How MN Medicaid Used Community Engagement to Address Health Disparities

Addressing health disparities within state Medicaid programs can help ensure that all beneficiaries have equal access to quality care. Prioritizing community engagement is key to reducing these disparities, according to Julie Marquardt, DPT, a deputy Medicaid director for Minnesota’s Medicaid program.

The program recently received the 2022 Medicaid Innovation Award for addressing health disparities, presented by the Robert Wood Johnson Foundation and the National Academy for State Health Policy. The award acknowledges state Medicaid programs that have demonstrated innovative approaches to improving beneficiary health amid significant public health challenges.

As a state with long-standing health disparities, Minnesota recognized the importance of taking action.

“One of the things we’ve committed to in the last several years is: if we’re going to solve the problem [of disparities in health outcomes], we need to work with the communities who are impacted by those disparities,” Marquardt, who is also the deputy assistant commissioner of the Minnesota Department of Human Services’ (DHS) healthcare administration, told HealthPayerIntelligence.

“There has been a series of initiatives and steps that we’ve been taking over time to more authentically engage with the communities that are served by our program so that we are developing solutions that are created with them. We’re committing to going back to them, continuing to build relationships, and then building solutions together that we can implement, and then measure the impact to see if it’s having the effect we all desire.”

While the state has been aware of the existing health disparities for quite some time, Marquardt noted that the current administration, in particular, has created a focused effort on being an anti-racist organization and has prioritized addressing these disparities.

The state’s Medicaid program has centered its efforts around a few key initiatives, most of which are built around community engagement.

The Building Racial Equity into the Walls of Minnesota Medicaid: A Focus on US-Born Black Minnesotans (BREW) report—spearheaded by Nathan Chomilo, medical director of Minnesota’s Medicaid program—was a significant piece of the state’s strategy for addressing health disparities.

“[The report] focused on US-born Black Minnesotans and their experience in the Medicaid program and eliciting feedback from them, recommendations from them, and developing, together, solutions for improving the experience and health outcomes for Black Minnesotans,” Marquardt explained.

The BREW report engaged Medicaid beneficiaries in the Black community, as well as community organizations that represent the Black community and healthcare providers that treat this population.

After gathering feedback from community members, the report recommended calls to action in three areas. The Minnesota DHS should simplify and support enrollment and renewal, increase investment in culturally relevant care for Black beneficiaries in Minnesota, and fund community conversations with these beneficiaries that can influence policies.

Marquardt also highlighted the state’s Integrated Care for High Risk Pregnancies (ICHRP) initiative, which focuses on improving maternal and birth outcomes in the Black and American Indian communities.

Similar to the BREW report, this initiative relies on community engagement.

“It engages doulas who provide services to Black and American Indian women. It includes providers who treat them, and members of the community that also experience what is it like to be pregnant in the Medicaid program in Minnesota,” Marquardt shared.

In addition, the Minnesota DHS released a report about Minnesotans living in deep poverty. The report included interviews with Medicaid beneficiaries and individuals receiving other social services within the state.

The administration has also prioritized reducing racial health disparities when it comes to contracting with managed care organizations. These efforts were informed by input from local counties and other initiatives like the BREW report and ICHRP, Marquardt said. These efforts are relatively new and will kickstart health plan changes in January 2023.

As for the BREW report and ICHRP initiatives, the Minnesota Medicaid program has received positive feedback from the communities engaged in these efforts.

“Certainly, ICHRP is an improved experience for Black and American Indian women in how they experience that whole perinatal care,” Marquardt noted. “Is someone who understands their cultural background, who understands their beliefs and desires, is that reflected in the care they’re getting?”

“So, I think there’s a difference in experience. Ultimately, we want to see the improvement in maternal and infant mortality, which is a little tricky of a measure to do because there are so few, but each one matters, so you want to eliminate all of them.”

The program will not know how the initiatives have impacted overall health outcomes until more time has passed, Marquardt mentioned. However, positive experiences within the community indicate that health outcomes will improve.

“We would know that we’re not in the right place if the community isn’t experiencing something different,” she said. “If something to them isn’t changing, that would probably be an early indicator that what we’re doing is not very effective.”

Addressing health disparities is critical to ensuring that all Medicaid beneficiaries receive equitable healthcare. Leveraging community engagement efforts can help states reduce disparities and improve health equity, as Minnesota’s Medicaid program has demonstrated.

“One of the most important things is to establish the processes that you use through trusted resources,” Marquardt asserted. “We couldn’t be doing this without help from the community, with community organizations and really getting their commitment, and committing to funding them adequately so they can support this work.”

The administration strives to continue addressing health disparities and improving experiences among its beneficiary populations.

“We all know we still have lots of work to do, but I think we’re committed to doing it,” Marquardt concluded. “So, that’s probably the last thing we should be letting people know is we’re not done by any stretch.”