Tiffany Donelson, President and CEO, Connecticut Health Foundation
For those of us who have worked toward health equity, who have spent the past few years building toward incremental gains and pushing for larger change, the events of this year can feel like one big backslide. At times, it’s overwhelming.
Yet this is not the time to get bogged down by the size of the challenge or by analysis paralysis. From where I sit, I see five roles that philanthropy can play in the rollout of changes to Medicaid.
I recognize that everyone has a different local and state landscape. Some states—like mine—have leaders who are generally supportive of equity and have a history of prioritizing health. Other states do not. At the same time, we all serve communities that face significant harms from the federal reconciliation law, and there are ways we can help make a difference. No matter what state you are in, or the risk tolerance of your foundation, we all can play a role in minimizing harm to our communities. Here are five roles:
Helping States Implement the Law
For most states subject to the new work requirements, implementation will require creating new systems. The timeline is tight, and the stakes are high; the design of these systems will play a major role in how easy or burdensome it is for people to get and stay covered. We have let our state leaders know that as philanthropy, it’s not our role to pay for the systems, but our funding can help them bring in expertise to develop strategies to make these systems as user-friendly as possible.
We know that no matter how good a design is on paper, the true test is how it works for the people who need it. In philanthropy, we can use our funding and influence to help ensure that the people who will be most affected by the new requirements are involved in testing the systems they will have to use to get or stay covered.
Ensuring that Communities Are Informed
While the provisions of the new reconciliation law take effect over time, people are already panicking about losing access to health care and the other benefits they rely on. It’s critically important that people who will be most affected by these changes know what’s happening and know what to do to stay covered.
Like many funders, we have built up a network of trusted messenger organizations that we support to share important information with their communities. Trusted messengers will be critical as these changes take effect. These can be community-based organizations, community health workers, local influencers, and others who community members trust and rely on for information. Funding these networks now and in the coming years can help to ensure that those most affected will have the information they need.
State agencies will also need to develop their own plans to communicate with the people they serve, and supporting this work—through thought partnership or funding—can go a long way.
Connecting State Agencies and Communities
There’s great value in connecting our trusted messenger networks to state agencies, so state agencies can test messages and learn what’s most important to the people they serve, and trusted messengers can hear information from official channels.
We saw the value of this firsthand during the unwinding of Medicaid coverage after the end of the COVID-19 public health emergency. We regularly convene our trusted messenger grantees and invite representatives from state agencies and our state’s health insurance exchange. The agency leaders share information, but some of the most valuable exchange occurs when trusted messengers provide feedback on what they’re seeing on the ground. In one case, a trusted messenger shared that her organization, a health ministry, worked with people on their enrollment applications after church on Sundays, but they often ran into barriers because the exchange’s call center wasn’t open during those times. Soon after, the exchange extended its hours. Other trusted messengers have described glitches their community members were facing, prompting state social service agency officials to dig deeper to identify and solve the problems.
Making Sure There’s Good Data
We live in an era when misinformation can be easier to find than valid information from reliable sources. Philanthropy can serve as a source of truth, connecting those in the field and policymakers to reliable sources of data. This could mean sharing data from KFF, the Commonwealth Fund, state agencies, and other sources, or commissioning data collection and analysis at the state or local level.
Even when data exists, it’s not always easy to find, and this is a gap philanthropy can fill. We’ve found that posting data related to health and disparities on our website, in an easy-to-navigate format, leads to wider use of the data; it’s quoted in news articles, in legislative testimony, and by other organizations, providing important context to conversations about health policy.
As the provisions of H.R.1 take effect, ensuring that solid baseline data and monitoring are in place to document the impact—with information on the population overall and broken out by race, ethnicity, and other categories—will be critical to future efforts to protect and strengthen coverage.
Inform the Field
National funders can be especially helpful in elevating the experiences of states. States will be implementing the new law in their own ways, with different levels of enthusiasm and timelines, and there’s a lot we can all learn from this variation. National funders and Grantmakers In Health will be well-positioned to share best practices and cautionary tales. These can serve as early warning systems for all of us.
Many of these efforts can seem like minimizing harm more than working toward health equity—a frustrating position to be in. At the same time, many of these strategies can position our states and communities to do more when the environment shifts. Investing in trusted messengers, data analysis, and systems that serve people most effectively will be valuable in tough times and more favorable ones, and investing our time and resources into supporting our communities can build trust in lasting ways.