Health equity

CMS’ health equity strategy will build on the Biden-Harris Administration’s commitment to advancing racial equity and support for underserved communities through the federal government, as described in President Biden’s Executive Orders 13985 and 14091.

A key pillar of CMS’ Strategic Plan is health equity. CMS’ strategies to advance health equity address the disparities that underlie our health system through stakeholder engagement and by building this pillar into the core functions of the agency.

How can CMS address health equity?

CMS programs cover more than 160 million people across the country through the 3Ms - Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and the Marketplace. In short, CMS provides health coverage to 1 in 2 Americans.

CMS programs are critical to ensuring all Americans have access to quality health care. Our goal is to ensure that every person has the opportunity to access the care they seek at an affordable cost.

These programs distribute substantial funding throughout the U.S. health care system annually and CMS provides quality oversight for most hospitals, health systems, health care facilities and providers across the country.

The following are examples of how CMS programs are moving the needle on health equity:

Pregnancy-related mortality rates are two to three times higher among Black non-Latino and American Indian/Alaska Native populations compared to White populations, even when adjusted for education and income. Nationally, roughly 40% of U.S. births are covered by the Medicaid program, Latino, Black, and American Indian and Alaska Native individuals. Therefore, the Medicaid program can play a key role in reducing disparities in maternal health outcomes.

CMS is working improve access to continuous coverage and quality of care in the postpartum period by working closely with states to encourage uptake of 12 months of extended postpartum coverage for pregnant people enrolled in Medicaid and CHIP.

After substantially increasing Affordable Care Act Marketplace outreach and education, and with the American Rescue Plan’s enhanced and expanded premium tax credits, more people of color are accessing quality health care coverage through the ACA Marketplace.

Since 2020, Black consumer enrollment has increased by 49 percent, Latino consumers saw a 53 percent increase in enrollment, and American Indian and Alaska Native consumers saw a 32 percent enrollment.

CMS and the Social Security Administration are implementing provisions of the Inflation Reduction Act that expand eligibility for the full Medicare Part D Low Income Subsidy (LIS) or “Extra Help” program benefit.

CMS is also improving access to health care and lowering costs for millions of Americans by streamlining enrollment in the Medicare Savings Programs for people with limited income and resources.

CMS estimates these improvements will save older adults and people with disabilities nearly 19 million hours in paperwork each year and reduce state administrative burden by over 2 million hours annually. These actions together will help an estimated 1.2 million older adults and people with disabilities with limited income afford their Medicare coverage and health care costs.

How is CMS working to address health equity?

CMS is working to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all people served by our programs by incorporating the perspective of lived experiences and integrate safety net providers and community-based organizations into our programs. Together this work will eliminate avoidable differences in health outcomes experienced by people who are disadvantaged or underserved and providing the care and support that people need to thrive.

Health Equity at CMS: Equity is in Every Pillar

All of CMS’s work is organized and managed along six strategic pillars that promote the establishment of broad programmatic goals. CMS is building health equity into each of its strategic pillars with the goal of improving the health care experience and outcomes of the communities we serve. The following section details key actions undertaken at CMS to advance health equity.

Expand Access

Marketplace

Increasing Coverage to Reduce Health Disparities.
Reports have shown significant gains in health insurance coverage during the 2021 and 2022 HealthCare.gov Open Enrollment periods among populations with historically higher uninsured rates such as Black and Latino consumers.
Impact: Reduces the uninsured rate among underserved communities.

Medicaid & CHIP

A Majority of States Offer Full Year of Medicaid Coverage After Pregnancy.
CMS continues to improve access to continuous coverage and quality of care in the postpartum period by working closely with states to encourage uptake of 12 months of extended postpartum coverage for pregnant people enrolled in Medicaid and CHIP.
Impact: Increases access to services in the postpartum period for underserved enrollees known to be at higher risk of adverse outcomes.

Expanding Access to School-Based Services.
CMS released a guide to help schools give care to children in Medicaid and CHIP, including behavioral health services. The guide provided states with claims guidance, technical assistance, and best practices.
Impact: Addresses the growing concerns in youth behavioral health, which disproportionately impact children and teens living in low-income communities, ethnic minority youth, LGBQ+ youth, and those with special needs.

Medicare & Medicaid

Streamlining Enrollment in Medicare Savings Programs.
Reduces red tape and simplifies Medicare Savings Program enrollment. The Medicare Savings Programs offers financial assistance to people with limited income and resource to afford their Medicare costs helping millions of seniors and people with disabilities afford coverage. CMS also worked to improve access to the Medicare Savings Programs through public outreach and partnership with states.
Impact: Improve access to care and economic security for low-income older adults and people with disabilities.

Medicare

Addressing Health-Related Social Needs.
CMS finalized coding and payment changes to better account for resources involved in furnishing patient-centered care with a multidisciplinary team of clinical staff and other auxiliary personnel.
Impact: These types of services are expected to be disproportionately used to help individuals from underserved communities. The new coding and payment for Social Determinants of Health (SDOH) risk assessment recognizes when practitioners spend time and resources assessing SDOH that may impact their ability to treat the patient.
Advancing Health Equity and Caregiver Support.
CMS finalized a proposal to pay practitioners for training caregivers to support patients with certain diseases or illnesses (e.g., dementia) as part of a treatment plan.
Impact: Supports care for persons with Medicare by better training caregivers. Underserved populations are more likely to have family caregivers.
Translated CMS Resources.
CMS translates the “Medicare & You” handbook and other educational materials for Medicare beneficiaries into additional languages. For example, CMS translated the Medicare & YOU handbook into Chinese, Korean, and Vietnamese for the first time.
Impact: Increases the accessibility of CMS programs and resources.

Engage Partners

Office of Program Operations & Local Engagement (OPOLE)

CMS convenes all parts of the Agency under the Elevating Stakeholder Voices CCI to better coordinate CMS’ engagement work, including with underserved and underheard communities to inform a vast array of policies and programs.
Impact: Strategically ensures that individuals with lived experience, including underheard and underserved communities, have a strong voice throughout CMS’ policymaking and implementation process supporting CMS’ health equity efforts.

Office of Minority Health

CMS Health Equity Conference
CMS hosted its inaugural Health Equity Conference in June 2023 at Howard University. The conference convened leaders in health equity from federal agencies, health provider organizations, academia, community-based organizations, and others, both in person and virtually.
Impact: Conference attendees heard from CMS’s leadership on recent developments on CMS programs, learned about up-to-date research on health equity, discussed promising practices, and collaborated on community engagement efforts.
Health Equity Technical Assistance.
The CMS Health Equity Technical Assistance Program supports health care professionals, health plans and systems, State Medicaid Agencies, federal, state, tribal and territorial, and local health agencies, universities, community partners and all other external CMS stakeholders, as well as across CMS, as they we work together to embed health equity within CMS programs, policies, and operations.
Impact: This program advances health equity efforts within the federal government and among local communities and CMS partners.

Medicare & Medicaid

Medicare Savings Programs Public Outreach and Education.
Continued support and outreach for Medicare beneficiaries on Medicare Savings Programs and other cost-savings programs. During the Open Enrollment period we included messaging on MSP in the outreach campaign such as within a print advertisement and social media.1-800 MEDICARE representatives are also trained to provide education on the Medicare Savings Programs as well as other ways for beneficiaries to reduce their costs.
Impact: Increases the education of people with Medicare on the availability of programs to reduce their costs.

Medicare

Rewarding Excellence for Underserved Populations (REUP)
CMS is rewarding providers that provide quality care to a higher percentages of underserved populations with upside-only monetary award. Through this payment policy CMS is incentivizing excellent care, without lowering standards and avoiding unintended penalties on providers treating underserved populations.
Impact: Supports high-quality care for underserved populations.

Marketplace

Increased Marketplace Enrollment Outreach to Underserved Populations.
CMS invested almost $100 million in grant funding to Navigator organizations for the 2024 Open Enrollment Period to provide increased and enhanced enrollment assistance to help consumers find the right health coverage option, complete their Marketplace application, and enroll in coverage in Federally-facilitated or State Partnership Marketplaces.
Impact: Increasing opportunities and assistance for people to enroll in coverage is critical to reducing health disparities.

Office of Communications

CMS National Stakeholder Calls
CMS holds quarterly National Stakeholder Calls provide an opportunity for CMS to share information related to policies or initiatives with the stakeholder community at large. All stakeholders who interact with CMS programs, policies, or initiatives or work with providers, beneficiaries, or consumers who rely on CMS services can join these calls.
Impact: Gives CMS partners an opportunity to hear about CMS initiatives.

Office of Program Operations & Local Engagement (OPOLE)

CMS convenes all parts of the Agency under the Elevating Stakeholder Voices CCI to better coordinate CMS’ engagement work, including with underserved and underheard communities to inform a vast array of policies and programs.
Impact: Strategically ensures that individuals with lived experience, including underheard and underserved communities, have a strong voice throughout CMS’ policymaking and implementation process supporting CMS’ health equity efforts.

Drive Innovation

Innovation Center

Building On CMS's Accountable Care Vision To Improve Care For Medicare Beneficiaries.
ACOs are an important mechanism to reach more underserved populations and close disparities in access to care and outcomes. The ACO Realizing Equity, Access, and Community Health (REACH) Model and the Shared Saving Program have implemented health equity payment adjustments to account for social risk among underserved populations and increased ACO participation among safety net providers. ACO REACH also requires Health Equity Plans and Health Equity Data Reporting, as well as representation by beneficiary advocates on ACO governing boards who must hold voting rights.
Impact: The Innovation Center has made meaningful progress in each of these areas. Read their Key Concept on Health Equity.
Advancing Health Equity Through The CMS Innovation Center: FirstYear Progress And What’s To Come
The CMS Innovation Center launched a new health equity initiative in 2022, proposing to: develop new models and revise existing models to promote and incentivize equitable care; increase participation of safety-net providers; increase collection and analysis of equity data; and monitor and evaluate models for health equity impact.
Impact: The Innovation Center has made meaningful progress in each of these areas.
Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities
The Accountable Health Communities (AHC) model launched in 2017 to test the impact of identifying and addressing Medicare and Medicaid beneficiaries’ health-related social needs (HRSNs) on health care use and costs. This report shares lessons learned from the model.
Impact: New Innovation Center models are required to collect and report demographic and, where feasible, social needs data to CMS. In addition, the lessons learned from this model will inform future models and policies.

Standards & Quality

Birthing Friendly Designation.
CMS finalized several new quality measures for maternal care including the “severe maternal morbidity”, the inclusion of C- section data for hospitals, and the attestation measure to ensure that hospitals and health systems are participating in quality improvement. The latter measure forms the bases of the newly launched “Birthing Friendly” designation on CMS’ Care Compare site, which is a public designation indicating that the hospital or health system is participating in, and implementing actions, to improve maternal care.
Impact: These quality measures and the designation can increase access to quality care and reduce the maternal morbidity and mortality disparities that disproportionately affect persons of color.

Office of Minority Health

Mapping Medicare Disparities Tool
CMS has designed an interactive map, the Mapping Medicare Disparities (MMD) Tool, to identify areas of disparities between subgroups of Medicare enrollees in health outcomes, utilization, and spending. It is an excellent starting point to understand and investigate geographic and racial and ethnic differences in health outcomes.
Impact: This information may be used to inform policy decisions and to identify underserved populations and geographies.
Sickle Cell Disease Action Plan
CMS has completed a plan for how to address barriers and challenges faced by sickle cell disease patients throughout CMS’ programs and policies.
Impact: This plan can help reduce barriers for people with sickle cell disease, which disproportionately impacts people of color, including Black and Hispanic communities.

Marketplace

Collecting Health Equity Data
Starting in the fall of 2023, the Marketplace application now asks for optional demographic questions regarding sex assigned at birth, sexual orientation, and gender identity.
Impact: Collecting sexual orientation and gender identity data will help to improve the Marketplace consumer experience by enabling consumers to attest in a way that better reflects and affirms their identities. These questions will also be used to analyze health disparities in access to coverage.

Health equity

Health equity

Health equity

How is health equity incorporated into CMS’ work?

How can CMS address health equity?

The following are examples of how CMS programs are moving the needle on health equity:

Medicaid

Marketplace

Medicare

How is CMS working to address health equity?

Health Equity at CMS: Equity is in Every Pillar

Expand Access

Marketplace

Medicaid & CHIP

Medicare & Medicaid

Medicare

Engage Partners

Office of Program Operations & Local Engagement (OPOLE)

Office of Minority Health

Medicare & Medicaid

Medicare

Marketplace

Office of Communications

Office of Program Operations & Local Engagement (OPOLE)

Drive Innovation

Innovation Center

Standards & Quality

Office of Minority Health

Marketplace

Protect Programs

Medicare

Foster Excellence

Office of Human Capital and Office of the Administrator