By Anne Swerlick, Senior Policy Analyst, Florida Policy Institute
Experts agree that to reduce health disparities, you first need to know where they exist.
The collection of health plan performance measure data, such as timely prenatal care and well-child check-ups, broken down by demographic factors like race and ethnicity is essential for developing targeted health equity strategies.
The Medicaid program offers policymakers a unique opportunity to move forward on this front. In Florida, more than 5 million people are enrolled in Medicaid and over 60 percent of enrollees are people of color.
The 2022 Florida Legislature seized this opportunity through unanimous passage of House Bill 855. It was signed into law (Chap. No. 2022-54, Laws of Florida) by Governor Ron DeSantis on April 6, 2022.
Beginning in calendar year 2026, the new law requires each Medicaid managed care organization (MCO) to stratify and publicly report performance measure data by age, race, ethnicity, primary language, sex, and disability (as determined by the Social Security Administration). The new law also requires MCOs to collect and report on an expanded set of performance measures including the Adult and Child Core sets. These are national key indicators of access to, and quality of, health care received by Medicaid beneficiaries.
Florida law already specified that the MCOs and state Medicaid agency — the Agency for Health Care Administration (AHCA) — collect and report on Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. This information is used by the state to monitor access and by beneficiaries to help select MCOs. Relying on this data, AHCA reported significant improvements in quality of care delivered by MCOs over the past ten years. However, the data were not stratified — a critical element for identifying if certain populations are faring better than others.
In a 2019 report focusing on child health racial and ethnic disparities, Florida Policy Institute urged policymakers to go further. FPI recommended that state Medicaid law be amended to require the collection of stratified performance measure data as an essential strategy for reducing disparities. With assistance from the Georgetown University Center for Children and Families, FPI made the case for why collection of this data is crucial to ensure that every Floridian enrolled in Medicaid has access to high quality care. During the 2021 session, the bill unanimously passed the House; however, it did not move in the Senate.
That changed with the 2022 session. Identical bills filed in the House and Senate passed unanimously through all six committees of reference and in both chambers. Why was 2022 the year to make this happen, particularly in a session of highly publicized divisive legislative conversations around race and equity issues?
A confluence of factors gave these bills momentum:
First, as a prelude to a new procurement round for MCO contracts effective July 1, 2026, Florida legislators focused on a major overhaul of current Medicaid managed care statutes. These laws had not been reviewed since 2014 when Medicaid managed care went statewide. Since that time, legislative oversight of the program has been sparse. Focus on this statutory revision elevated visibility of the Medicaid managed care program and, consequently, policymaker scrutiny.
Second, Florida’s Medicaid managed care program is big business. The program is dominated by national for-profit players including Centene, United, Molina, and Humana. The program also comprises a significant part of the budget. Total state and federal funds appropriated for this upcoming fiscal year (starting July 1, 2022) exceed $25 billion, the largest sum in the history of the program.
Third, while AHCA has been touting overall improvement in Medicaid managed care performance measures, there are troubling signs that not everyone is benefitting. A 2019 agency report on “preventable health care events” looking at hospital admission, readmission and emergency department visits that might have been prevented with better access to primary care, and improved medication management or better coordination of care, identified multiple disparities based on race and other demographic factors. Another 2021 report from the agency’s contracted external quality review organization (EQRO) showed alarming access and other quality deficits for people in need of mental health and substance use disorder treatment.
Finally, even in Florida, where months ago the Governor declared the end of the state public health emergency, COVID-19 continues to loom large over health policy discussions. While health disparities have been a long-standing problem, the pandemic made it substantially more visible with staggering rates of infection and death in communities of color.
Collection of this stratified data alone does not guarantee action on disparities. But it is an essential first step. The Legislature’s unanimous passage of HB 855 reflects a new commitment to a vision that the Medicaid program can be instrumental in achieving greater health equity for all Floridians.
Anne Swerlick has over 30 years of experience as a public interest attorney, focusing on health, economic and social justice issues. Throughout most of her professional career, she has worked as a legal services attorney representing indigent clients throughout Florida on a broad range of poverty law issues.