SHADAC Expertise

Health Equity

Health Equity

Improvements in health equity depend on a better understanding of health disparities and efforts to reduce avoidable differences in health outcomes as well as other conditions, such as access to safe housing, healthy food, transportation and jobs. Better data collection and measurement are essential, particularly for monitoring and addressing the inequitable impacts of the pandemic.  SHADAC’s work in this area includes projects focused on equity in the Medicaid program, in-depth resources focused on data and measurement, and highlighting successful strategies in advancing health equity for key public health efforts, such as vaccination.

Relevant SHADAC work:
Click on any title below to learn more about the project.

Medicaid Equity Monitoring Tool: Phased Project with RWJF

With support from the Robert Wood Johnson Foundation, SHADAC is leading a multi-phased project to assess whether identifying a set of key equity-related indicators and populating these relevant measures into a larger digital tool (i.e., a “Medicaid Equity Monitoring Tool”) could be a helpful, feasible, and reliable way of tracking and advancing progress in achieving health equity in Medicaid at the state and federal levels. SHADAC is currently in Phase 2 of the project, which involves collaborating with a new partner, Health Leads, which will facilitate community engagement in helping to develop this tool, as well as conducting additional background research into the data and contextual measures that could populate such a tool. As with the first phase, work in Phase 2 will close with a recommendation to RWJF regarding the feasibility of moving forward with building, operating, and maintaining a Medicaid Equity Monitoring Tool.

Federal Survey Sample Size Analysis: Disability, Language, and Sexual Orientation and Gender Identity

SHADAC was contracted by the Medicaid and CHIP Payment and Access Commission (MACPAC) to analyze the quality and availability of data for different demographic populations facing health inequities. SHADAC researchers reviewed 13 federal surveys to determine if they had questions about disability, primary language, limited English proficiency (LEP), and sexual orientation and gender identity (SOGI). Findings from the report noted that a majority of surveys include questions regarding functional disabilities, but fewer than half include questions about intellectual disabilities, serious mental illness, primary language, LEP, and SOGI.

Collection of Key Demographic Data on Medicaid Applications 

Race, Ethnicity, Language Data

Collecting and monitoring data on Medicaid enrollees that is broken down by race, ethnicity, and language (REL) is an essential first step in assessing health disparities as well as identifying strategies for improvement in state Medicaid programs. Although all state Medicaid agencies and most U.S. territories collect self-reported data on REL from applicants during the eligibility and enrollment process, many states continue to face longstanding and persistent challenges in collecting complete, accurate, and granular data on REL. In this issue brief prepared for State Health and Value Strategies with funding from the Robert Wood Johnson Foundation, SHADAC researchers provide an overview of federal REL data collection standards, and examine Medicaid application questions, answer options, and instructional language used by Medicaid programs in all 50 states, the District of Columbia, and five U.S. territories

Self-Reported Disability Data

One-third of Medicaid enrollees report having a disability, but only 11% of the Medicaid population qualify for Medicaid based on a disability determination. Very little is known about people who self-identify as having a disability within the Medicaid program who are not a part of the group that qualifies for benefits through a disability-related eligibility category, and only one state is collecting disability data in alignment with the current federal standard. In this issue brief, prepared for State Health and Value Strategies, SHADAC provides an overview of current disability data collection standards and documents how all 50 states are collecting self-reported disability information on their Medicaid applications, and identifies opportunities to improve disability data collection. Find that full brief here.

Sexual Orientation and Gender Identity (SOGI) Data

Thirteen million people identify as part of a sexual or gender minority (SGM) in the United States, and an estimated 1.17 million of those SGM adults (age 18-64) have Medicaid as their primary source of health insurance. SHADAC researchers have authored a new State Health and Value Strategies brief documenting the few examples of SOGI data collection efforts occurring at the federal level and in Medicaid, and highlights the efforts of an Oregon community stakeholder process that identified several key areas for SOGI data improvement. A new brief with updated recommendations and current SOGI data collection methods is set to be released in early 2024. Check back for a link to the updated brief.

Disparities in Minnesota’s COVID-19 Vaccination Rates

Partnering with the Minnesota Electronic Health Record Consortium, SHADAC delved deep into an analysis of COVID-19 vaccination rates in Minnesota. Unlike many other studies, we were able to examine not only how COVID-19 vaccination rates differed across different demographic groups, but also how those disparities developed over time. Together, the findings from this new study highlight two main points: First, Minnesota’s COVID-19 vaccination efforts resulted in clear disparities - looking at detailed data illustrates the ways that certain groups were left vulnerable to COVID-19 for much longer than others. Second, our findings on disparities in the time Minnesota took to vaccinate half of different subpopulations demonstrate the importance of monitoring such health equity measures over time. Health equity requires urgency. Review the full brief here.

Past Work

Borrowing Proven Policy Strategies to Vaccinate Kids Against COVID-19

With the authorization of the first COVID-19 vaccine for children ages five and older, most kids in the United States are now eligible to be immunized. The objective of this brief, produced by SHADAC researchers for State Health & Value Strategies (SHVS), is to highlight the strategies and tools that have contributed to prior successful U.S. efforts to widely vaccinate children against contagious diseases and reduce vaccination disparities, so that they may be applied to initiatives to immunize kids against COVID-19.

Collection and Availability of Data on Race, Ethnicity, and Immigrant Groups in Federal Surveys that Measure Health Insurance Coverage and Access to Care

This SHADAC brief was created to assist state and federal analysts with survey development and/or analysis of existing survey data to generate estimates of health insurance coverage and access to care across racial and ethnic groups and according to nativity and/or immigrant status. The brief presents the collection and classification of survey data for populations defined by race, ethnicity, and nativity/immigrant (REI) status as well as the availability of these data in public use files.

Expert Perspective: States' Reporting of COVID-19 Health Equity Data

States’ Reporting of COVID-19 Health Equity Data looks in-depth at which states are reporting data on the impacts of COVID-19 on vulnerable populations, including communities of color, populations with lower incomes, and residents of congregate living facilities. Also included are interactive maps that explore the extent to which states are reporting data breakdowns by age, gender, race, ethnicity, and locational levels (ZIP code), group residence type, and for health care workers.