States accelerated bills focused on health equity from 2020 to 2023, Chartis analysis finds

States have accelerated legislation intended to promote health equity in the last few years, with a special focus on several key areas like bias training and maternal health, a new analysis found (PDF). 

Chartis, a healthcare consulting firm, used more than three years of data from state departments of health and state legislatures from January 2020 to August 2023. The analysis, complemented by an interactive tracker, covers all 50 states, Washington, D.C., and U.S. territories. 

“Healthcare inequities continue to be one of the most significant and complex challenges in healthcare today,” report co-author Shaifali Ray, principal and vice president of the Chartis Center for Health Equity & Belonging, said in a press release. For organizations to move the needle, they need to know about the evolving regulatory landscape, she added. 

At a national level, the Centers for Medicare & Medicaid Services, The Joint Commission and the National Committee for Quality Assurance have introduced new requirements, certifications and initiatives to address health equity. Many states have followed suit, in particular for their Medicaid programs. A total of 41 states have new, expanded or planned Medicaid initiatives to address racial and ethnic disparities.

Other areas of focus for states have included increasing access, addressing social drivers of health, behavioral health care and maternal health outcomes, per Chartis. States have established requirements for increasing cultural humility or providers and staff, expanding outreach to underserved populations and establishing the infrastructure and capabilities to assess and reduce disparities. 

Those with the most statutes include Washington, Illinois, Maryland, Colorado and New York. Meanwhile, those with the fewest statutes include Arkansas, Idaho, North Dakota, Mississippi, Nebraska, South Carolina, Texas, Wisconsin and Wyoming. 

“Having regulations at the federal level and at the state level can really help to support the work we see many of our healthcare organizations already doing,” Ray told Fierce Healthcare.

While 2020 was mostly focused on COVID-19 and infrastructure support, 2021 focused on insurance coverage expansion and education of healthcare workers on implicit bias. Then, 2022 and 2023 saw an emphasis on maternal and infant health. The number of bills grew exponentially each year.

Four states didn’t enact any statutes—Kansas, Montana, New Mexico and South Dakota—though that doesn’t mean they have no statutes on health equity at all.

In a report on its findings, Chartis encouraged healthcare organizations to stay abreast of regulatory activity and to reevaluate their health equity goals to ensure they align with emerging requirements. Chartis also encouraged organizations to evaluate their collection and use of demographic data, develop a dashboard that summarizes data on disparities and evaluate and update their training and education.

“Government policy is a really impactful way to ensure that organizations are maintaining compliance and following regulations,” Ray said. “They can also facilitate opportunities to accelerate change.” 

Chartis hopes to update the tracker on an ongoing basis.