5 state Medicaid programs that promote health equity

Medicaid programs have become incubators for innovation in health equity and addressing social determinants of health.

At the direction of the federal government, states are expanding access to maternal health services and clinical trials, for instance. Twenty-seven states expanded postpartum coverage for up to 12 months through financial incentives offered under the American Rescue Plan Act of 2021. Medicaid programs in Maryland, Michigan, Rhode Island and the District of Columbia also expanded coverage for doula services during the prenatal, labor and postpartum periods.

New federal requirements also pushed Medicaid agencies to begin covering costs related to care in clinical trials. The guaranteed coverage should connect more low-income people to new treatments and technologies and expedite research timelines.

States have also launched initiatives around the mental health crisis, the opioid epidemic, homelessness and poverty, and are pushing managed care plans to reduce health disparities by connecting members to community resources. Here are five states implementing new Medicaid initiatives that promote health equity:

Oregon: The Beaver State was the first to gain approval from the Centers for Medicare and Medicaid Services to cover mobile crisis intervention services through the Oregon Health Plan, its Medicaid program. Starting in January, the stabilization services will largely be deployed to help children, young adults and their families experiencing behavioral health crises, according to the state. The mobilization units are modeled after the Crisis Assistance Helping Out On The Streets (CAHOOTS) program started in Eugene, Oregon, five years ago and will be connected to national emergency hotlines, including 988, which debuted this year to address mental health emergencies.

North Carolina: Its Medicaid program began a five-year, $650 million pilot program to study the impact of providing housing, food, transportation and other social supports to high-needs beneficiaries. The program expanded those services to 33 counties in the Tar Heel State this year, offering benefits including up to $1,250 per month in housing support, funding for violence interventions, meal delivery services and a transportation allowance. The initiative also includes a team of care managers that coordinate primary care, mental health and non-medical needs among high-risk enrollees.

Ohio: Medicaid created a managed care program for children with complex behavioral health needs called Ohio Resilience through Integrated Systems and Excellence. OhioRISE, as it’s known, coordinates services among schools, providers, health insurers and community organizations for children and adults under 20 years old who require significant behavioral healthcare. The program offers intensive home-based treatment, access to residential facilities, and mobile response and stabilization services. Ohio Medicaid also seeks to prevent children being transferred to state custody because their conditions have gone untreated.

California: The first wave of reforms from the Golden State’s ambitious five-year plan to transform Medi-Cal began in 2022. The state will reimburse for services that improve access for underserved populations and supplement clinical care with non-medical services such as housing, nutrition and peer support. The services launched this year include enhanced care management, dental care and behavioral health support. Medi-Cal is also modifying its payment system to include features such as establishing additional performance incentives and categorizing community healthcare as preventive care that is reimbursed.

Arizona: The state’s Medicaid program, called the Arizona Health Care Cost Containment System, obtained federal approval for an effort to reduce homelessness. Arizona will target people with mental illness, who are pregnant, who have a chronic health condition or are transitioning out of institutional settings such as prisons or psychiatric facilities. The state expects to provide financial aid for rent, utility costs, housing deposits and other services to low-income enrollees. Arizona Medicaid also coordinates preventive care, mental health services, substance use interventions and other social supports for eligible beneficiaries.