Fighting the Institutionalization of Racism in Medicaid

Paul Shafer is an assistant professor of health law, policy, and management at the Boston University School of Public Health, follow him on Twitter @shaferpr. Nambi Ndugga is a policy analyst at the Boston University School of Public Health, follow her on Twitter @joerianatalie.

In January 2020, the Centers for Medicare and Medicaid Services (CMS) issued a letter to state Medicaid directors that let them convert Medicaid programs from the current state-federal partnership model to a block grant model. The block grant model would introduce caps to Medicaid funding. These changes could have detrimental impacts on historically marginalized populations who have already been adversely affected by the pandemic.

In an editorial in the American Journal of Public Health, we discuss how block grants and other recent pushes, like work requirements and elimination of retroactive eligibility, in Medicaid policy in combination with established structural discriminatory practices negatively affect Black Americans and other people of color.

As we wrote,

HAO [Healthy Adult Opportunities] could have devastating impacts on lower-income families who may be unable to pay ‘up to 5% of their household income’ to cover out-of-pocket costs or will be punished by suspension from Medicaid for failing to pay any required premiums. States will also be able to adjust benefits, cost-sharing, and other requirements to stay within budget without additional CMS approval. Due to the large and persistent structural inequities faced by Black Americans and other people of color daily, this could have a particularly devastating impact on their health.

The persistent inequities experienced by marginalized populations and their ties to poor health outcomes has been extensively documented. As we navigate a pandemic and economic recession, now, more than ever is the time for public health professionals and policy-makers to call out these injustices.

Read more here.

Research for this piece was supported by the Laura and John Arnold Foundation.

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