State Budget Includes Two Key Health Equity Provisions
[Update - July 26 - The Governor signed the Fiscal Year 2019 budget today, and did NOT veto either of the health equity provision. Both of the provisions described below are now a part of state law. We are very thankful to the Governor and the Executive Office of Health and Human Services for their support of these important steps forward.]
After weeks of delays, the conference committee reconciling the House and Senate budget bills released the final state budget proposal for this fiscal year. The budget includes two strong steps for health equity that we have been actively pushing for:
First the budget establishes an Office of Health Equity within the state’s Executive Office of Health and Human Services. While Massachusetts continues to lead nationally in health coverage, racial and ethnic minority residents continue to have lower rates of health care access and use in Massachusetts, and worse health outcomes.
The Office will coordinate resources throughout state government with the goal of eliminating racial and ethnic health disparities. The Office is directed to create a state health equity plan, collaborate with other agencies (including housing, transportation, environment, education and labor), and facilitate development of interagency initiatives. Following annual hearings, it will issue an annual report to evaluate progress and identify best practices.
The provision mirrors language we first drafted over a decade ago, and HCFA looks forward to working closely with the new office to advance health justice.
Second, the budget also included a provision requiring MassHealth to report on the impact of its ACOs on social determinants of health. MassHealth ACOs will be responsible for screening their 800,000 members for health-related social needs, such as housing insecurity, food insecurity, transportation needs, and exposure to violence – issues directly related to poor health outcomes, health inequities, and high health care costs. These reports will allow policymakers and the public to assess the progress being made by ACOs, and strengthen their accountability.
This provision was a priority of the ACHI Coalition (Alliance for Community Health Integration) that HCFA plays a major role in.
The text of the two provisions is below.
Office of Health Equity:
Section 16AA. (a) As used in this section the following words shall have the following meanings unless the context clearly requires otherwise:
“Disparities”, differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific racial and ethnic groups.
“Office”, the office of health equity.
(b) There shall be an office of health equity within the executive office of health and human services. The office shall be under the supervision and control of a director of health equity who shall be appointed by and shall report to the secretary of health and human services.
The health disparities council established in section 16O shall serve as an advisory board to the office.
(c) The office shall coordinate all activities of the commonwealth to eliminate racial and ethnic health and health care disparities. The office shall set goals for the reduction of disparities and prepare an annual plan for the commonwealth to eliminate disparities.
(d) The office shall collaborate with the executive offices and state agencies on disparities reduction initiatives to address the social factors that influence health inequality. The executive offices shall include, but not be limited to, the executive office of health and human services, the executive office of housing and economic development, the executive office of public safety and security, the executive office of energy and environmental affairs, the Massachusetts Department of Transportation, the executive office of labor and workforce development and the executive office of education. The office shall facilitate communication and partnership between these executive offices and agencies to develop greater understanding of the intersections between agency activities and health outcomes. The office shall facilitate the development of interagency initiatives to address the social and economic determinants of health disparity issues including, but not limited to: (i) health care access and quality; (ii) housing availability and quality; (iii) transportation availability, location and cost; (iv) community policing and safe spaces; (v) air, water, and land usage and quality; (vi) employment and workforce development; and (vii) education access and quality.
(e) The office shall evaluate the effectiveness of programs and interventions to eliminate health disparities, identifying best practices and model programs for the commonwealth.
(f) The office shall prepare an annual health disparities report. The report shall evaluate the progress of the commonwealth toward eliminating racial and ethnic health disparities using, where possible, quantifiable measures and comparative benchmarks and, where possible, shall detail such progress on a regional basis. The office shall hold public hearings in several regions of the commonwealth to gather public information on the topics of the report. The report shall be filed with the governor, the clerks of the house of representatives and senate, the members of the health disparities council and the health policy commission not later than July 1. The report shall be posted on the official website of the commonwealth.
MassHealth ACO Social Dertiminants of Health Reporting
[MassHealth must report] … a summary of spending and activities related to traditionally nonreimbursed services to address health-related social needs including, but not limited to, home and community-based services, housing stabilization and support, utility assistance, nonmedical transportation, physical activity, nutrition and sexual assault and domestic violence supports; provided further, that such summary shall include, to the maximum extent practicable, aggregated data on the results of preventative health care services such as health-related social needs screening, the number of referrals to human service providers to address such screening, the result of such referrals and changes in health status; provided further, that such data shall be stratified by demographic factors to support an analysis of the impact on health disparities; provided further, that where data is not available, a report on progress toward establishing necessary data systems shall be provided; . . .