Medicaid serves as a vital public health safety net for over 79 million people, including many from historically excluded or marginalized communities. There is a great opportunity to improve Medicaid programs’ accountability for persistent health inequities by confronting the historical and structural racism perpetuated in the administration, policies, and practices that undergird the program.

The Medicaid Equity Monitoring Tool (MET) project is a collaborative effort from the State Health Access Data Assistance Center (SHADAC) with support from the Robert Wood Johnson Foundation (RWJF) and partner organizations working to assess whether a data tool could increase accountability for state Medicaid programs to advance health equity while also improving population health.

During the first phase of this project, a wireframe was created to organize the different sections of a potential tool, including a section on "Underlying Factors" that lead to and perpetuate health inequities for people of color and other historically marginalized communities.

In order to inform the Medicaid Equity Monitoring Tool (MET) project and the Underlying Factors section of the tool, SHADAC produced an annotated bibliography of resources to better understand the available academic and gray literature on those underlying factors of health inequities in Medicaid.

While the bibliography covers a number of structural and systemic underlying factors of health inequities (e.g., ableism, sexual orientation and gender identity discrimination), most of the resources compiled in the bibliography address structural racism specifically. These resources discuss the history, policy context, and impacts of systemic racism on Medicaid recipients.

As a follow-up to the creation of the annotated bibliography, SHADAC’s Health Equity Fellow held consulting conversations with authors of select resources cited in the structural racism section. Through these conversations, our goal was to:

1. Connect with experts in order to elicit feedback on key insights from SHADAC’s annotated bibliography

2. Ask experts questions about what topics related to systemic racism need to be discussed within the tool

3. Discuss strategies on how best to convey and disseminate this important information

This brief summarizes these conversations, including specific examples and quotes from experts, for audiences interested in communicating about the effects of structural racism with the aim to dismantle it.