Authors: Kelsey Brykman, Center for Health Care Strategies

To provide more effective, equitable care to people served by Medicaid, policymakers, plans, and health care providers are increasingly engaging community members to help inform program design and implementation. Enhanced community engagement can help foster trust between health care organizations and historically disenfranchised communities, focus on community priorities, and support strategies to implement culturally effective services.

New Medicaid rule supports enhanced beneficiary engagement

Effective July 9, 2024, the Ensuring Access to Medicaid Services final rule released by the Centers for Medicare & Medicaid Services (CMS) seeks to improve access to and quality of care for Medicaid beneficiaries. One aspect of the rule is revised Medicaid regulations aimed at enhancing the engagement of individuals with lived experience, which requires states to implement a revised advisory committee structure. Existing ‘Medical Care Advisory Committees’ (MCACs) will be renamed ‘Medicaid Advisory Committees’ (MACs) and states must also establish a new ‘Beneficiary Advisory Council’ (BAC). BACs will consist entirely of current or former Medicaid members, their family members, and caregivers, MACs will be required to have 25 percent of their membership drawn from the BACs. The rule also broadens the range of topics these committees will be able to advise Medicaid agencies on. Thus, instead of being limited to advising on medical services, proposed MACs will also be able to advise Medicaid on other issues impacting health outcomes such as eligibility and enrollment, Medicaid communications to members and providers, and disparities and biases in Medicaid.

Why is this important?

While MCACs were previously required to include “members of consumers’ groups,” vague regulations resulted in wide variation in how states used MCACs and the extent to which states engaged members with lived experience. This update: (1) sets a higher standard for the level of state engagement of individuals with Medicaid lived experience; and (2) supports an environment more conducive to effective member engagement. Feedback informing the rulemaking process described that individuals with lived experience often face challenges participating in multi-stakeholder committees due to factors such as unequal power dynamics or uncomfortable environments. In response to this, CMS is positioning BACs as a supportive, comfortable space for individuals with lived experience to discuss Medicaid issues. The aforementioned requirement for MACs to include BAC members also provides a way for members with lived experience to inform broader, multi-stakeholder discussions.

While state officials are already preparing for these changes, provider and community-based organizations may also have a role to play in shaping the MACs, sharing information with Medicaid members who may be interested in participating in the BACs and supporting their participation.

To what extent will individuals with complex needs be involved and supported?

Individuals enrolled in Medicaid have high and disproportionate rates of complex health and social needs. CMS encourages states to implement MACs/BACs that represent the diversity of their state’s Medicaid program. For instance, CMS notes in the final rule that states may consider representation from groups such as individuals with lived experience related to behavioral health services, “health or service issues pertaining specifically to people over age 65,” and “health or service issues pertaining specifically to people with disabilities.” Additionally, the rule expands requirements for how state staff must support MACs and BACs, to ensure meaningful participation among members with lived experience, such as by “providing research or other information needed.”

Resources to Support States in Engaging Individuals with Complex Needs

As states implement new MAC and BAC policies, policymakers can look to the following resources to understand emerging best practices for and examples of member engagement approaches:

Beyond the above resources, the Evidence-to-Action Collection, Community Engagement Interventions to Improve Health Equity, offers additional resources describing practical strategies for health care professionals to improve health equity through more effective member and community engagement. See also CHCS’ Community Member Engagement Resource Center, a resource that provides practical guidance for engaging Medicaid members in policy and program design development.

Print this Page
Share