Study calls for racial equity improvement in Minnesota Medicaid program

Minnesota leaders are calling for changes in the state Medicaid program to improve racial equity and health outcomes, particularly for Black residents born in the U.S.

Black Minnesotans born in the country experience some of the state's starkest health disparities, according to a report from the Minnesota Department of Human Services (DHS). For example, U.S.-born Black Minnesotans have three times the rate of asthma, depression and heart failure and heart conditions that lead to hospitalizations compared with Black residents born outside the country, according to the report.

With more than 40% of Black Minnesotans, including two-thirds of Black children, receiving health care coverage through the state's Medicaid program, the report focuses on program changes that can help build health equity.

"It is an indisputable fact that Minnesota has a staggering racial health equity problem, and ignoring the stain of institutional racism has not made it go away," said Dr. Nathan Chomilo, Medicaid medical director and the report's lead author.

Specifically, the report recommends the state make it easier to enroll and renew Medicaid coverage, expand access to culturally relevant care and engage the community in the process of creating policy for the program.

"There have been plenty of reports that have detailed disparities and the gaps in health care," Chomilo said. "We wanted to acknowledge that context and put forward actions that make us accountable to the community and start building forward."

Chomilo has long been involved in addressing racial and health inequities. He's a co-founder of Minnesota Doctors for Health Equity — a statewide coalition of physicians and other health professionals working to address structural racism and the impacts it has on who gets health care and who doesn't.

Taking over as Medicaid medical director in early 2020, Chomilo expected it would take several years to address some of these disparities. Then the COVID-19 pandemic hit Minnesota and a police officer killed George Floyd, setting off a racial reawakening that accelerated the opportunity to have these conversations about racial inequity in health care, Chomilo said.

In making the report, Chomilo said it was important to engage the community. "They often have the answers, but we often haven't been listening," he said.

Two online community conversations have been scheduled from 6 to 7:30 p.m. on April 19 and May 9 to discuss the report's findings and next steps. To register, go to mn.gov/dhs/public-participation.

The report notes it doesn't seek Medicaid-funded services that are racially exclusive.

"These changes will lead to improvements not only for the Black community, but also for other communities that experience health disparities," Human Services Commissioner Jodi Harpstead said.

According to DHS officials, Gov. Tim Walz's budget for the legislative session includes several proposals that align with the report's recommendations, such as simplifying the enrollment and renewal processes in Medical Assistance and MinnesotaCare that will provide more consistent coverage and fewer gaps in care.

Another proposal would provide continuous Medicaid coverage for 12 months at a time for children, bringing Minnesota in line with most other states.

Other items in the governor's budget include making it easier to access culturally relevant care, such as doulas, and funding community conversations to make public health care programs more responsive to the people they serve.