Centering Health Equity in Medicaid Section 1115 Demonstrations

A series from State Health and Value Strategies shares strategies for states to consider as they work to advance health equity and address structural racism through Medicaid Section 1115 demonstrations.

The Issue

A recognition by leaders and policymakers in many states that longstanding structural racism has caused disproportionate health risks and poorer health outcomes for communities of color is prompting action to prioritize and advance health equity. One key strategy states are using to test new or innovative ideas related to health equity in their Medicaid programs is Section 1115 demonstrations.

These briefs examine the role of Medicaid Section 1115 demonstrations in advancing health equity. The main document examines Medicaid’s role in promoting health equity and describes ways states can advance health equity through each demonstration lifecycle stage. The companion outlines specific, innovative policies to advance health equity via Section 1115 demonstrations.

Key Findings

• Innovative Medicaid 1115 demonstration policies—whether equity-focused or not—can be developed with an equity lens at each demonstration lifecycle stage: planning and design, implementation and monitoring, and evaluation.
• States can advance health equity through Section 1115 demonstrations by: incorporating equity components into demonstration renewals; developing entirely new, equity-focused demonstrations; and evaluating the impacts of existing demonstrations on health equity.
• Successfully centering health equity in the design and implementation of Section 1115 demonstrations requires trust, partnership, and communication with people directly impacted by demonstration policies.
• States can leverage Section 1115 demonstration initiatives to advance health equity through: eligibility policy, benefit enhancements, coverage affordability strategies, and expenditure authority for pilot programs/delivery system reform.

Conclusion

Section 1115 demonstrations are a powerful tool for states to advance health equity in Medicaid. Demonstrations offer a broad range of flexibilities related to Medicaid eligibility, benefits, affordability, and payment and delivery system reform. Given these flexibilities, as well as the populations that Medicaid covers, Section 1115 demonstrations can be used to respond to health disparities and address health equity in a variety of ways.

State Health and Value Strategies—Princeton University School of Public and International Affairs 

State Health and Value Strategies (SHVS) assists states in their efforts to transform health and healthcare by providing targeted technical assistance to state officials and agencies. The program is a grantee of the Robert Wood Johnson Foundation, led by staff at Princeton University’s School of Public and International Affairs. The program connects states with experts and peers to undertake healthcare transformation initiatives. By engaging state officials, the program provides lessons learned, highlights successful strategies and brings together states with experts in the field. Learn more at www.shvs.org.

Manatt Health

Manatt Health integrates legal and consulting expertise to better serve the complex needs of clients across the healthcare system. Our diverse team of more than 160 attorneys and consultants from Manatt, Phelps & Phillips, LLP and its consulting subsidiary, Manatt Health Strategies, LLC, is passionate about helping our clients advance their business interests, fulfill their missions, and lead healthcare into the future. For more information, visit www.manatt.com/Health.