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NASHP Selects Emerging Leaders of Color Fellows
I am very pleased to announce the inaugural class of NASHP’s Emerging Leaders of Color Fellowship as a small step to achieve our goals of racial equity in state health policy. We were humbled to receive 108 applications for the three available fellowships and moved by the testimony of each fellow as they shared their lived experiences.
They spoke of the urgent and personal issues they confronted in the nation’s health care system: watching a parent visit the emergency room countless times for chronic health episodes, feeling helpless while siblings maneuvered a difficult and fragmented system, and witnessing the health of friends worsen as a result of discriminatory practices.
As a result of their experiences and dedicated work within the field, we are confident these emerging leaders will passionately drive the health policy solutions needed to advance health equity. Following a review of applications and interviews with finalists, we have selected these emerging leaders:
Abena Asare currently works as a program assistant at Prevention Institute (PI), a national public health nonprofit headquartered in Oakland, California. She helps coordinate prevention initiatives focused on collaborative and community-based approaches to addressing intimate partner violence and mental health and well-being as part of PI’s Safety and Wellbeing team. She has provided technical assistance to communities across California through a program called Safety Through Connection, supported cities across the country through the Making Connections for Mental Health and Wellbeing Among Men and Boys initiative, and helped facilitate PreventConnect web conferences focused on sexual and domestic violence prevention. She currently serves on the Community Engagement, Advocacy, and Policy committee of M.O.T.H.E.R. Lab, a lab focused on eradicating the inequities Black women face. She is passionate about health equity and addressing the determinants of health that impact the maternal and child health population in the United States. Abena is pursuing her MPH concentrating in Maternal, Child, and Adolescent Health at University of California, Berkeley and graduated from Wellesley College in 2018 with a BA in psychology and health and society.
Ronique Taffe is a product development analyst for the National Committee for Quality Assurance (NCQA), working on the creation and iteration of population health-based accreditation and distinction products. Prior to joining NCQA in 2014, she interned at Johns Hopkins University School of Medicine where she was a research assistant and oversaw the implementation of health literacy interventions focusing on chronic conditions, such as diabetes and high blood pressure. She also interned for the US Food and Drug Administration (FDA) where she collaborated with consumer safety officers to analyze and compile trends on the similarities and differences in how foreign pharmacies operate. Ronique now works on several NCQA enterprise-level projects focused on advancing health equity. She graduated from the University of Maryland, College Park in 2019, where she was awarded an MPH and received her BA in health administration and policy, with a minor in sociology, from the University of Maryland, Baltimore County in 2014.
Stacey Riddick is a motivated early career public health professional whose passion for eliminating health disparities serves as a driving force in both her educational and occupational pursuits. Stacey is an alumna of Spelman College, a historically black liberal arts school for women located in Atlanta. At Spelman, she majored in biology with a minor in public health. Before Spelman, Stacey attended St. Cecilia Academy in Nashville. Her active academic and extracurricular involvement transferred over to Spelman and the Atlanta Westside community, where she was a scholar and community health advocate. As a current ORISE Fellow in the Enteric Diseases Epidemiology Branch at the Centers for Disease Control and Prevention, Stacey continues to leverage her natural science background and passion for social justice. She is seeking new opportunities to use science and policy as a tool to advance public health for marginalized populations.
The three fellows will partner with a NASHP state health policy leader of color to take on a project they will develop with that leader. They will also be invited to participate in NASHP’s ongoing work and will present their own initiatives at NASHP’s annual conference. Each fellow will receive a $2,000 stipend and free travel and registration at NASHP’s annual conference.
NASHP is grateful to these state health policy leaders who have guided our work and took time to review applications and interview candidates:
- Ana Novais, Assistant Secretary, Rhode Island Executive Office of Department of Health and Human Services
- Icilda Dickerson, Chief, Ohio Department of Medicaid. Long-Term Services and Supports Bureau
- Rene Mollow, Deputy Director, Health Care Benefits and Eligibility, California Department of Health Care Services
- Cheryl Roberts, Deputy Director for Programs, Virginia Department of Medical Assistance Services
- Dena Stoner, Director, Innovation Strategy, IDD/Behavioral Health Services,
Texas Health and Human Services - Mary McIntyre, Chief Medical Officer, Alabama Department of Public Health
NASHP’s team lead Adney Rakotoniaina, will continue to coordinate the program, aided by Salom Teshale and Maureen Hensley Quinn.
NASHP looks forward to collaborating with these fellows and bringing their voices and knowledge to our work.
States Build Infrastructure to Advance Equity in their COVID-19 Responses and Beyond
As COVID-19 continues to wreak havoc across the country and daily case counts exceed 150,000, many states are working to confront long-standing racial and ethnic disparities that the pandemic is laying bare.
While states are taking immediate action to address the health and economic consequences of the pandemic and preparing to distribute vaccines, their new approaches to health equity are critical first steps toward identifying and addressing systemic issues of discrimination, structural racism, and health care under-service that have led to COVID-19 disparities, and developing informed policies that advance equitable solutions.
States recognize that immediate action is needed to ensure that new strategies will reduce – rather than unintentionally exacerbate – the disparities among populations with disproportionate risk. Disparities will not be addressed without investing time and effort into learning from data and evidence, listening to the voices of populations most affected, and developing culturally competent responses.
State justice and equity task forces are being tasked to provide inclusive and transparent approaches to address persistent and historic circumstances that put some racial and ethnic minority populations at higher risk. Reducing health disparities and improving health equity in the face of COVID-19 is complex work that requires states to:
- Use data-driven approaches;
- Meaningfully engage communities of color directly impacted by COVID-19; and
- Develop culturally responsive policies and interventions to address the root causes of inequities.
The latest update to the National Academy for State Health Policy’s (NASHP) interactive map, How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities, shows more states are developing strategies and infrastructure to address these health equity issues. NASHP’s map shows 18 states that created task forces to address the high rates of COVID-19 cases and deaths in communities of color are continuing to enhance data-gathering and elevate issues by establishing new agencies and making high-level appointments. They are building strategies and infrastructure to address the issues of equity through meaningful action today and after the pandemic.
As a first step, many states have enhanced tracking and analysis of racial data to improve the identification of COVID-19 disparities, increase transparency, and inform their interventions. Examples include:
- California’s Department of Public Health assembled a Health Equity Technical Assistance Team that will partner with key community organizations and advocacy groups to develop best practices and resources. They also released a health equity metric that counties must meet on an ongoing basis, and/or demonstrate targeted investments to eliminate disparities in levels of COVID-19 transmission, in order to advance to a less restrictive tier of activities. The health equity metric dictates that in counties with populations exceeding 106,000, the county must ensure that the COVID-19 test positivity rate in economically disadvantaged neighborhoods, also known as Health Equity Quartile of the Healthy Places Index census tracks, do not significantly lag behind the rest of the county. Counties with populations less than 106,000 must demonstrate targeted investments.
- The Louisiana COVID-19 Health Equity Task force plans to create a health equity dashboard to measure progress in ensuring testing is available for all communities and providing the medical community with best practices.
- Massachusetts’ Task Force on Coronavirus and Equity compiled a repository of policies they support, including ensuring housing security and safety, securing worker rights, and implementing data collection and action planning for equity.
- New Jersey’s Department of Health improved its COVID-19 data tracking and added cases defined by race/ethnicity to the state dashboard.
- Tennessee’s Department of Health and Office of Minority Health’s Health Disparity Task Force recommended creating surveillance dashboards for special populations to inform responsive solutions and policies to reduce disparities. The task force implemented three COVID-19 surveillance dashboards that track pregnancies, disparities, and cases among school-aged children.
Two state’s attorneys general have taken actions to address racial equity through the justice system:
- Maryland Attorney General Brian Frosh created a COVID-19 Access to Justice Task Force to develop strategies and solutions for low-income Marylanders and communities of color who are disproportionately facing civil legal challenges due to COVID-19.
- The Massachusetts Office of the Attorney General released a report, Building Towards Racial Justice and Equity in Health: A Call to Action, that highlights the disproportionate toll the pandemic has taken on communities of color. The report calls for action in key areas:
- Collecting data for identifying and addressing health disparities;
- Equitable distribution of health care resources;
- Using telehealth as a tool for expanding equitable access to care;
- Health care workforce diversity; and
- Identification of social determinants of health and root causes of health inequities.
Other governors have worked to address racial disparities and create sustainable change:
- Michigan Gov. Gretchen Whitmer recently created the Black Leadership Advisory Council. This council is designed to bring together Black Michiganders to serve in an advisory capacity to the governor and recommend policies and actions to prevent and eradicate racial inequity in Michigan.
- Ohio Gov. Mike DeWine created the Ohio Governor’s Equity Advisory Board. This will be a permanent board that will guide leaders to address underlying conditions that contribute to outcomes disparities.
In addition to these strategies, COVID-19 vaccine distribution plans will provide another opportunity for states to address COVID-19 racial disparities. Mitigating health inequities and promoting justice are two of the four ethical principles that the nation’s Advisory Committee on Immunization Practices (ACIP) has established to guide its decision-making process if vaccine supply is limited. With the anticipated arrival of the COVID-19 vaccine, states are following suit with their vaccine distribution plan, focusing on an equitable distribution by identifying critical populations at high risk of infection.
The continued disparities underscore the urgency of immediate state responses to address issues of equity that the COVID-19 pandemic has laid bare, but without continued and focused investments, these important issues will not be solved. Strategies to track and respond to COVID-19 racial and ethnic disparities in case counts and deaths have catalyzed state actions that can continue beyond the pandemic. Indeed, states can set the stage for sustainable change as they:
- Improve data tracking, analysis, and transparency;
- Develop strategies to address racial equity through the health, human services, and justice systems; and
- Identify ways to meaningfully engage people of color in developing culturally responsive policies and interventions.
NASHP will continues to track and monitor COVID-19 response and engage with states to identify and spread promising practices to advance health equity.
New Tool Helps States Assess Hospital Community Benefit Spending on Health Equity
As the COVID-19 pandemic persists, states face difficult budget decisions. As states forgo billions of dollars in tax exemptions to nonprofit hospitals, it is more critical than ever that these exemptions yield genuine value to their communities.
A new National Academy for State Health Policy’s (NASHP) tool helps states gather detailed information from hospitals about their community benefit expenditures and activities during the pandemic.
In exchange for their tax exemptions, the federal government requires hospitals to conduct community health needs assessments (CHNAs) and develop implementation plans to address the identified needs and report their community benefit spending to the Internal Revenue Services each year. However, there are currently no federal requirements that require community benefit spending to be tied to hospitals’ CHNAs or their implementation plans.
States can go beyond the federal requirements and require or encourage more detailed reporting of hospitals’ community benefit expenditures and their impacts. However, additional details may be necessary to assess how hospitals are identifying shifting community needs during COVID-19 and how community benefit spending is shifting to meet those needs.
The need for additional or renewed focus on racial and ethnic health inequities has been highlighted by the pandemic, and this new NASHP tool will help states collect detailed data that will show whether hospital community benefit programs and spending are addressing disparities and promoting equity.
This template can be used to complement NASHP’s two other reporting templates that synthesized several state community benefit reporting tools to help states collect data on hospital expenditures and community benefit program outcomes.
This tool is designed to capture more granular and actionable information than is currently required by the IRS Form 990 Schedule H, which allows some hospital systems with multiple facilities to report in aggregate and does not require hospitals to tie their reported spending back to needs identified by their CHNAs or other sources. If a state requests any hospital or hospital system’s Form 990 Schedule H worksheet, the information gathered with this NASHP tool can be compared with any reported activities listed there.
NASHP’s tool requires:
- Each hospital in a health system to report individually, and
- Hospitals to include program and activity information that the IRS considers to be a community benefit, community-building, or community health improvement activity on Parts I and II of IRS Form 990, Schedule H.
Instructions are included with the tool, and states are encouraged to tailor the instructions, or the form itself, to match their needs.
Support for this work was provided by the New England States Consortium Systems Organization (NESCSO) and the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation or NESCSO.
States Work to Advance Racial Equity in COVID-19 Outcomes and Beyond
Disparities in states’ COVID-19’s health outcomes have driven home the need for policymakers to reassess their work to advance racial equity and redirect efforts to be more effective. A recent update to the National Academy for State Health Policy’s (NASHP) interactive map, How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities, reveals that more than half of all states are now actively engaged in advancing equity in their COVID-19 responses and beyond.
States are working to ensure equitable distribution of resources and funding to promote health and safety for all during the COVID-19 pandemic. Some states are also beginning the long-term work of addressing systemic racism and other root causes of the disparities illuminated by the pandemic.
As the pandemic progresses and reveals the disproportionate impact of the disease on people of color, several states have created task forces and workgroups to ensure the equitable distribution of testing, personal protective equipment (PPE), and information about the disease. Some states are funding these efforts to better achieve equitable health outcomes for communities of color.
In Maine, for example, Black Mainers represent about 1.4 percent of the total population, but over 22 percent of the COVID-19 cases whose race is known. Gov. Janet Mills announced that $1 million from the Coronavirus Relief Fund would be dedicated to expanding services like testing, case investigation, contact tracing, and education to help reduce the disproportionately large racial and ethnic disparities in COVID-19.
As the recommendations and findings from the state task forces are published, one theme that emerges is the need for states to engage with communities and prioritize the needs they identify. The examples below underscore a critical lesson that states have learned from COVID-19 – their prior strategies to advance equity were not sufficient and integrating community feedback is essential to forge new and effective strategies. These recommendations reflect the importance of involving communities and people of color in states’ long-term policies:
- In New Hampshire, the COVID-19 Equity Response Team released its initial Report and Recommendations in which they described the need for proactive community engagement, working toward an ideal of co-creation and community ownership.
- In Oregon, the Equity Framework in COVID-19 Response and Recovery features a commitment to make community-informed policy and forge partnerships by engaging with community leaders who should be an essential part of the decision-making process.
- In Washington State, proposed recommendations from the Governor’s Interagency Council on Health Disparities include the provision of opportunities for communities to take the lead in creating information about and for themselves, including through contracts and grants.
- In Virginia, Gov. Ralph Northam announced a pilot program in Richmond to increase equitable access to PPE in underserved communities that may be more adversely impacted by the COVID-19. The pilot program includes community engagement events and training on cultural humility and implicit bias for city personnel who engage with the community.
The themes of including communities in decision-making and in the crafting of emergency responses are reflected in state funding streams as well, with some states providing funds to community groups. The Utah COVID-19 Community Task Force created a multicultural subcommittee that oversees the COVID-19 Racial Equity & Inclusion Grant Fund. The fund provides grants up to $5,000 to community-based organizations that provide emergency assistance to multicultural communities. In Michigan, $20 million was made available to the Coronavirus Task Force on Racial Disparities to respond to community needs associated with the disparate impacts the virus has had on communities of color. Community groups were able to apply for the funding through the Rapid Response Initiative, with funds available for a wide range of needs.
As states continue to work towards equitable health outcomes and look for ways to counter a long history of systemic racism, several are focusing on children’s health as a way to address disparities and potentially influence health trajectories in the future. For example:
- New Hampshire’s Equity Response Report recommended Adverse Childhood Experiences (ACEs) as an area to explore to continue understanding and serving communities of need in New Hampshire, specifically communities of color, at both the state and local levels.
- Ohio’s COVID-19 Minority Health Strike Force Blueprint highlights strategies to improve health outcomes and advance equity for children, including strengthening early childhood education and specifically ensuring that K-12 chronic absenteeism reduction efforts meet the needs of children of color. Ohio’s Plan to Advance Equity highlights how childhood poverty disproportionately affects African American and Latinx children in Ohio. To address this, the governor established the Office of Children Services Transformation within the office of Children’s Initiatives and is investing $675 million to assist students’ wellness and success.
The COVID-19 pandemic is far from over, and the effectiveness of these strategies will be evaluated based on how well they reduce disparities in COVID-19 outcomes and the advancement of health and social equity beyond the pandemic. NASHP will continue to engage states in identifying promising practices and will provide tools and support as states implement their task force and workgroup recommendations and measure change and success over time.
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.
Lawrence, Massachusetts, Keeps the Community at the Center of Hospital Community Benefits
Lawrence, Massachusetts, a city that has struggled with poverty and poor health, is now a Culture of Health Prize winner due in part to state policies that bolster the city’s efforts to advance health equity and address social needs. These supportive state policies include guidelines governing the local hospital’s community health needs assessments, its community benefits investments, and its determination of need spending. The Mayor’s Health Task Force works closely with community partners and braids funding from a variety of sources to improve the social and economic factors that affect health. The city’s innovative work and longstanding partnerships offer a blueprint for cities and states interested in unlocking the potential of community-centered, multi-sector partnerships.
Download: Keeping the Community at the Center of Community Benefits Programs: Lessons from Lawrence, Massachusetts
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.
A Class Act: Coming Together to Improve School-Based Health Services
Thursday, August 16th
10:00am – 11:30am
Integrating health services in school settings can promote student health and readiness to learn. This session focuses on cross-agency collaboration between Medicaid and schools to improve coordination and delivery of school-based health services. The session includes a national overview of school health services delivery models, and Ohio and South Carolina officials share best practices of effective health-education state partnerships, including successes, challenges, and lessons learned.
Moderator
Colleen Sonosky, Associate Director, DC Department of Health Care Finance
Colleen Sonosky, JD is the Associate Director of the Division of Children’s Health Services in the Health Care Delivery Management Administration in the District of Columbia’s Department of Health Care Finance (DHCF). DHCF is the agency responsible for the administration of the Medicaid program and the Division of Children’s Health Services oversees policies and procedures for Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit—the pediatric component of the Medicaid program for children under 21. Ms. Sonosky serves as the District’s EPSDT Coordinator as well as the CHIP Director for the Medicaid-expansion program. In addition, Ms. Sonosky represents DHCF on the District-wide Child Fatality Review Committee, Interagency Coordinating Committee for Early Intervention, and the State Early Child Development Coordinating Committee (SECDCC) where she co-chairs the Health/Wellbeing Subcommittee. She has also served on many national work groups concerning maternal and child health.
Speakers
Anne De Biasi, Director of Policy Development, Trust for America's Health
Anne Ekedahl De Biasi is Director of Policy Development at the Trust for America’s Health (TFAH), a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. She is responsible for defining the agenda and general strategy associated with the organization’s goal to create a modernized, accountable public health system and to integrate prevention into a reforming health care delivery and financing system. Previously Anne served as the first Director of Child Health Policy and Advocacy at Nemours, Director of Public Policy at the National Breast Cancer Coalition and Director of the Children’s Dental Health Project. She was President/CEO of the Oak Orchard Community Health Center and came to Washington, D.C. as a Robert Wood Johnson Health Policy Fellow, working as health care staff for U.S. Senate Majority Leader Tom Daschle.
Lesley Scott-Charlton, Ohio Department of Medicaid, Medicaid Health Systems Administrator
Lesley Scott-Charlton currently serves as a Policy Administrator with the Ohio Department of Medicaid. She has over 20 years of experience in public service, policy development, and systems administration. Mrs. Scott-Charlton spends a great portion of her time presenting on initiatives that serve Ohio’s children and families. Her Collaborative efforts include partnerships with the Centers for Medicare and Medicaid Services; the US Department of Health and Human Services; the US Department of Education; State and Local Government agencies; Managed Care Plans; Hospital Associations; and Community organizations. Ms. Scott-Charlton’s Associate Degree training was in the field of Mental Health/Chemical Dependency/and Developmental Disabilities. Her confirmed bachelor degree training is in the field of Social Work, and subsequently dual Graduate degree training in School Counseling and Clinical Counseling from Capital University in Columbus, Ohio.
Pete Liggett, Deputy Director, SC Dept of Health and Human Services
Pete Liggett, Ph.D., licensed psychologist, serves as the Deputy Director of Long Term Care and Behavioral Health for the South Carolina Department of Health and Human Services. His focus is guiding long term care and behavioral health policies as SCDHHS transforms these critical services and explores ways to better integrate long term care and behavioral health with primary care services. He joined SCDHHS in August 2012 as Director of Behavioral Health.
Mark Smith, Agency Lead, Medicaid School Program, Ohio Department of Education
Mark H. Smith MPA, BA, QIDP, CPM, Agency Lead, Medicaid in Schools Program, Ohio Department of Education, is currently an administrator with the Ohio Department of Education (ODE), serving as the agency’s Medicaid lead as well as its lead health services administrator. Mark also currently serves on the National Alliance for Medicaid in Education’s Board of Directors and has served as NAME’s Past President.
In his work, Mark has presented nationally on topics related to school-based health, data sharing between education and health arenas, parental consent, HCBS waivers, intellectual disabilities program design, electronic signatures protocol, and telepractice service delivery.
Learn How States Can Blend, Braid, and Use Block Grant Funds to Promote Public Health
As federal officials hint at overwhelming changes in how state health programs will be funded in the future, policymakers are strategizing how to reconfigure their programs to take advantage of the promised brave new world of flexibility and realigned funding. The National Academy for State Health Policy (NASHP), the de Beaumont Foundation, and the Association of State and Territorial Health Officials recently convened a small group of state health policymakers from 11 states to strategically address opportunities and challenges that may result from changes to the federal funding landscape.
The meeting produced a new paper, Blending, Braiding, and Block-Granting Funds for Public Health and Prevention: Implications for States, that charts a way forward for states interested in coordinating work and resources across programs.
“This paper is an important and much needed resource for state officials seeking to improve health and health equity by investing in building stronger, healthier, and more resilient communities during this time of change,” said Ana Novais, executive director of health at the Rhode Island Department of Health. To learn more about Rhode Island’s innovative financing to advance health and health equity, read this blog.
The 2017 annual NASHP state health policy conference also addressed braiding and blending funds for improved population health. The session, presented in partnership with the de Beaumont Foundation, featured officials from Rhode Island, Louisiana, Vermont, and South Carolina. Each state uses innovative braiding or blending models to address population health and non-clinical health needs through programs such as supportive housing and nurse home visiting for low-income first-time mothers. Read more.
Presented in partnership with the de Beaumont Foundation
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
