States and local health departments, social service agencies, and related federal human services programs across the country serve some of the nation’s most underserved populations.

Government health and human services programs like Medicaid, Medicare, state health insurance exchanges, the Children’s Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF) face significant challenges when it comes to reaching vulnerable, disadvantaged, and hard-to-access to communities.

Yet, there are a number of evidence-based practices – implementable today – that can address these challenges, position the programs to effectively respond to public health threats, and improve overall citizen wellbeing.

Equity assessments and strategies

Health and health disparities in this country have existed for decades. COVID-19 exacerbated the inequities and demonstrated the disproportionate vulnerability among low-income and racial minority residents, refugees, immigrant, and migrant populations. Data show vastly higher COVID-19 case and death numbers among residents in poor neighborhoods and substantially higher rates of infection, hospitalization, and death among Black, Latinx, and American Indian and Alaska Natives Native Americans compared to White and Asian American/Pacific Islander individuals.

Unfortunately, this pattern of health inequity is replicated across these populations who also experience high rates of adverse social determinants of health. Root causes vary across populations and include access to and quality of care, education, language, health insurance, employment, income, community safety, stable housing, poor air and water quality, and low trust in government. This is why it’s essential to take a multifaceted approach to provide health and human services, starting with building partnerships, developing responsive, outcome-driven strategies, and improving the citizen journey to deliver effective program services to vulnerable communities amid an ever-changing health landscape.

Collaboration is a key, impactful strategy for reaching vulnerable communities, as factors affecting health equity are mostly localized.

• Enhanced, transparent communications build trust.
• Partnerships at the grassroots level with community leadership as well as organizations working with those communities.
• Together, health and human service programs and community groups can better address local needs, improve access to care and health care affordability, and promote up-to-date and accurate information about the services available to residents.

The data can also be used to tailor health programs to specific community needs. This is critical – because many people are enrolled in multiple health and human services programs. These individuals and families face a myriad of interconnected life challenges such as low-paying jobs, food insecurity, unsafe housing, lack of transportation, and few care options for their children and other dependents. Data from across programs can guide the design of effective health and health outreach solutions that deliver services where they’re needed most.

Across the board, innovative solutions – from implementing telehealth services to connecting with needed childcare and transportation to care coordination services – help bring important services and benefits to those in need.

Barrier and burden reduction

Beyond circumstances and the social determinants of health, significant barriers exist that prevent vulnerable individuals and minority or disadvantaged groups from even accessing health services and programs.

A comprehensive evaluation of these barriers is needed to enable agencies and programs to provide needed services that accommodate and/or extend additional support. These services include transportation, child and elder care, housing, legal, financial, emotional, and health care access support, and when possible, leverage networks such as family members, friends, and community resources.

Evaluation of barriers should explore individual and family needs, child support status, and other financial factors while identifying and mitigating barriers to employment such as training and professional development needs, health-related employment factors, and mental health and addiction/dependencies. These types of assessments can help drive equity in public service delivery. However, they must be standardized and accurate in determining functional eligibility or service level for home or community-based waivers and institutional services. High-quality, centralized, conflict-free analyses ensure that individuals receive the services they need without bias in the right service settings.

Lastly, “blending and braiding” services, i.e., combining two or more sources or streams of funding to support a program or activity, are important strategies that support the delivery of a set of services that meet the needs of citizens. These strategies enable agencies to centralize services and to avoid burden, redundancy, and confusion from the citizen perspective. Education and early childcare organizations have been using blending and braiding at the local, state, and federal levels for the past decade to sustain or increase funding. This strategy allows providers to expand and improve the quality of services and accelerate their delivery to vulnerable communities.

In part 2 of this two-post series, we’ll explore two more sets of best practices and methods for advancing health equity:  procurement and contracting and stakeholder and community engagement.

To learn more about how Maximus works to help agencies and programs holistically address health inequities, visit our Public Health practice here.