Let’s face it – health equity shouldn’t be optional in healthcare. It should be baked into the whole system.

But what’s the current state of health equity efforts from the Centers for Medicare & Medicaid Services (CMS)? And why should you care?

In 2025, CMS is doubling down on health equity through updated frameworks, strategic initiatives, and program enhancements. Their goal? Reduce health disparities, improve access for underserved populations, and make equity the backbone of healthcare.

So let’s dive into what CMS is doing, what’s working, what’s not, and what it means for patients and providers.

Skip ahead:

1. CMS Health Equity Framework
2. Key Programs and Initiatives
3. Preventive Care and Community Engagement
4. Challenges and Policy Changes
5. What This Means For You

CMS Health Equity Framework: The Big Picture

CMS isn’t just talking about health equity – they’ve created a comprehensive 10-year Framework for Health Equity (2022-2032) to guide their work.

Think of it as their roadmap to eliminating avoidable health disparities for disadvantaged groups. And it’s built around five strategic priorities:

1. Better data collection – You can’t fix what you don’t measure. CMS is enhancing data on demographics and social determinants of health to understand where disparities exist.

2. Smarter resource allocation – Making decisions about where to invest that will create more equitable outcomes.

3. Supporting providers and health plans – Offering guidance and incentives for culturally-tailored, high-quality care.

4. Removing access barriers – Addressing language barriers, health literacy challenges, and disability accommodations to improve patient safety and experience.

5. Community collaboration – Working with state, local, and community organizations to drive health equity initiatives effectively.

This framework isn’t just gathering dust on a shelf – it’s actually shaping CMS programs and policies across the board.

Key CMS Health Equity Programs and Initiatives

1. Medicare Advantage Gets an Equity Upgrade

If you’re one of the millions of Americans on Medicare Advantage, listen up. CMS has made important updates for 2025:

• Better access to mental health care – New requirements ensure MA plans have enough outpatient behavioral health providers in their networks. This is huge for addressing mental health disparities.

• Health Equity Index in Star Ratings – Plans are now incentivized to improve care quality for underserved populations without penalizing providers who serve complex patients.

• Culturally appropriate services – MA plans must offer services tailored to diverse populations, breaking down language and cultural barriers that affect care.

2. Addressing Social Determinants of Health (SDOH)

Let’s be real – your zip code often determines your health outcomes more than your genetic code. CMS is finally addressing this with:

• Standardized SDOH screening – New billing code G0136 allows providers to be reimbursed for screening patients for social risk factors during Annual Wellness Visits. And it’s covered 100% with no patient cost-sharing!

• Care coordination for social needs – Medicare now reimburses providers for helping patients navigate resources for transportation, housing, and food insecurity.

• Support for caregivers and community health – New Community Health Integration and Principal Illness Navigation programs help connect patients with vital social resources.

3. Rewarding Excellence for Underserved Populations (REUP)

Instead of just penalties, CMS launched REUP to provide financial rewards to healthcare organizations that demonstrate excellence in caring for underserved communities.

This is a smart approach – motivating providers to prioritize health equity without risking financial penalties if they serve challenging populations.

Advancing Preventive Care and Community Engagement

Prevention is cheaper than treatment – both in dollars and human suffering. And it’s especially important for vulnerable populations.

CMS is emphasizing preventive care through:

• Advanced Primary Care Management (APCM) – A new bundled care program that expands coverage for Medicare beneficiaries without chronic conditions. This promotes early intervention before problems become severe.

• Annual Wellness Visits with SDOH focus – Encouraging health assessments that incorporate social factors for more personalized care planning.

CMS is also bringing stakeholders together through events like the annual CMS Health Equity Conference, where government officials, healthcare providers, academics, and community organizations share best practices and build partnerships.

Continuing Challenges and Policy Developments

Not everything is perfect in CMS’s equity efforts. Some recent policy changes have sparked debate in the health equity community.

For instance, CMS announced they’ll no longer require health equity plans as part of Equity Operations Manual submissions starting in 2025. Critics worry this could reduce transparency and accountability.

But it’s not all concerning news. CMS finalized the 2025 Marketplace Integrity and Affordability Final Rule, which includes repealing the prohibition on denying health insurance due to unpaid past premiums. This should increase insurance accessibility for many Americans.

What This Means For You

If you’re a healthcare provider, these changes mean new opportunities for reimbursement when addressing social needs and providing culturally appropriate care. It also means new metrics to track and report.

If you’re a patient – especially one from an underserved community – these initiatives should translate to better access, more personalized care, and improved outcomes over time.

And if you’re a health system leader or policymaker, CMS’s framework provides a roadmap for aligning your own equity efforts with national priorities.

Health equity isn’t just a nice-to-have – it’s essential for building a healthcare system that works for everyone.

The CMS health equity updates for 2025 represent real progress, though challenges remain. By prioritizing equity in policies, programs, and partnerships, CMS is laying the groundwork for a healthcare system that doesn’t just treat disease but addresses its root causes and ensures everyone has a fair shot at good health.