blgbllgbfs acflon relafed fo quallfy oF care and dellvery sysfeu reForu. 1able 3 (nexf page) provldes an
overvlew oF sfafes' acflons ln fbese areas. As prevlously nofed, fbe acflvlfles descrlbed bere are fbose fbaf
were fbe Focus oF fbls parflcular learnlng collaboraflve and do nof represenf fbe fofallfy oF sfafes' bealfb
equlfy or bealfb reForu eFForfs.
STAT ACTION RlATD TO COvRAG AND ACCSS
Parflclpaflng sfafes bave underfalen a nuuber oF acflvlfles fbaf caplfallze on lncreased lnsurance coverage
under fbe ACA. 1bey are fallng sfeps fo ensure fbaf newly covered raclal and efbnlc ulnorlfles under fbe
ACA Vedlcald expanslon and bealfb lnsurance excbange bave equlfable access fo care. 1bese sfafes are
worllng fo advance bealfb equlfy fbrougb.
lnsurance excbange plannlng and leadersblp, -
Consuuer asslsfance and oufreacb ln navlgafor prograus, and -
Dafa sbarlng agreeuenfs and analyses fo lnForu Vedlcald prograu enrolluenf and servlce provl- -
slon.
xchange p|anning and |eadership
As acflvlfy ln Connecflcuf and Vlnnesofa sbow, lnfegraflng bealfb equlfy lnfo lnsurance excbange plannlng
Frsf enfalls educaflng pollcyualers fasled wlfb developlng fbe excbange abouf fbe needs oF dlverse popu-
laflons and ways fbaf pollcyualers can pursue bealfb equlfy as a goal oF excbange lupleuenfaflon. lrou
fbere, excbange leaders can weave bealfb equlfy lnfo eacb sfage oF plannlng.
Connect|cat
Connecflcuf's OFFce oF Healfb keForu and lnnovaflon ls developlng bealfb equlfy fralnlng For lfs Healfb
lnsurance Lxcbange 8oard oF Dlrecfors. An oufslde experf wlll lead fbe fralnlng, bowever fbe OFFce wlll
collaborafe wlfb ofber sfafe agencles fo lncorporafe lnfernal experflse and resources on bealfb dlsparlfles
wlfbln fbe sfafe. Sfafe bealfb dlsparlfles dafa Frou fbe publlc bealfb deparfuenf wlll be sbared durlng fbe
fralnlng, as wlll lnForuaflon on bealfb equlfy luproveuenf eFForfs ln ofber sfafes. Addlflonally, fbe OFFce wlll
provlde bealfb equlfy fralnlng fo fbe Governor's Healfb Care Cablnef, wblcb advlses fbe Governor on luple-
uenfaflon oF Federal bealfb reForu and developuenf oF an lnfegrafed bealfb care sysfeu ln fbe sfafe.
V|nnesota
Larller fbls year, ueubers oF fbe Vlnnesofa Healfb lnsurance Lxcbange Advlsory 1asl lorce devofed an
enflre ueeflng fo fbe foplc oF bealfb equlfy.
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1be Vedlcald and bealfb couulssloners sbared dafa abouf
bealfb dlsparlfles ln fbe sfafe, soclal deferulnanfs oF bealfb ln fbe sfafe, and fbe Fnanclal lupllcaflons oF
dlsparlfles. Consuuers and consuuer represenfaflves provlded concrefe pollcy recouuendaflons For ad-
dresslng dlsparlfles fbrougb fbe excbange, sucb as adopflng dafa collecflon sfandards fo capfure dlsparl-
fles and ensurlng culfurally approprlafe consuuer oufreacb.
41
8ased on fbe lnForuaflon presenfed, fbe fasl
Force vofed fo couulf fo uallng eacb oF lfs pollcy recouuendaflons or declslons only aFfer conslderlng
14
TAl 3: STAT ACTION THROUGH TH HAlTH QUITY lARNING COllAORATIv TO ADvANC HAlTH QUITY USING
SlCT ACA AND STAT POlICY lvRS
ACA-Re|ated Iocus Area and State Activity AR CT HI MN NM OH vA
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Oufreacb and Lnrolluenf
Creafe and provlde culfurally senslflve educaflonal
uaferlals fo fbe publlc

lncorporafe bealfb equlfy conslderaflons lnfo
consuuer asslsfance and oufreacb fbrougb
navlgafor prograus
Develop dafa sbarlng agreeuenfs fo analyze

enrolluenf and prlorlflze areas For oufreacb and
enrolluenf eFForfs
Healfb lnsurance/8eneFf Lxcbange

Develop guldellnes For collecflng race/efbnlclfy/
language dafa

Provlde bealfb equlfy dafa and educaflon For
plannlng or advlsory board ueubers

Lnsure dlverse sfalebolder represenfaflon on
plannlng or advlsory enflfles

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Vedlcald Provlder 1ralnlng and Lxpecfaflons
Develop culfural coupefency fralnlng and/or
provlde anfl-oppresslon assessuenfs For Vedlcald
provlders

laclllfafe uanaged care confracf language cbanges
fo lncrease accounfablllfy fo dellver culfurally
senslflve care and/or reduce bealfb dlsparlfles

Healfb and Vedlcal Houes
Conducf oufreacb fo dlverse couuunlfles abouf
bealfb boues fo lnForu plannlng

Plan For uedlcal boue rollouf ln raclally/efbnlcally
dlverse couuunlfles

Develop and conducf culfural coupefency fralnlng
For uedlcal boue provlders

Pursue Federal supporf opporfunlfles fo luprove
payuenf and care dellvery

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kace/Lfbnlclfy/Language (kLL) Dafa
lnvenfory Vedlcald, publlc bealfb and ofber agency
dafabases fo assess and luprove collecflon oF kLL
dafa

Develop pollces fo govern kLL dafa collecflon
fbrougb all-payer clalus dafabases

Lxplore developuenf oF sfandardlzed and
lnfegrafed uefrlcs fo analyze dlsparlfles dafa
across sfafe agencles

15
fbe pollcy's lupacf on bealfb dlsparlfles. ln fbls way, eFForfs fo advance bealfb equlfy are lnfegrafed lnfo
excbange plannlng. A crlflcal precursor fbaf uade fbls acflon posslble ln Vlnnesofa was bavlng fasl Force
ueubers-fbe volces wlfb aufborlfy af fbe pollcy-uallng fable-wbo represenf couuunlfles and wbo
fbeuselves are raclal or efbnlc ulnorlfles
Consumer assistance and outreach in navigator programs
Under fbe ACA, sfafes bave fbe opflon fo run bealfb lnsurance excbanges lndependenfly or ln parfner-
sblp wlfb fbe Federal governuenf. ln lebruary 2u12, Arlansas declded fo pursue fbe opflon fo a develop
a Federally-Faclllfafed excbange (llL), wblle ualnfalnlng sfafe operaflon oF core excbange Funcflons sucb
as consuuer asslsfance plannlng and plan uanageuenf.
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1brougb fbls Sfafe Parfnersblp uodel, Arlansas
bas fbe Fexlblllfy fo deslgn lfs navlgafor prograu ln coupllance wlfb guldellnes sef Forfb ln fbe ACA and
supporf fbe cerflFcaflon and fralnlng oF ellglble lndlvlduals fo serve as navlgafors.
/r|ansas
Arlansas ls uslng lfs navlgafor prograu fo advance pollcy levers aFForded by fbe excbange fo address
bealfb equlfy fbrougb consuuer engageuenf, oufreacb, and navlgafor prograu deslgn. lor exauple, fbe
Arlansas lnsurance Deparfuenf and lnsurance Deparfuenf Healfb 8eneFfs Lxcbange Parfnersblp Dlvlslon
bas engaged couuunlfy-based organlzaflons, consuuer advocafes, and couuunlfy ueubers ln educa-
flonal acflvlfles fo couuunlcafe opporfunlfles wlfbln fbe excbange fo advance bealfb equlfy. 1be sfafe ls
also currenfly worllng on a 1raln fbe 1ralner' currlculuu and resource foolbox For couuunlfy organlzers
fo Faclllfafe couuunlcaflon oF excbange pollcy developuenfs befween fbe sfafe and pofenflal excbange
enrollees and sollclf Feedbacl fbrougb publlc couuenf on planned pollcy developuenfs. Lessons learned
Frou fbese couuunlfy engageuenf acflvlfles wlll be sbared wlfb sfafe pollcyualers deslgnlng excbange
plans and fbe navlgafor prograu fo address fbe needs oF ulnorlfy couuunlfles.
Addlflonally, fbe Arlansas lnsurance Deparfuenf's Healfb 8eneFf Lxcbange Plannlng Dlvlslon, wblcb
oversees fbe developuenf oF fbe Sfafe Parfnersblp uodel, esfabllsbed a Consuuer Advlsory Couulffee
and conducfs consuuer Focus groups fo develop oufreacb recouuendaflons fo reacb dlverse populaflons.
1brougb fbe navlgafor prograu, fbe sfafe ls loollng fo lupleuenf cerflFcaflon pollcles fbaf wlll allow
broad parflclpaflon ln fbe prograu. 1bls wlll be an luporfanf conslderaflon For oufreacb ln rural areas and
locallfles wlfb blgb concenfraflons oF lndlvlduals Frou raclal and efbnlc ulnorlfy groups. llnally, Arlansas ls
worllng fo develop culfural coupefency confracf language fo be lncluded ln klPs For organlzaflons apply-
lng fo parflclpafe ln fbe navlgafor granf prograu. Lxauples oF provlslons are as Follows.
1o ensure selecfed Navlgafors are frusfed sources oF bealfb care coverage lnForuaflon ln fbe cou- -
uunlfles fbey cboose fo serve, fbaf servlces are culfurally and llngulsflcally approprlafe, and fbaf
lnForuaflon ls relayed ln a way fbaf slupllFes cbolces and conslders fbe lndlvldual needs oF eacb
consuuer and fbelr Faullles,
1o creafe a poslflve oplnlon oF fbe excbange, lfs beneFfs, and fbe luporfanf role bealfb lnsurance -
coverage can play ln reduclng bealfb care dlsparlfles.
1o uaxlulze coverage For fbe unlnsured or underlnsured ln fbe excbange. -
Data agreements and ana|ysis to inform Medicaid enro||ment and service provision
As descrlbed below, \lrglnla ls esfabllsblng a dafa sbarlng agreeuenf fo lnForu Vedlcald enrolluenf and
servlce provlslon.
16
v|rg|n|a
\lrglnla bas creafed a new uecbanlsu For cross-agency collaboraflon fo undersfand and address dlsparlfles
ln enrolluenf and oufcoues. ln fbe sfafe, unlnfended pregnancy rafes are blgbesf auong cerfaln groups
oF wouen, sucb as wouen ages 18 fo 24, wouen wbose lncoue ls below fbe poverfy llne, and 8lacl or
Hlspanlc wouen.
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l|an l|rst, a Faully plannlng prograu wlfbln Vedlcald, bas fargefed oufreacb eFForfs fo
areas wlfb blgb lnFanf uorfallfy rafes. kecenfly, fbe sfafe's bealfb and Vedlcald (Vedlcal Asslsfance Ser-
vlces) deparfuenfs enfered lnfo a dafa sbarlng agreeuenf fo evaluafe and lnForu l|an l|rst enrolluenf and
provlslon oF servlces. 1be bealfb deparfuenf analyzed l|an l|rst dafa uslng geograpblc lnForuaflon sysfeus
(GlS) uapplng ln conjuncflon wlfb uulfl-level spaflal analysls. GlS uapplng and spaflal analysls are fools
fbaf analyze and dlsplay geograpblcally reFerenced (and ofber) dafa fo descrlbe fbe geograpblc relaflon-
sblps and pafferns.
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Spaflal analysls was used fo ldenflFy couuunlfles wbere uulflple rlsl Facfors, sucb as low lncoue or
Vedlcald ellglblllfy and sborf blrfb lnfervals, overlap. wlfb fbls lnForuaflon, Vedlcald can uore eFFclenfly
fargef l|an l|rst oufreacb, enrolluenf and prograu servlces fo fbe couuunlfles wlfb fbe uosf rlsl Facfors
and blgbesf need. Glven general deuograpblc lnForuaflon abouf fbe sfafe's geograpblc areas, agency sfaFF
can surulse wblcb locallfles are uosf raclally and efbnlcally dlverse and besf enable fbeu fo address raclal
and efbnlc dlsparlfles ln lnFanf uorfallfy. 1belr nexf sfeps wlll be lncludlng race and efbnlclfy dafa ln fbe
analysls For a uore accurafe assessuenf oF raclal and efbnlc dlFFerences ln enrolluenf. lncludlng fbls dafa
Frou fbe oufsef sfrengfbens fbe sfafe's ablllfy fo assess dlsparlfles ln rlsl Facfors and prlorlflze couuunl-
fles wlfb populaflons oF color Faclng dlsparlfles ln oufcoues.
Recommendations based on state actions to advance hea|th equity through coverage and access
strategies
1be Followlng recouuendaflons euerged Frou parflclpaflng sfafes' experlences advanclng bealfb equlfy
fbrougb excbange plannlng, navlgafor prograus, Vedlcald and bealfb agency dafa agreeuenfs and analy-
sls, and bealfb plan educaflon abouf bealfb equlfy.
losfer collaboraflon befween Vedlcald agencles, bealfb deparfuenfs, and ulnorlfy bealfb agen- -
cles, fbe laffer bave exlsflng educaflonal resources, couuunlfy nefworls, relevanf race/efbnlclfy/
language dafa, and quanflfaflve analyflc experflse fbaf can belp Vedlcald agencles prlorlflze ouf-
reacb and servlce provlslon eFForfs and allocaflon oF resources fo uaxlulze refurn on lnvesfuenf.
Lnsure excbange-plannlng (and all ofber pollcy-uallng) enflfles bave dlverse ueubersblp and -
lnclude couuunlfy ueubers wbo wlll lllely parflclpafe as consuuers ln fbe excbange.
STAT ACTION RlATD TO QUAlITY AND DlIvRY RIORM
ln addlflon fo addresslng equlfy ln access fbrougb ACA and sfafe pollcy levers, parflclpaflng sfafes bave
ldenflFed opflons For caplfallzlng on fbe bealfb dellvery reForu and quallfy luproveuenf couponenfs oF
ACA. Sfafes are fallng sfeps fo ensure fbaf dellvery reForu lnlflaflves lnfegrafe a bealfb equlfy lens fo en-
sure blgb-quallfy, equlfable care For all. Parflclpaflng sfafes seel fo advance bealfb equlfy fbrougb.
Healfb and uedlcal boues, -
kace/efbnlclfy/language dafa guldellnes and recouuendaflons, -
Culfural coupefency fralnlng For Vedlcald provlders, and -
Vedlcald uanaged care confracflng and educaflon. -
17
Hea|th and medica| homes
Naflonally fbere bas been a prollFeraflon oF sfafe leglslaflon and lnlflaflves fo prouofe adopflon oF fbe
paflenf-cenfered uedlcal boue (PCVH) care dellvery uodel.
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Llle bealfb boues aufborlzed under ACA,
fbe PCVH ls an enbanced uodel oF prluary care fbaf oFFers conflnuous, feau-based, coordlnafed, blgb
quallfy, saFe, and wbole-person orlenfed care fo paflenfs and a payuenf sfrucfure fo supporf fbe neces-
sary lnvesfuenfs For fbls care by provlders.
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8ofb bealfb and uedlcal boues play an luporfanf role ln
fransForulng fbe dellvery oF paflenf-cenfered bealfb care For raclal and efbnlc ulnorlfles. As exauples
Frou Oblo, Vlnnesofa, and Hawall sbow, parflclpaflng sfafes are advanclng bealfb equlfy by lnfegraflng
fbe needs oF dlverse populaflons lnfo bealfb and uedlcal boue lnlflaflves vla slfe selecflon crlferla, pro-
vlder educaflon, and couuunlfy engageuenf ln plannlng. 1belr worl oFFers ldeas bow sfafes can ensure
bealfb boues and uedlcal boues ueef fbe needs oF dlverse populaflons.
On|o
ln Oblo, 2u1u leglslaflon (House 8lll 198) esfabllsbed fbe Paflenf-Cenfered Vedlcal Houe Lducaflon Pl-
lof Prograu, fbrougb wblcb 44 pracflces aFFllafed wlfb uedlcal and nurslng scbools were selecfed fo pro-
uofe adopflon oF fbe paflenf-cenfered uedlcal boue (PCVH) uodel oF prluary care.
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1be pllof prograu
oFFers fulflon asslsfance fo prluary care career sfudenfs, fralns fbeu ln fbe PCVH uodel, and engages
fbeu ln pracflcal, on-fbe-ground PCVH experlence.
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Larller fbls year, fbe sfafe announced nof only a
Fnanclal couulfuenf fo supporf lupleuenfaflon oF fbe exlsflng projecf buf also an expanslon fo slx ad-
dlflonal pracflces. Collaboraflon befween fbe Oblo Healfb Lqulfy Learnlng Collaboraflve 1eau and fbe
Oblo OFFce oF Healfb 1ransForuaflon led fo fbe declslon fo fargef fbe expanslon fo bealfb provlders wbo
prluarlly serve raclal and efbnlc ulnorlfles and underserved couuunlfles.
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1be sfafe selecfed addlflonal
pracflces based on soclo-econoulc Facfors and raclal and efbnlc dlverslfy. ln addlflon, every pracflce fbaf
recelves fralnlng dollars uusf supporf af leasf 15 percenf unlnsured or Vedlcald-ellglble paflenfs. 1bls eF-
Forf fo fargef populaflons wbo bear a dlsproporflonafe burden oF dlseases and poor bealfb oufcoues wlll
provlde Fasfer refurn on lnvesfuenf fbrougb luproved oufcoues and bealfb sfafus and ln cosf savlngs. lf
also provldes a way fo belp advance bealfb equlfy. 1brougb fbe Oblo Paflenf-Cenfered Prluary Care Col-
laboraflve, fbe sfafe's bealfb deparfuenf ls Faclllfaflng fbe PCVH projecf expanslon and wlll belp lnForu
sfafewlde PCVH pollcy.
V|nnesota
A second way parflclpaflng sfafes bave lnfegrafed bealfb equlfy lnfo uedlcal boues ls vla provlder fraln-
lng. Larller fbls year, Vlnnesofa developed and bosfed a bealfb equlfy educaflonal sesslon For uedlcal
boue (lnown as bealfb care boue') provlders as parf oF broad provlder fralnlng. 1be bealfb equlfy
worlsbop was bosfed by bealfb deparfuenf sfaFF and Feafured besf pracflces ln provldlng culfurally cou-
pefenf care and lncluded foplcs sucb as race/efbnlclfy/language dafa collecflon and use, and provlslon oF
paflenf - and Faully-cenfered care For dlverse populaflons.
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1be worlsbop was nof a one-flue evenf, as
bealfb equlfy and culfural coupefence are now foplcs For conslderaflon as Fufure educaflon sesslons are
planned auong fbe sfafe's bealfb care boues learnlng collaboraflve.
aaa||
Hawall bas lnfegrafed bealfb equlfy lnfo bealfb and uedlcal boue plannlng fbrougb educaflonal worl-
sbops and Focus groups wlfb raclal and efbnlc ulnorlfles. Hawall's declslon fo develop fbese worlsbops
was lnFuenced by Connecflcuf's Fndlng oF slgnlFcanf publlc learnlng curves abouf fbe concepf and Func-
flon oF uedlcal and bealfb boues, as well as publlc undersfandlng oF fbe lupllcaflons oF bealfb reForu.
1allng a lesson Frou Connecflcuf's experlence, Hawall declded fo deslgn couuunlfy-based worlsbops fo
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educafe fbe publlc abouf ley lupllcaflons oF bealfb reForu wlfbln couuunlfles. 1be 9u-ulnufe worlsbops
provlded lnForuaflon abouf bealfb care reForu Frou a consuuer perspecflve and descrlbed bealfb and
uedlcal boues.
Addlflonally, fbe Hawall Deparfuenf oF Healfb beld Focus groups wlfb uenfal bealfb consuuers served by
couuunlfy uenfal bealfb cenfers and Federally quallFed bealfb cenfers fo sollclf Feedbacl abouf culfural
needs and preFerences For accesslng bealfb boues and ensurlng quallfy servlce dellvery, parflcularly care
coordlnaflon auong uedlcal and bebavloral bealfb freafuenf provlders. 1be sfafe wlll sbare Feedbacl Frou
fbe worlsbops and Focus groups wlfb groups guldlng bealfb boue and ofber projecf plannlng. lnslgbfs wlll
conflnue fo lnForu dellvery sysfeu reForu eFForfs. lor exauple, fbe sfafe ls pursulng a Prluary and 8ebav-
loral Healfb Care lnfegraflon (P8HCl) granf Frou fbe Federal Subsfance Abuse and Venfal Healfb Servlces
Adulnlsfraflon fo Faclllfafe lupleuenfaflon oF fbe sfafe's pllof 8l-Dlrecflonal lnfegraflon oF 8ebavloral
Healfb/Prluary Care Deuonsfraflon Projecf.
51
Rl data co||ection guide|ines and recommendations
Healfb Lqulfy Learnlng Collaboraflve sfafes are all lnvesfed ln lncreaslng fbe valldlfy and use oF race/
efbnlclfy/language (kLL) dafa fo undersfand, assess, and luprove quallfy oF care For ulnorlfles. worllng
fbrougb respecflve sfafe oFFces or enflfles devofed fo bealfb reForu, bofb Vlnnesofa and Connecflcuf
bave ldenflFed pollcy levers and opporfunlfles For luprovlng kLL dafa guldellnes and recouuendaflons.
V|nnesota
ln 2u1u, as a resulf oF sfafe leglslaflon,
52
fbe bealfb and Vedlcald (Huuan Servlces) deparfuenfs ln Vln-
nesofa conducfed an lnvenfory oF kLL bealfb-relafed dafa fbey collecf and consulfed wlfb a sfalebolder
worlgroup fo develop recouuendaflons For luprovlng kLL dafa collecflon fo ensure suFFclenf lnForuaflon
fo asses prograu oufcoues and uale pollcles fo address bealfb dlsparlfles.
53
1be worlgroup's dafa collec-
flon pollcy and couuunlcaflon recouuendaflons were lncluded ln a 2u11 reporf fo fbe sfafe leglslafure.
54
1be worlgroup recouuended fbaf lf, or a slullar enflfy, conflnue fo ueef. 1be Healfb Lqulfy Learnlng
Collaboraflve bas energlzed fbe 4u-ueuber worlgroup by glvlng lf fbe concrefe fasl oF creaflng a consen-
sus recouuendaflon on fbe sfandardlzed collecflon oF kLL dafa For sfafe bealfb reForu acflvlfles. Over fbe
suuuer, fbe worlgroup wlll presenf lfs recouuendaflons fo fwo broad enflfles guldlng pollcyuallng ln fbe
sfafe. fbe Governor's 1asl lorce on Healfb keForu (couprlsed oF publlc and prlvafe secfor represenfaflves
fasled wlfb luprovlng bealfb and access, lowerlng cosfs, and addresslng dlsparlfles) and fbe Healfb lnsur-
ance Lxcbange 1asl lorce. 1be worlgroup's recouuendaflons lnclude.
55
Healfb care organlzaflons ln Vlnnesofa wlll collecf dafa on race, efbnlclfy/frlbal aFFllaflon, and -
language, adberlng fo sfandards adopfed by fbe sfafe.
Addlflonal dafa collecflon varlables sbould represenf Facfors fbaf lnFuence bealfb, sucb as -
socloeconoulc sfafus and acculfuraflon.
A unlForu codlng sfrucfure sbould be developed fo Faclllfafe dafa excbange auong bealfb care -
organlzaflons, and
1be worlgroup wlll conflnue fo deFne locally relevanf cafegorles For efbnlclfy and language and -
develop recouuendaflons For fbe reporflng and sbarlng oF kLL dafa wlfb sfalebolders.
19
Connect|cat
ln recognlflon fbaf accurafe and sfandardlzed dafa are cruclal fo ldenflFylng needs and prlorlflzlng lu-
proveuenf, Connecflcuf's OFFce oF Healfb keForu and lnnovaflon (OFFce) ls explorlng opflons For col-
lecflng and uflllzlng kLL Frou fbe sfafe's all-payer clalus dafabase (APCD). Nlne sfafes bave an APCD, and
seven sfafes, lncludlng Connecflcuf, are ln fbe process oF lupleuenflng one.
56
APCDs are a crlflcal fool
sfafes use fo generafe couparable bealfb care cosf, quallfy and uflllzaflon lnForuaflon Frou all payers ln a
sfafe. 1be dafa belps fargef areas For luproveuenf by ldenflFylng varlaflons, wben publlc, fbe dafa also en-
able consuuers and purcbasers fo coupare cosf and quallfy fo uale uore lnForued declslons. As bealfb
care reForu ls lupleuenfed, APCDs wlll play an luporfanf role ln fbe evaluaflon oF ley reForu eFForfs seel-
lng fo address rlslng bealfb care cosfs, lncreased access fo care, and populaflon bealfb luproveuenf.
57
[une 2u12 leglslaflon ln Connecflcuf enables fbe OFFce fo prouulgafe regulaflons For APCD dafa collec-
flon.
58
OFFce sfaFF wanf fo ensure fbaf as fbe APCD ls developed, lf confalns conslsfenf kLL dafa fo lnForu
bealfb sysfeu luproveuenf sfrafegles and pollcy recouuendaflons fbaf address dlsparlfles and advance
bealfb equlfy. Connecflcuf bas exlsflng pollcles fo draw Frou, speclFcally fbe publlc bealfb deparfuenf's
dafa collecflon sfandards For race/efbnlclfy cafegorles, wblcb preceded fbe AFFordable Care Acf buf are
conslsfenf wlfb fbe Acf's provlslons relafed fo kLL dafa collecflon.
59
OFFce and publlc bealfb sfaFF are
lnferesfed ln explorlng a sfafewlde, cross-agency approacb fo luproved kLL dafa collecflon.
Cu|tura| competency training for Medicaid providers
ln 2uu1, fbe U.S. Deparfuenf oF Healfb and Huuan Servlces' OFFce oF Vlnorlfy Healfb developed na-
flonal sfandards For culfurally and llngulsflcally approprlafe servlces (CLAS) ln bealfb care.
6u
1be 14 CLAS
sfandards are relevanf For all bealfb care provlders, fbey address culfurally coupefenf care, language ac-
cess servlces, and organlzaflonal supporfs For culfural coupefence. 1belr purpose ls fo reduce dlsparlfles
by belplng organlzaflons and provlders respond fo fbe culfural and llngulsflc needs oF dlverse populaflons.
1be sfandards lnclude several guldellnes as well as requlreuenfs For Federal granfees.
v|rg|n|a
As parf oF fbe Healfb Lqulfy Learnlng Collaboraflve, \lrglnla bas belped uale CLAS sfandards lnForua-
flon uore avallable fo Faully plannlng provlders. As prevlously uenfloned, \lrglnla Vedlcald bas a sfafe
plan auenduenf For a Faully plannlng prograu branded as l|an l|rst. l|an l|rst oFFers ellglble uen and
wouen servlces fo belp prevenf unplanned pregnancles.
61
Vedlcald updafed lfs l|an l|rst provlder fraln-
lngs fo lnclude lnForuaflon on CLAS. wben Vedlcald conducfed Fve Face-fo-Face sfafewlde fralnlngs oF
Faully plannlng provlders, lf sbared lnForuaflon Frou fbe bealfb deparfuenf's CLAS fralnlngs fo address
and ensure culfural coupefency.
62
1bese fralnlngs wlll ensure fbaf as uore consuuers becoue ellglble For
servlces under fbe Vedlcald expanslon, fbelr Faully plannlng provlders wlll provlde culfurally approprlafe
and senslflve care.
Medicaid managed care contracting and education
Parflclpaflng sfafes also bave pursued sfrafegles fo recouuend or requlre Vedlcald uanaged care orga-
nlzaflons (VCOs) fo couplefe speclFc bealfb equlfy responslblllfles, wblcb a nuuber oF sfafes, lncludlng
New Vexlco and CallFornla currenfly do.
63
Addlflonally, sfafes are provldlng bealfb equlfy lnForuaflon fo
Vedlcald VCOs. 1brougb fbese sfrafegles, fbe sfafes bope fo leverage coverage expanslons fo prouofe
quallfy care and bealfb equlfy.
20
On|o
Oblo bas bad uandafory uanaged care For Vedlcald-ellglble Faullles and cblldren slnce 2uu6, currenfly
fbe sfafe bas confracfs wlfb seven VCOs. Oblo Vedlcald (Deparfuenf oF [ob and laully Servlces) re-
vlews uanaged care plan confracf (provlder agreeuenf) language a couple oF flues eacb year fo defer-
ulne lF addlflonal pollcles or clarlFcaflons are needed. 1be uosf recenf revlew occurred ln sprlng 2u12.
Oblo Healfb Lqulfy feau ueubers uef wlfb confracf sfaFF and proposed fbe Followlng oF uanaged care
organlzaflons (VCOs).
64
Sysfeuaflc collecflon oF selF-ldenflFed kLL paflenf dafa, -
8effer ldenflFcaflon and uanageuenf oF groups lnown fo experlence bealfb care dlsparlfles, -
Use oF culfurally approprlafe uaferlals by fbe worlForce, and -
Lsfabllsbuenf oF and parflclpaflon ln a Vedlcald Healfb Lqulfy worlgroup fbaf wlll regularly -
revlew uanaged care confracfs, creafe and lupleuenf basellne dafa ueasures, and llnl VCOs fo
organlzaflons fbaf can belp fbeu develop culfurally approprlafe uaferlals and lupleuenf eFFec-
flve soluflons fo decrease bealfb dlsparlfles.
ln addlflon fo VCOs and Vedlcald, fbe Healfb Lqulfy worlgroup would lnclude represenfaflves oF fbe
bealfb deparfuenf and fbe Oblo Couulsslon on Vlnorlfy Healfb. 1be Vedlcald agency ls currenfly re-
vlewlng fbe recouuended language, fbe feau parflclpaflng ln fbls projecf bopes fo bave lf Fnallzed For
lupleuenfaflon lafer fbls year fo be eFFecflve wlfb fbe nexf confracf perlod (beglnnlng [anuary 2u13).
v|rg|n|a
1bls suuuer, \lrglnla's CbleF Depufy For Publlc Healfb ls scbeduled fo presenf fo fbe Vedlcald Vanaged
Care Organlzaflon (VCO) worlgroup lnForuaflon regardlng lnFanf uorfallfy and l|an l|rst ln fbe con-
fexf oF bealfb equlfy. 1be worlgroup ls uade up oF execuflve adulnlsfrafors Frou fbe sfafe's slx confracf-
ed VCOs, and fbereFore provldes an opporfunlfy For fbe sfafe fo reacb ley parfners fo address raclal
and efbnlc dlsparlfles ln lnFanf uorfallfy. 1bls presenfaflon ls anofber exauple oF bow publlc bealfb and
Vedlcald agencles can collaborafe fo sbare lnForuaflon abouf exlsflng raclal and efbnlc dlsparlfles ln
bealfb sfafus and bealfb care and creafe opporfunlfles fo address fbeu.
Using Data to ngage Communities in Po|icy Deve|opment in New Mexico
1be New Vexlco Deparfuenf oF Healfb bas lnsflfufed a new uodel For bealfb plannlng fo creafe
a couuon language across local, 1rlbal, reglonal and sfafe pollcy. keFerred fo as 1arn tne Care,
fbls uodel For plannlng and declslon-uallng provldes a Foruu For fbe sfafe and couuunlfles fo
worl collaboraflvely fo address uufually ldenflFed populaflon bealfb needs. As oF Vay 2u12, fbe
Deparfuenf bad beld Four publlc 1arn tne Care ueeflngs across fbe sfafe. Lacb ueeflng enabled
uarglnallzed couuunlfy ueubers fo volce fbelr uosf crlflcal populaflon bealfb needs, provlde a
consensus vofe on wblcb bealfb needs fo address, and propose sfrafegles fo do so. 1be Deparf-
uenf sfrafeglcally used sfafewlde dlsparlfles dafa fo ldenflFy locaflons For fbe ueeflngs as a way
fo eupower dlsadvanfaged couuunlfy ueubers fo advocafe For fbeuselves ln bealfb pollcy and
as parf oF fbe bealfb sysfeu. 1be ueeflngs resulfed ln a couulfuenf fo Fufure collaboraflve worl
befween fbe sfafe and couuunlfles on dafa and pollcy luproveuenf. Couuunlfy Feedbacl wlll
lnForu fbe Deparfuenf's 2u13 Sfafewlde Healfb luproveuenf Plan. New Vexlco's use oF dlsparl-
fles dafa fo engage vulnerable couuunlfles ln bealfb and bealfb pollcy plannlng ls a sfrafegy
ofber sfafes could use ln a varlefy oF foplc areas fo advance bealfb equlfy.
21
Recommendations based on state actions to advance hea|th equity using qua|ity and de|ivery sys-
tem strategies
8ased on parflclpaflng sfafes' acflvlfles fo advance bealfb equlfy fbrougb quallfy luproveuenf and dellv-
ery sysfeu reForu sfrafegles, fbe Followlng recouuendaflons euerged.
lncorporafe culfural coupefence, kLL dafa and bealfb equlfy conslderaflons lnfo bealfb and uedl- -
cal boues fbrougb selecflon crlferla, provlder fralnlng, and/or consuuer engageuenf,
wbere posslble, esfabllsb sfandards For kLL dafa collecflon and use ln APCDs, -
Lducafe uedlcal provlders abouf culfural coupefency and llnl provlders fo exlsflng resources fbaf -
wlll belp fbeu dellver culfurally-senslflve care,
Use Vedlcald purcbaslng and regulafory sfrafegles fo requlre or encourage uanaged care organl- -
zaflons and provlders fo address bealfb dlsparlfles For blgb quallfy, paflenf-cenfered care, and
Use Vedlcald bealfb plan or provlder fralnlngs and convenlngs fo sbare fools and resources abouf -
dlsparlfles and bealfb equlfy and ensure provlder culfural coupefence.
22
Tvtubjojoh!Tubuf!Fggpsut!up!Bewbodf!Ifbmui!Frvjuz
B
s a Fnal sfep ln fbls projecf, NASHP bosfed an ln-person ueeflng oF sfafe Healfb Lqulfy Learnlng
Collaboraflve feau ueubers and Federal oFFclals fo provlde a Foruu For sbarlng sfafe and Federal
lnlflaflves fo advance bealfb equlfy fbrougb bealfb reForu as well as fbe pollcy levers avallable af
fbe sfafe and Federal levels fo Faclllfafe fbese eFForfs. 1be nexf day, sfafe feau ueubers convened agaln fo
reFecf on fbelr experlences parflclpaflng ln fbe Collaboraflve and fo ldenflFy acflon sfeps and proulslng
sfafe sfrafegles For advanclng bealfb equlfy fbrougb bealfb reForu lupleuenfaflon. 1bls secflon descrlbes
fbe fbeues fbaf euerged Frou fbe ueeflngs.
lederal dafa and fools can lnForu and supporf sfafe eFForfs, -
Sfafes play a cruclal role ln engaglng couuunlfles fbaf ls nof posslble af fbe Federal level, -
Cross-agency collaboraflon ls ley fo advanclng equlfy, and -
lraulng bealfb equlfy as an lssue oF quallfy, cosf and jusflce ls luporfanf ln garnerlng wldespread -
lnferesf and fallng advanfage oF fbe uosf opporfunlfles fo advance cbange.
IDRAl DATA AND TOOlS TO SUPPORT STAT IIORTS
ln addlflon fo seellng ouf ACA granf opporfunlfles, parflclpaflng sfafes bave used ofber Federal, non-
ACA resources fo supporf sfafe-level acflon fo advance bealfb equlfy. Oblo's publlc bealfb deparfuenf,
For exauple, regularly reFerences dafa Frou fbe Agency For Healfbcare kesearcb and Quallfy (AHkQ)'s
Naflonal Healfbcare Dlsparlfles keporfs and Naflonal Healfbcare Quallfy keporfs fo provlde a naflonal
confexf For fbe luporfance oF luprovlng bealfb care quallfy and access, as well as fo ueasure quallfy and
access ln Oblo relaflve fo ofber sfafes and fbe naflon.
65
1be AHkQ reporfs fracl ueasures fo assess frends
ln bealfb care quallfy (eFFecflveness, saFefy, fluellness, efc.) as well as access For vulnerable populaflons.
1o belp ofber sfafe agencles lncorporafe bealfb equlfy lnfo luproveuenf and prlorlfy-sefflng eFForfs, fbe
Oblo Couulsslon on Vlnorlfy Healfb clfes as a feuplafe fbe goals and sfrafegles recouuended ln fbe
Frsf Nat|ona| Sta|eno|der Strategj jor /cn|e|ng ea|tn Lqa|tj, publlsbed by fbe U.S. Deparfuenf oF Healfb
and Huuan Servlces (HHS)' OFFce oF Vlnorlfy Healfb ln 2u11.
66
1bls fype oF lnForuaflon can be lncluded
ln educaflonal worlsbops For pollcyualers guldlng bealfb reForu lupleuenfaflon fo provlde couparaflve
lnForuaflon and esfabllsb or relnForce fbe luporfance oF addresslng raclal and efbnlc dlsparlfles ln bealfb
sfafus and bealfb care.
lederal agencles are luprovlng collaboraflon and weavlng dlsparlfles reducflon acflvlfles fbrougbouf fbelr
eFForfs, wblcb lllely wlll bave a rlpple eFFecf ln sfafes. As a resulf oF ACA, fbere are now (new) OFFces oF
Vlnorlfy Healfb ln Four HHS agencles. fbe Cenfers For Vedlcare & Vedlcald Servlces (CVS), fbe lood and
Drug Adulnlsfraflon (lDA), fbe Healfb kesources and Servlces Adulnlsfraflon (HkSA), and fbe Subsfance
Abuse and Venfal Healfb Servlces Adulnlsfraflon (SAVHSA).
67
1bere also ls a Federal lnferagency group
devofed fo bealfb equlfy, wblcb lncludes fbe Deparfuenfs oF [usflce, Labor and HHS.
Durlng fbe ueeflng, sfafes oFFered a Few suggesfed Federal acflons or guldance fbaf would supporf bealfb
equlfy eFForfs, lncludlng.
kecouuendlng or requlrlng bealfb dlsparlfles uefrlcs Frou sfafe Vedlcald agencles ln order fo -
draw Federal uafcblng Funds For Vedlcald,
Provldlng guldance For bow navlgafors wlll reacb dlverse and vulnerable populaflons fbrougb lnsur- -
ance excbanges and ln Vedlcald, and
23
keFerenclng sfrafegles fo reduce raclal and efbnlc dlsparlfles (e.g., culfural coupefence, language -
asslsfance, oufreacb fo or lncluslon oF dlverse couuunlfles) ln Federal granfs.
TH ROl OI STATS IN IACIlITATING COMMUNITY NGAGMNT
Alfbougb sfafes oFfen lool fo Federal agencles For guldance and leadersblp ln bealfb and bealfb care
reForu, Federal oFFclals rely on sfafes For asslsfance foo. Veeflng parflclpanfs uade clear fbaf one crlflcal
plece oF bealfb reForu fbaf fbe Federal governuenf cannof do-couuunlfy engageuenf and educaflon-
ls an luporfanf parf oF advanclng bealfb equlfy. lederal agencles do nof bave fbe capaclfy (or experlence)
fo reacb ouf fo local couuunlfles, and wblle local organlzaflons and couuunlfles fbeuselves bave fbe
uosf experflse and capaclfy ln couuunlfy engageuenf, sfafe agencles are able fo engage couuunlfy
ueubers ln pollcyuallng and as parf oF sfalebolder convenlng.
Several sfafe ulnorlfy bealfb oFFce oFFclals nofed fbaf fbelr oFFces' roles and responslblllfles lnclude cou-
uunlfy engageuenf, as sucb, fbey bave exlsflng nefworls oF couuunlfy leaders and represenfaflves as well
as uecbanlsus fo engage couuunlfles (e.g., vla newsleffers or regular publlc ueeflngs). Sfafe pollcyualers
can Faclllfafe fbe process oF ralslng couuunlfy awareness and educaflng fbe publlc abouf bealfb reForu
and bealfb equlfy. lor exauple, fbe Arlansas Sfafe Healfb Lqulfy Collaboraflve (ASHLC) ls a coallflon oF
sfalebolders Frou uulflple secfors wbo convene quarferly fo exaulne lssues oF bealfb equlfy wlfbln fbe
sfafe. 1brougb fbe ASHLC, fbe sfafe bas been able fo develop and dlsfrlbufe a uonfbly newsleffer For fbe
publlc blgbllgbflng lnForuaflon abouf bealfb equlfy evenfs and resources wlfbln fbe couuunlfy, parflcu-
larly as fbey relafe fo bealfb reForu.
Parflclpaflng sfafes eupbaslzed fbe luporfance oF a second level oF engageuenf. engaglng couuu-
nlfy ueubers ln fbe pollcy-uallng process, as evldenced ln Vlnnesofa's excbange plannlng. Couuunlfy
ueuber lnslgbf and experlence belp sbape fbe course oF acflon fo ensure prograus and pollcles ueef fbe
needs oF fbe publlc-fbose uosf dlrecfly aFFecfed by bealfb and bealfb care pollcy.
CROSS-AGNCY COllAORATION
Durlng fbe ln-person ueeflng, sfafe feau ueubers Frou publlc bealfb, ulnorlfy bealfb and Vedlcald
agencles eupbaslzed fbe role oF ongolng collaboraflon ln uovlng Forward pollcy recouuendaflons and ln
ralslng lnfernal and exfernal awareness abouf bealfb equlfy. 1brougb regular ueeflngs and couuunlcaflon,
feau ueubers ldenflFed ways fbaf fbey could belp eacb ofber by poollng fbelr respecflve experflse and
drawlng Frou exlsflng resources. lor exauple, a nuuber oF parflclpaflng sfafes used dlsparlfles dafa Frou
publlc bealfb deparfuenfs fo lnForu broader dlscusslon oF bealfb reForu pollcy (excbange developuenf)
and lnlflaflves (uedlcal boues), as well as Vedlcald prograus (enrolluenf, prlorlflzaflon oF oufreacb eF-
Forfs). ln Oblo, fbe collaboraflon oF fbree blgb-level dlrecfors Frou fbe Vlnorlfy Healfb Couulsslon, Publlc
Healfb Deparfuenf and Vedlcald agency was ley fo advanclng recouuendaflons For draFf uanaged care
confracf language. 1bls projecf provlded fbe necessary Foruu For cross-agency collaboraflon fo lever-
age lnfernal experflse and resources fo propose fbe language af fbe exacf flue oF agency-wlde revlew oF
confracfs.
QUITY AS A QUAlITY, COST AND [USTIC ISSU
Anofber fbeue fbaf euerged Frou ueeflng dlscusslon was fbe need fo recognlze fbaf sfalebolders coue
fo fbe fable fo address bealfb dlsparlfles For dlFFerenf reasons, uslng dlFFerenf ferus, and lf ls luporfanf
fo speal fbe language' oF eacb. wbereas soclal jusflce and equallfy are ley prlnclples For ulnorlfy bealfb
oFFces, eFFclency and cosf confalnuenf are parauounf fo Vedlcald agencles. ln flues oF budgef cufs For
publlc bealfb and Vedlcald, ldenflFcaflon oF pofenflal cosf savlngs (e.g., fbrougb luproved prevenflve
24
care or avolded euergency deparfuenf use) can be persuaslve ln uallng fbe case For lnvesfuenf ln new
sfrafegles. Several sfafe feaus Found fbaf Fraulng bealfb equlfy as an lssue oF quallfy luproveuenf belped
garner lnferesf and buy-ln. lor exauple, language perfalnlng fo culfural coupefency or dlsparlfles reduc-
flon can Fall under quallfy luproveuenf responslblllfles ln uanaged care confracfs or as parf oF uedlcal
boue or ACO provlder responslblllfles.
Sfafe and Federal agencles eupbaslzed Fndlng posslblllfy and opporfunlfy fo advance bealfb equlfy even
wben nof expllclfly reFerenced or requlred. Af fbe Federal level, fbe Cenfer For Vedlcare and Vedlcald
lnnovaflon (CVVl) bas a sfafufory responslblllfy fo address cosfs, fbere ls no expllclf reFerence fo dlsparl-
fles reducflon or advanclng bealfb equlfy ln lfs ulsslon or purpose. wlfb fbe preponderance oF evldence
oF fbe cosfs assoclafed wlfb dlsparlfles,
68
lnlflaflves fbaf seel fo address dlsparlfles as parf oF cosf con-
falnuenf eFForfs aoa|d Ff wlfb CVVl's ulsslon. lnferesflngly, ln [uly 2u12, CVVl announced a new Sfafe
lnnovaflon Vodels (SlV) lnlflaflve fo provlde $275 ullllon ln Fundlng For selecfed sfafes fo fesf payuenf
and servlce dellvery uodels wlfbln fbe confexf oF larger bealfb sysfeu fransForuaflon. Sfafes fbaf apply
are encouraged fo lnclude care uodels and lnfervenflons fbaf alu fo reduce bealfb dlsparlfles and ad-
dress fbe soclal, econoulc, and bebavloral deferulnanfs oF bealfb.'
69
25
Mfttpot
T
everal overarcblng lessons euerge Frou parflclpaflng sfafes' acflvlfles and experlences as parf oF fbe
Healfb Lqulfy Learnlng Collaboraflve.
Advancing hea|th equity does not depend so|e|y on ACA imp|ementation, but ACA provides -
a unique p|atform to cata|yze state efforts. ACA's nuuerous provlslons relafed fo reducflon oF
dlsparlfles ln bealfb and care oFFer rare opporfunlfles fo advance bealfb equlfy. ACA bas provlded
uouenfuu ln sfafes wbere leadersblp ls acflvely pursulng ACA-relafed granfs and worllng fo
couply wlfb fbe Acf's provlslons. Af fbe saue flue, uany oF fbe pollcy levers parflclpaflng sfafes
are leveraglng-fbrougb regulaflon and purcbaslng, For exauple-are appllcable regardless oF fbe
sfafe's supporf For ACA.
language matters: qua|ity improvement, popu|ation hea|th, pub|ic hea|th systems change, -
and patient-centeredness a|| have hea|th equity components. Parflclpaflng sfafes' experl-
ence ls fbaf fbe worl oF advanclng bealfb equlfy requlres collaboraflon auong sfalebolders and
agency represenfaflves wbo uay seldou parfner wlfb eacb ofber, and wbo oFfen speal ln dlF-
Ferenf ferus because fbey operafe ln dlFFerenf envlronuenfs. DeFnlng and ensurlng couuon
undersfandlng oF ferus sucb as bealfb equlfy, bealfb dlsparlfles, soclal deferulnanfs oF bealfb,
and even couuunlfy are a crlflcal sfep. As one sfafe oFFclal nofed, lf ls equally luporfanf fo
undersfand fbe culfures oF parfners by ldenflFylng and Fndlng a way fo reFecf bacl (and ueef)
fbelr needs and prlorlfles, be fbey econoulc, soclal, and/or uoral. Pollcles and prograus llnled fo
quallfy luproveuenf, populaflon bealfb, publlc bealfb sysfeus cbange, and paflenf-cenferedness
are jusf a Few exauples oF opporfunlfles fo lncorporafe (and franslafe fo) bealfb equlfy.
State agencies wou|d |ike more opportunities for peer-to-peer |earning around issues of -
hea|th equity. 1brougbouf fbls projecf, sfafe feaus bave been encouraged fo bulld collabora-
flve parfnersblps across Vedlcald, publlc bealfb, and ulnorlfy bealfb agencles, as fbese oFFces
sbare coupleuenfary goals. However, fbe uouenfuu fo collaborafe on sfrafegles fo advance
bealfb equlfy can becoue dlFFculf ln fbe Face oF day-fo-day couulfuenfs and coupeflng prlorl-
fles. Sfafe oFFclals ln fbls projecf expressed lnferesf ln conflnulng fbe relaflonsblps fbey Forued
fbrougb fbe Healfb Lqulfy Learnlng Collaboraflve, and are eager fo engage ln slullar opporfunl-
fles fo convene, especlally ln-person, around lssues oF bealfb equlfy.
Participation in mu|ti-state efforts he|ps |egitimize efforts to advance hea|th equity. - Prlor
fo fbe sfarf oF fbls projecf, sfafe feaus parflclpaflng ln fbe learnlng collaboraflve were all ln fbe
process oF addresslng bealfb equlfy ln fbelr sfafes. However, several sfafe feau ueubers agreed
fbaf developlng a Forual sfafe feau-one recognlzed as parflclpaflng ln a uulfl-sfafe lnlflaflve-
was an luporfanf sfep ln leglflulzlng and Furfberlng worl fo advance bealfb equlfy ln fbelr sfafes.
Communities need to be partners in po|icy deve|opment and imp|ementation. - Sfafe feaus
repeafedly eupbaslzed fbe need For an acflve couuunlfy role ln sbaplng, revlewlng, recouuend-
lng, and belplng fo lupleuenf bealfb pollcy lF lf ls fo ueef fbe needs oF couuunlfles. Couuunlfy-
based organlzaflons and consuuer groups lead couuunlfy engageuenf processes, buf sfafe
oFFclals can ensure couuunlfy represenfaflves and lndlvldual consuuers (nof jusf consuuer
advocafes) are a parf oF bealfb reForu and ofber pollcy-uallng. Publlc bealfb and ulnorlfy bealfb
26
deparfuenfs oFfen bave exlsflng nefworls and engageuenf sfrafegles fo asslsf slsfer sfafe agen-
cles.
Data are power, and states continue to work to improve data co||ection and use to advance -
hea|th equity. As one sfafe oFFclal puf lf, You cannof uanage wbaf you cannof ueasure.' Dafa
analyses and fools sucb as GlS uapplng can belp ldenflFy populaflons and locallfles suFFerlng
Frou fbe greafesf bealfb dlsparlfles and lnForu prlorlflzaflon oF resources For navlgafors, bealfb
boues, and accounfable care organlzaflons. Parflclpaflng sfafes are af dlFFerenf sfages oF lnven-
forylng and analyzlng kLL dafa collecflon and use, and fbey are lnferesfed ln uslng bealfb equlfy
ueasures and uefrlcs fo assess progress and creafe accounfablllfy For luproveuenf. Ofber lnfer-
esfs are sbarlng kLL dafa befween Vedlcald and publlc bealfb agencles, and lncorporaflng dafa
on soclal deferulnanfs oF bealfb lnfo sfafe dlsparlfles reporfs.
27
Dpodmvtjpo
U
be sfafe feaus parflclpaflng ln fbe Healfb Lqulfy Learnlng Collaboraflve ldenflFed and pursued
a nuuber oF sfrafegles fo advance bealfb equlfy fbrougb bealfb reForu lupleuenfaflon. 1brougb
affenflon fo lssues oF bealfb care access, quallfy, eFFclency, and populaflon bealfb and nuuerous
provlslons perfalnlng fo dlsparlfles reducflon, ACA provldes uouenfuu as well as resources fo spur sfafe
and Federal acflon ln advanclng bealfb equlfy For raclally, efbnlcally and llngulsflcally dlverse populaflons.
1be recenf Supreue Courf rullng enables fbe Healfb Lqulfy Learnlng Collaboraflve sfafes' luproveuenf
eFForfs fo conflnue uovlng Forward. wlfb fbe rullng, all sfafes now bave crlflcal declslons fo uale abouf
fbe lnsurance excbange and Vedlcald expanslon, bofb oF wblcb are opporfunlfles fo address dlsparl-
fles ln coverage. Sfafes can conflnue fo advance cbange by leveraglng fbelr roles as regulafors, purcbas-
ers, conveners, and dafa sfewards. 1be sfrafegles oF fbe seven parflclpaflng sfafes oFFer exauples oF bow
pollcy ualers can advance bealfb equlfy uslng ACA and sfafe-level pollcy levers. Parflclpaflng sfafes bave
lnfegrafed bealfb equlfy lnfo uanaged care confracfs, provlder fralnlngs, uedlcal boue crlferla, and dafa
collecflon and sbarlng sfandards, all fo ensure fbey ueef fbe needs oF dlverse consflfuenfs, wlfb fbe goal
oF luprovlng bealfb care quallfy and reduclng cosfs.
State lo||cjma|er's Ca|de lor /danc|ng ea|tn Lqa|tj 1nroagn ea|tn kejorm |mp|ementat|on
Bqqfoejy
29
Bqqfoejy;!Ifbmui!Frvjuz!Mfbsojoh!Dpmmbcpsbujwf!!
Jo.Qfstpo!Nffujoh!Qbsujdjqbout
[une !, 2!2, washington, DC
Arkansas
Varqulfa Llffle
Asslsfanf Dlrecfor oF Pollcy and Plannlng
Arlansas Deparfuenf oF Huuan Servlces
Cresbelle Nasb
Asslsfanf ProFessor
Unlverslfy oF Arlansas For Vedlcal Sclences
Vlcbelle Sulfb
Dlrecfor, OFFce oF Vlnorlfy Healfb
Arlansas Deparfuenf oF Healfb
Connecticut
Sylvla GaFFord
Lxecuflve Prograu Dlrecfor
Connecflcuf Deparfuenf oF Soclal Servlces
Vargaref Hynes
Senlor Lpldeulologlsf
Connecflcuf Deparfuenf oF Publlc Healfb
Vaffbew Salner
Pollcy Analysf
Sfafe oF Connecflcuf OFFce oF Healfb keForu and
lnnovaflon
kaja Sfaggers-Hallu
Lxecuflve Dlrecfor
Connecflcuf Couulsslon on Healfb Lqulfy
Hawaii
Cbrlsflan (Kluo) Alaueda
Dlrecfor, OFFce oF Healfb Lqulfy
Hawall Deparfuenf oF Healfb
Davld Salauofo
Depufy Dlrecfor
Hawall Deparfuenf oF Healfb
Curfls 1oua
Vedlcal Dlrecfor
Hawall Vedlcald
Minnesota
[eanne Ayers
Asslsfanf Couulssloner
Vlnnesofa Deparfuenf oF Healfb
AlFred 8ablngfon-[obnson
Presldenf and CLO
Sfalrsfep loundaflon
Davld Sfroud
Vanager, Cenfer For Healfb Sfaflsflcs
Vlnnesofa Deparfuenf oF Healfb
Anfonla wllcoxon
Dlsparlfles keducflon Consulfanf
Vlnnesofa Deparfuenf oF Huuan Servlces
New Mexico
[eFF Lara
keglon 4 Publlc Healfb Dlrecfor
New Vexlco Deparfuenf oF Healfb
Ohio
[obnnle (Cblp) Allen
Dlrecfor oF Healfb Lqulfy
Oblo Deparfuenf oF Healfb
Angela Dawson
Lxecuflve Dlrecfor
Oblo Couulsslon on Vlnorlfy Healfb
Carol ware
Senlor Prograu Adulnlsfrafor
Oblo Deparfuenf oF [ob and laully Servlces
30
virginia
Asbley Harrell
Supervlsor, Dlvlslon oF Vafernal and Cblld Healfb
\lrglnla Deparfuenf oF Vedlcal Asslsfance Servlces
kebecca Vendoza
Dlrecfor, Dlvlslon oF Vafernal and Cblld Healfb
\lrglnla Deparfuenf oF Vedlcal Asslsfance Servlces
Vlcbael koysfer
Dlrecfor, OFFce oF Vlnorlfy Healfb
and Healfb Lqulfy
\lrglnla Deparfuenf oF Healfb
Aetna
Gllllan 8arclay
\lce Presldenf
Aefna loundaflon
Velenle Vagnoffa
Granfs Vanager
Aefna loundaflon
NASHP
8rlffany Glles
kesearcb Asslsfanf
Carrle Hanlon
Prograu Vanager
Dlane [usflce
Senlor Prograu Dlrecfor
Auanda klcbardson
CDC lellow
[lll kosenfbal
Prograu Dlrecfor
31
Foeopuft
1 Cenfers For Dlsease Confrol and Prevenflon. CDC Healfb Dlsparlfles and lnequallfles keporf. VVwk
2u11,6u(Suppl). 82. Avallable. bffp.//www.cdc.gov/uuwr/pdF/ofber/su6uu1.pdF.
2 Paflenf Profecflon and AFFordable Care Acf ]P.L. 111-148], 2u1u
3 Cenfers For Dlsease Confrol and Prevenflon. CDC Healfb Dlsparlfles and lnequallfles keporf. VVwk
2u11,6u(Suppl). 82. Avallable. bffp.//www.cdc.gov/uuwr/pdF/ofber/su6uu1.pdF.
4 Paflenf Profecflon and AFFordable Care Acf ]P.L. 111-148], 2u1u
5 Unlfed Sfafes Census 8ureau, /n O|der and Vore u|erse Nat|on bj V|dcentarj, (wasblngfon, DC. Unlfed Sfafes
Census 8ureau, 2uu8). kefrleved [une 25[uly 17, 2u12. Avallable. bffp.//www.census.gov/newsroou/releases/ar-
cblves/populaflon/cbu8-123.bful.
6 Naflonal Parfnersblp For Acflon, Healfb Lqulfy and Dlsparlfles.' kefrleved [uly 17, 2u12. Avallable. bffp.//ulnorl-
fybealfb.bbs.gov/npa/feuplafes/browse.aspx?lvl-1&lvlld-34.
7 Cenfers For Dlsease Confrol and Prevenflon, Soclal Deferulnanfs oF Healfb.' kefrleved [uly 17, 2u12. Avallable.
bffp.//www.cdc.gov/soclaldeferulnanfs/DeFnlflons.bful.
8 U.S. Deparfuenf oF Healfb and Huuan Servlces. S /ct|on l|an to kedace kac|a| and Ltnn|c u|spar|t|es. / Na-
t|on lree oj u|spar|t|es |n ea|tn and ea|tn Care, (wasblngfon, D.C.. U.S. Deparfuenf oF Healfb and Huuan Servlces,
2u11). Avallable. bffp.//ulnorlfybealfb.bbs.gov/npa/feuplafes/confenf.aspx?lvl-1&lvlld-33&lD-285.
9 world Healfb Organlzaflon, Couulsslon on Soclal Deferulnanfs oF Healfb, C|os|ng tne Cap |n a Cenerat|on. ea|tn
Lqa|tj tnroagn /ct|on on tne Soc|a| ueterm|nants oj ea|tn (Geneva. world Healfb Organlzaflon, 2uu8.) Avallable.
bffp.//wbqllbdoc.wbo.lnf/publlcaflons/2uu8/97892415637u3_eng.pdF.
1u Cenfers For Vedlcare and Vedlcald Servlces, Sect|on 2703. State Opt|on to lro|de ea|tn omes jor Lnro||ees a|tn
Cnron|c Cond|t|ons. ea|tn omes jor Ved|ca|d Lnro||ees a|tn Cnron|c Cond|t|ons. / Conersat|on a|tn CVS and States
kegard|ng tne /C/ State l|an Opt|on, (wasblngfon, DC. Cenfers For Vedlcare and Vedlcald Servlces, 2u1u.) Avallable.
bffp.//nasbp.org/slfes/deFaulf/Fles/1CVS.pdF?q-Fles/1CVS.pdF.
11 Henry [. Kalser laully loundaflon, Ved|ca|d's Nea ea|tn ome Opt|on, (wasblngfon DC. Henry [. Kalser laully
loundaflon, 2u11). Avallable. bffp.//www.lFF.org/uedlcald/upload/8136.pdF.
12 Cenfer For Vedlcare and Vedlcald Servlces, Cenfer For Vedlcare and Vedlcald lnnovaflon, Abouf fbe CVS ln-
novaflon Cenfer.' kefrleved [uly 17, 2u12. Avallable. bffp.//www.lnnovaflons.cus.gov/Abouf/lndex.bful.
13 Dennls P. Andrulls, ef al., lat|ent lrotect|on and /jjordab|e Care /ct oj 20!0. /danc|ng ea|tn Lqa|tj jor kac|a||j
and Ltnn|ca||j u|erse lopa|at|ons (wasblngfon, DC, [olnf Cenfer For Pollflcal and econoulc Sfudles, 2u1u). Avallable.
bffp.//www.jolnfcenfer.org/slfes/deFaulf/Fles/upload/researcb/Fles/Paflenf%2uProfecflon%2uand%2uAFFord-
able%2uCare%2uAcf.pdF.
14 U.S. Deparfuenf oF Healfb and Huuan Servlces, lupleuenfaflon Guldance on Dafa Collecflon Sfandards For
kace, Lfbnlclfy, Sex, Prluary Language, and Dlsablllfy Sfafus,' kefrleved [uly 17, 2u12. Avallable. bffp.//aspe.bbs.gov/
dafacncl/sfandards/ACA/43u2/lndex.sbful.
15 Healfb Care and Lducaflon keconclllaflon Acf oF 2u1u ]PL 111-152 23u3]
16 Laura Grossuan, Kafbarlne wlfgerf, and Cafberlne Hess, 1oward Veeflng fbe Needs oF \ulnerable Populaflons.
lssues For Pollcyualers' Conslderaflon ln lnfegraflng a SaFefy Nef lnfo Healfb Care keForu lupleuenfaflon, (Porf-
land, VL. Naflonal Acadeuy For Sfafe Healfb Pollcy, 2u12). Avallable. bffp.//www.nasbp.org/slfes/deFaulf/Fles/
saFefy.nef_.bcr_.pdF.
32
17 Nat|ona| lederat|on oj |ndependent 8as|ness et a|. . Sebe||as, Secretarj oj ea|tn and aman Ser|ces, et a|., 567
U.S.__(2u12). Avallable. bffp.//www.supreuecourf.gov/oplnlons/11pdF/11-393c3a2.pdF. Also see Sara kosenbauu,
1be Supreue Courf's Vedlcald kullng. A SblFf ln Klnd, Nof Verely Degree',' ea|tn /jja|rs 8|og, [une 28, 2u12.
Avallable. bffp.//bealfbaFFalrs.org/blog/2u12/u6/28/fbe-supreue-courfs-uedlcald-rullng-a-sblFf-ln-llnd-nof-
uerely-degree/.
18 [. Lee Hargraves, 1ne |nsarance Cap and V|nor|tj ea|tn Care !997-200!, (wasblngfon, DC. Cenfer For Sfudylng
Healfb Sysfeu Cbange, 2uu2). Avallable. bffp.//www.bscbange.cou/CON1LN1/443/443.pdF.
19 Henry [. Kalser laully loundaflon, 1ne Un|nsared. / lr|mer, (wasblngfon, DC. Henry [. Kalser laully loundaflon,
2u11.) Avallable. bffp.//www.lFF.org/unlnsured/upload/7451-u7.pdF.
2u Vara Youdeluan, Culfural Coupefency, fbe ACA, and Proulslng Pracflces.' Presenfaflon on NASHP weblnar
Strateg|es to Lnsare lart|c|pat|on oj u|erse lopa|at|ons |n Ved|ca|d and L\cnange l|ans, Noveuber 29, 2u11.
21 Henry [. Kalser laully loundaflon, / lro|e oj ea|tn |nsarance L\cnange Lnro||ees, (wasblngfon, DC. Henry [. Kal-
ser laully loundaflon, 2u11.) Avallable. bffp.//www.lFF.org/bealfbreForu/upload/8147.pdF.
22 Cenfers For Dlsease Confrol and Prevenflon, OFFce oF Vlnorlfy Healfb and Healfb Dlsparlfles, Lllulnaflng kaclal
and Lfbnlc Healfb Dlsparlfles,' kefrleved [uly 1u17, 2u12. Avallable. bffp.//www.cdc.gov/oubd/abouf/dlsparlfles.
bfu.
23 Cenfers For Vedlcare and Vedlcald Servlces, Sect|on 2703. State Opt|on to lro|de ea|tn omes jor Lnro||ees a|tn
Cnron|c Cond|t|ons. ea|tn omes jor Ved|ca|d Lnro||ees a|tn Cnron|c Cond|t|ons. / Conersat|on a|tn CVS and States
kegard|ng tne /C/ State l|an Opt|on, (wasblngfon, DC. Cenfers For Vedlcare and Vedlcald Servlces, 2u1u.) Avallable.
bffp.//nasbp.org/slfes/deFaulf/Fles/1CVS.pdF?q-Fles/1CVS.pdF.
24 Cenfers For Vedlcare and Vedlcald Servlces, clrcular leffer. SVLD= 1u-u24, ACA= 12, ke. Healfb Houes For
Lnrollees wlfb Cbronlc Dlsease, Nov. 16, 2u1u. Avallable. bffp.//downloads.cus.gov/cusgov/arcblved-downloads/
SVDL/downloads/SVD1uu24.pdF.
25 Cenfers For Dlsease Confrol and Prevenflon, CuC ea|tn u|spar|t|es and |neqaa||t|es keport - Un|ted States, 20!!
(Aflanfa, GA. Cenfers For Dlsease Confrol and Prevenflon, 2u11). Avallable. bffp.//www.cdc.gov/uuwr/pdF/ofber/
su6uu1.pdF.
26 Dennls P. Andrulls, ef al., lat|ent lrotect|on and /jjordab|e Care /ct oj 20!0. /danc|ng ea|tn Lqa|tj jor kac|a||j
and Ltnn|ca||j u|erse lopa|at|ons (wasblngfon, DC, [olnf Cenfer For Pollflcal and econoulc Sfudles, 2u1u). Avallable.
bffp.//www.jolnfcenfer.org/slfes/deFaulf/Fles/upload/researcb/Fles/Paflenf%2uProfecflon%2uand%2uAFFord-
able%2uCare%2uAcf.pdF.
27 U.S. Deparfuenf oF Healfb and Huuan Servlces Cenfers For Vedlcare and Vedlcald Servlces, lederal keglsfer
76, no. 212 (Noveuber 2, 2u11). Avallable. bffp.//www.gpo.gov/Fdsys/plg/lk-2u11-11-u2/pdF/2u11-27461.pdF.
28 lbld.
29 koberf A. 8erenson and kacbel A. 8urfon, Healfb Pollcy 8rleF. Nexf Sfeps For ACOs,' ea|tn /jja|rs, [anuary 31,
2u12. Avallable. bffp.//bealfbaFFalrs.org/bealfbpollcybrleFs/brleF_pdFs/bealfbpollcybrleF_61.pdF.
3u U.S. Deparfuenf oF Healfb and Huuan Servlces Cenfers For Vedlcare and Vedlcald Servlces, lederal keglsfer
76, no. 212 (Noveuber 2, 2u11). Avallable. bffp.//www.gpo.gov/Fdsys/plg/lk-2u11-11-u2/pdF/2u11-27461.pdF.
31 U.S. Deparfuenf oF Healfb and Huuan Servlces, lupleuenfaflon Guldance on Dafa Collecflon Sfandards For
kace, Lfbnlclfy, Sex, Prluary Language, and Dlsablllfy Sfafus,' kefrleved [uly 17, 2u12. Avallable. bffp.//aspe.bbs.gov/
dafacncl/sfandards/ACA/43u2/lndex.sbful.
32 Paflenf Profecflon and AFFordable Care Acf ]P.L. 111-143 43u2]. Avallable. bffp.//www.gpo.gov/Fdsys/plg/
8lLLS-111br359uenr/pdF/8lLLS-111br359uenr.pdF.
33
33 Auerlcan Publlc Healfb Assoclaflon, Prevenflon and Publlc Healfb lund. Dedlcafed fo luprovlng our Naflon's
Publlc Healfb,' kefrleved [uly 17, 2u12. Avallable. bffp.//www.apba.org/Nk/rdonlyres/63A8u8u3-AC58-418L-82-
l8-79ul446LAA28/u/PrevenflonPubllcHealfbFacfsbeef.pdF.
34 Cenfers For Dlsease Confrol and Prevenflon, Vallng Healfb Llvlng Lasler. Couuunlfy 1ransForuaflon Granfs
Prograu,' kefrleved [uly 17, 2u12. Avallable. bffp.//www.cdc.gov/couuunlfyfransForuaflon/pdF/cfg-Facfsbeef.pdF.
35 Douglas w. LluendorF, 1esfluony beFore fbe Subcouulffee on Healfb, Couulffee on Lnergy and Couuerce,
U.S. House oF kepresenfaflves Congresslonal 8udgef OFFce, C8O's /na|js|s oj tne Vaor ea|tn Care Leg|s|a-
t|on Lnacted |n Varcn 20!0, Hearlng, Varcb 3u, 2u11. Avallable. bffp.//www.cbo.gov/slfes/deFaulf/Fles/cboFles/
Ffpdocs/121xx/doc12119/u3-3u-bealfbcareleglslaflon.pdF. Accessed [uly 5, 2u12.
36 lnfernal kevenue Servlce, Not|ce and keqaest jor Comments kegard|ng tne Comman|tj ea|tn Needs /ssessment ke-
qa|rements jor 1a\-e\empt osp|ta|s, Not|ce 20!!-S2. Avallable. www.lrs.gov/pub/lrs-drop/n-11-52.pdF.
37 Varfba H. Souervllle, ef al., osp|ta| Comman|tj 8enets ajter tne /C/. lartnersn|ps jor Comman|tj ea|tn |mproe-
ment (8alfluore, VD. 1be Hlllfop lnsflfufe, 2u12). Avallable. bffp.//www.rwjF.org/Fles/researcb/74u14.5716.bosplfal-
couuunlfybeneFfs.2u12.Feb.pdF.
38 Naflonal ConFerence oF Sfafe Leglslafures, Sfafe ProFles. Vlnorlfy Healfb and Healfb Lqulfy OFFces,' kefrleved
[uly 17, 2u12. Avallable. bffp.//www.ncsl.org/lssues-researcb/bealfb/dlsparlfles-sfafe-proFles.aspx.
39 Alan well, State lo||cjma|ers' lr|or|t|es jor Saccessja| |mp|ementat|on oj ea|tn kejorm, (Porfland, VL. Naflonal
Acadeuy For Sfafe Healfb Pollcy, 2u1u). Avallable. bffp.//nasbp.org/slfes/deFaulf/Fles/sfafe.pollcyualer.prlorlfles.
For.bealfb.reForu.pdF.
4u See [anuary 17, 2u12 ueeflng uaferlals af Healfb lnsurance Lxcbange Advlsory 1asl lorce, Avallable. bffp.//
un.gov/couuerce/lnsurance/foplcs/uedlcal/excbange/Lxcbange-Advlsory-1asl-lorce/.
41 lor exauple see, Vlnnesofa Deparfuenf oF Couuerce, wbaf Can fbe lnsurance Lxcbange Do fo 1aclle Healfb
Dlsparlfles,' kefrleved [uly 17, 2u12. Avallable. bffp.//un.gov/couuerce/lnsurance/luages/LxcbHealfbDlsparl-
fleskecouuend.pdF and Vlnnesofa Deparfuenf oF Couuerce, Pollcy Levers For Addresslng Healfb Dlsparlfles
fbrougb fbe Lxcbange,' kefrleved [uly 17, 2u12. Avallable. bffp.//un.gov/couuerce/lnsurance/luages/LxcbAddress-
lngHealfbDlsparlfles.pdF.
42 Arlansas Healfb 8eneFfs Lxcbange Parfnersblp, lederal Lxcbange Parfnersblp Vodel For Arlansas, kefrleved [uly
17, 2u12. Avallable. bffp.//bbe.arlansas.gov/lederalParfnersblpVodel.pdF.
43 Asbley Harrell and kebecca Vendoza, \lrglnla's laully Plannlng Prograu,' Presenfaflon af NASHP conFerence
/danc|ng Lqa|tj tnroagn ea|tn Care kejorm. / State-ledera| u|scass|on oj lrom|s|ng State |n|t|at|es, wasblngfon, DC,
Vay 31, 2u12).
44 Addlflonal GlS uapplng resources are avallable Frou fbe Cenfers For Dlsease Confrol and Prevenflon af bffp.//
gls.cdc.gov/ and fbe Naflonal Cancer lnsflfufe af bffp.//gls.cancer.gov/.
45 1o learn uore abouf sfafes' Vedlcald uedlcal boue lnlflaflves, see bffp.//www.nasbp.org/ued-boue-uap.
46 Paflenf Cenfered Prluary Care Collaboraflve, [olnf Prlnclples oF fbe Paflenf-Cenfered Vedlcal Houe,' kefrleved
[uly 17, 2u12. Avallable. bffp.//www.pcpcc.nef/jolnf-prlnclples.
47 Oblo House 8lll 198, kefrleved [uly 17, 2u12. Avallable. bffp.//www.leglslafure.sfafe.ob.us/bllls.cFu?lD-128_
H8_198.
48 1o learn uore, see. Oblo Acadeuy oF laully Pbyslclans, Oblo PCVH Pllof Projecf.' kefrleved [uly 17, 2u12.
Avallable. bffp.//www.obloaFp.org/ObloPCVHProjecf/.
34
49 Oblo Deparfuenf oF Healfb, Oblo fo Lxpand Paflenf-Cenfered Prluary Care lnlflaflve.' News kelease. [anuary
18, 2u12. kefrleved [uly 17, 2u12. Avallable. bffp.//www.odb.oblo.gov//uedla/ODH/ASSL1S/llles/web feau/Fea-
fures/pcubannounceuenf.asbx.
5u [eanne Ayers, Advanclng Lqulfy fbrougb Couuunlfy Lngageuenf ln Vlnnesofa.'
Presenfaflon af NASHP conFerence /genda jor State Leadersn|p on /danc|ng Lqa|tj tnroagn ea|tn Care kejorm, wasb-
lngfon, DC, [une 1, 2u12).
51 Subsfance Abuse and Venfal Healfb Servlces Adulnlsfraflon, lY 2u12 Granf kequesf For Appllcaflons (klA).
PPHl - 2u12 - Prluary and 8ebavloral Healfb Care lnfegraflon (PPHl-2u12)
(Sborf 1lfle. P8HCl), kefrleved [uly 17, 2u12. Avallable. bffp.//www.saubsa.gov/granfs/2u12/su_12_uu8.aspx.
52 Vlnnesofa Sesslon Laws 2u1u llrsf Speclal Sesslon, Cbapfer 1 Arflcle 19 Secflon 23.
53 Vlnnesofa Deparfuenf oF Healfb and Vlnnesofa Deparfuenf oF Huuan Servlces, Co||ect|on oj kac|a|/ Ltnn|c
ea|tn uata bj tne V|nnesota uepartments oj ea|tn and aman Ser|ces, (Sf. Paul, VN. Vlnnesofa Deparfuenf oF
Healfb and Vlnnesofa Deparfuenf oF Huuan Servlces), 12-14. Avallable. bffp.//www.bealfb.sfafe.un.us/ouub/pub-
llcaflons/raclalefbnlcdafa2u11.pdF.
54 lbld.
55 Davld Sfroud, Collecflng kace, Lfbnlclfy, and Language Dafa ln Vlnnesofa.' Presenfaflon af NASHP conFerence
/danc|ng Lqa|tj tnroagn ea|tn Care kejorm, wasblngfon, DC, Vay 31, 2u12).
56 All-Payer Clalu Dafabase Councll, lnferacflve Sfafe keporf Vap.' kefrleved [uly 17, 2u12. bffp.//www.apcdcoun-
cll.org/sfafe/uap.
57 Pafrlcl 8. Vlller, Denlse Love, Lully Sulllvan, [o Porfer, and Auy Cosfello, All Payer Clalus Dafabases. An Over-
vlew For Pollcyualers (wasblngfon, DC. Sfafe Coverage lnlflaflves, 2u1u). Avallable. bffp.//www.sfafecoverage.org/
Fles/SCl_All_Payer_Clalus_keporfkL\.pdF.
58 Sfafe oF Connecflcuf Subsflfufed House 8lll No. 5u38, Publlc Acf 12-166, 2u12. Avallable. bffp.//www.cga.
cf.gov/2u12/AC1/Pa/pdF/2u12PA-uu166-kuuH8-u5u38-PA.pdF.
59 Connecflcuf Deparfuenf oF Publlc Healfb, Healfb lnForuaflon Sysfeus and keporflng Secflon, lo||cj on Co||ect-
|ng Soc|odemograpn|c uata (HarfFord, C1. Connecflcuf Deparfuenf oF Publlc Healfb, 2uu8). Avallable. bffp.//www.
cf.gov/dpb/llb/dpb/blsr/pdF/dpb_dafa_collecflon_pollcy_sepf2uu8.pdF.
6u Unlfed Sfafes Deparfuenf oF Healfb & Huuan Servlces OFFce oF Vlnorlfy Healfb. Naflonal Sfandards on
Culfurally and Llngulsflcally Approprlafe Servlces (CLAS). kefrleved [uly 17, 2u12. bffp.//ulnorlfybealfb.bbs.gov/feu-
plafes/browse.aspx?lvl-2&lvllD-15.
61 \lrglnla Deparfuenf oF Vedlcal Asslsfance Servlces, Vafernal and Cblld Healfb Prograus.' kefrleved [uly 17,
2u12. bffp.//duasva.duas.vlrglnla.gov/Confenf_pgs/ucb-boue.aspx.
62 \lrglnla Deparfuenf oF Healfb. CLAS Acf \lrglnla. Culfurally and Llngulsflcally Approprlafe Healfb Care Ser-
vlces.' kefrleved [uly 17, 2u12. Avallable. bffp.//www.vdb.vlrglnla.gov/obpp/CLASacf.
63 See, For exauple, Sfafe oF CallFornla Healfb and Huuan Servlces Agency, Deparfuenf oF Healfb Servlces,
Veuoranduu Frou Susanne V. Hugbes, Vedl-Cal Vanaged Care Dlvlslon, Aprll 2, 1996, Avallable. bffp.//www.dbcs.
ca.gov/Forusandpubs/Docuuenfs/VVCDAPLsandPollcyLeffers/PL1999/VVCDPL99uu1.pdF and Sfafe oF CallFor-
nla Healfb and Huuan Servlces Agency, Deparfuenf oF Healfb Servlces, Veuoranduu Frou 1anya Houuan, Vedl-
Cal Vanaged Care Dlvlslon, Noveuber 1u, 2u1u, Avallable. bffp.//www.dbcs.ca.gov/Forusandpubs/Docuuenfs/
VVCDAPLsandPollcyLeffers/PL2u1u/PL1u-u12.pdF.
64 Carol L. ware, [obnnle Allen, and Angela Dawson, Lessons Learned Frou Oblo. Vovlng ln fbe klgbf Dlrecflon 1o-
wards Healfb Lqulfy.' Presenfaflon af NASHP conFerence /danc|ng Lqa|tj tnroagn ea|tn Care kejorm. / State-ledera|
u|scass|on oj lrom|s|ng State |n|t|at|es, wasblngfon, DC, Vay 31, 2u12.
65 Agency For Healfbcare kesearcb and Quallfy, 20!! Nat|ona| ea|tncare Qaa||tj 8 u|spar|t|es keports (koclvllle,
VD. Agency For Healfb kesearcb and Quallfy, 2u11). Avallable. bffp.//www.abrq.gov/qual/qrdr11.bfu.
35
66 Naflonal Parfnersblp For Acflon fo Lnd Healfb Dlsparlfles. Nat|ona| Sta|eno|der Strategj jor /cn|e|ng ea|tn Lq-
a|tj (koclvllle, VD. U.S. Deparfuenf oF Healfb & Huuan Servlces, OFFce oF Vlnorlfy Healfb, 2u11. Avallable. bffp.//
ulnorlfybealfb.bbs.gov/npa/feuplafes/confenf.aspx?lvl-1&lvlld-33&lD-286.
67 Unlfed Sfafes Deparfuenf oF Healfb & Huuan Servlces OFFce oF Vlnorlfy Healfb. OFFces oF Vlnorlfy Healfb'
kefrleved [uly 17, 2u12. Avallable. bffp.//ulnorlfybealfb.bbs.gov/feuplafes/browse.aspx?lvl-1&lvllD-45.
68 1bouas A. La\elsf, Darrell [. Gaslln, and Pafrlcl klcbard, 1ne Lconom|c 8arden oj ea|tn |neqaa||t|es |n tne Un|ted
States (wasblngfon, DC. [olnf Cenfer For Pollflcal and Lconoulc Sfudles, 2uu9). Avallable. bffp.//www.jolnfcenfer.
org/bpl/slfes/all/Fles/8urden_OF_Healfb_llNAL_u.pdF.
69 U.S. Deparfuenf oF Healfb and Huuan Servlces, Cenfers For Vedlcare and Vedlcald Servlces, Cenfer For Vedl-
care and Vedlcald lnnovaflon, State |nnoat|on Vode|s. land|ng jor Vode| ues|gn and Vode| 1est|ng /ss|stance. land|ng
Opportan|tj Namber. CVS-!C!-00!, p7. [uly 19, 2u12. Avallable. bffp.//lnnovaflons.cus.gov/llles/x/Sfafelnnova-
flon_lOA.pdF.

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