Medicaid and Safety-Net Providers: An Essential Health Equity Partnership


The following report from The Commonwealth Fund was funded in part by Episcopal Health Foundation through support to the Geiger Gibson/RCHN Community Health Foundation Research Collaborative.

Achieving greater health equity demands a fundamental rethinking of the ways in which care is organized and delivered, a more expansive view of what constitutes “basic health care,” and payment reforms that support models that can serve as anchors in the highest-need communities and can ensure continuity of care. Achieving these models requires partnerships between payers and the providers serving high-need communities and populations. In this regard, the Medicaid program, which so singularly reflects a blend of insurance coverage and public health funding flexibility, possesses a unique ability to undertake, in partnership with safety-net providers, payment and delivery reforms that enhance equity and access in the nation’s underserved communities.

  • Issue: Medicaid’s dramatic growth, coupled with its transformation into an active health care purchaser, has elevated the role of safety-net providers in ensuring health care access and promoting health equity. Given the heightened focus on equity for low-income populations, communities of color, people with complex medical conditions, and medically underserved communities, it is a particularly important time to examine the implications of Medicaid’s evolution for these essential providers.
  • Goal: To describe Medicaid’s evolution as a health care purchaser, examine the implications for safety-net providers, and discuss strategies to better ensure health equity for enrollees.
  • Findings and Conclusions: Safety-net providers play an essential health equity role in Medicaid by virtue of their location in high-risk communities, their obligation to serve all community residents, and the ways in which they have adapted services to meet community and patient needs. Two key strategies could strengthen the health care safety net while promoting greater alignment with modern Medicaid practice and policy: 1) ensuring that managed care organizations include safety-net providers as in-network providers for all services covered under their agreements with state purchasers; and 2) introducing value-based payment strategies that reward providers for achieving health equity goals for the communities and populations they serve.
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