5 solutions for bettering well being care fairness

The pandemic has further exposed the health inequalities and inequalities that exist in the United States and highlighted the crucial link between socio-economic circumstances and health outcomes.

Policy makers have long struggled to provide disadvantaged Americans with better access to basic health care. According to a new report from American health insurance plans, expanding and redesigning Medicaid could be part of the solution.

“As the state program that provides access to basic health care for over 77 million low-income adults, children, pregnant women, older adults and people with disabilities, Medicaid has a unique opportunity to address the social risk factors that disproportionately affect these vulnerable people in the population,” says it in the report.

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These socio-economic barriers, or social determinants of health, include inadequate access to nutritious food, a lack of affordable housing, a lack of convenient and efficient transportation, limited opportunities for quality education and meaningful employment, limited broadband access, and much more. These barriers affect a person’s ability to lead a healthy life, reach their full potential, and access quality health care, and they can put them at greater risk of developing chronic diseases. The results can often be poorer health outcomes, more hospitalizations, and higher costs.

“For example, a person may be hospitalized for diabetes due to food insecurity, develop asthma due to poor housing conditions, frequent emergency room visits because of homelessness, or develop a stress-related illness such as high blood pressure due to unemployment,” the report said. “There is growing evidence that these challenges can not only lead to poorer health outcomes for beneficiaries and higher Medicaid costs, but also exacerbate health inequalities for a wide range of populations, particularly racial and ethnic minorities.”

The pandemic has further exposed the health inequalities and inequalities that exist in the United States and highlighted the crucial link between socio-economic circumstances and health outcomes. It also highlighted the important role Medicaid and policy flexibility play in the ability of states, Medicaid managed care organizations, and other stakeholders to address these socio-economic risk factors for the Medicaid population. This could lead to more adequate services that help meet individual needs, promote greater equity in health care, and lower the overall cost of care by reducing unnecessary hospitalizations and routine emergency room visits.

The organization offers several policy recommendations:

  • Increase flexibility with Medicaid waivers.
  • Create a path for interdisciplinary and interagency waivers.
  • Expand the interpretation of quality improvement activities for the purpose of calculating the Medicaid Plan’s medical loss ratios to include spending on interventions that address social determinants of health so that those activities are treated as health-related rather than administrative costs.
  • Allow more leeway in using “instead of services”.
  • Add flexibility to allow Medicaid MCO providers to participate in joint funding agreements with other members of the community.

“Medicaid is an essential safety net and offers unique opportunities to meet the health-related social needs of vulnerable populations,” the report concluded. “Medicaid MCOs work closely with CMS and Medicaid government agencies to address the underlying causes of poor health in those most in need.

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