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
EVIDENCE ROUNDUP
This blog post is part of a Playbook series connecting evidence and implementation resources with emerging state and federal policies to help enhance services for people with complex needs.
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:
- Leveraging Community Expertise to Advance Health Equity: Principles and Strategies for Effective Community Engagement: Based on interviews with states, community-based organizations, consumer advocacy groups, and philanthropic organizations, this report provides recommendations on how to design and implement community engagement initiatives to advance health equity.
- Exploring Consumer Engagement Experiences: A Research Project Co-Led by the National Consumer Scholars: This study highlights the experiences of consumers and staff of health and social service organizations involved in community engagement work and provides insights to support effective consumer engagement, including for individuals with complex needs.
- Medi-Cal Member Advisory Committee: Design Recommendations for the California Department of Health Care Services: This report describes recommendations and research that informed the California Department of Health Care Services’ launch of its Medi-Cal Member Advisory Committee in February 2023.
- Strategies for Meaningfully Engaging MassHealth Members to Inform Program and Policy Decisions: Drawing from a literature review and interviews, this report shares a Medicaid member engagement framework and principles to guide state policymakers.
- Building Trust: Leadership Reflections on Community Empowerment and Engagement in a Large Urban Initiative: Based on interviews of agencies participating in a Los Angeles County Department of Mental Health community capacity-building initiative, this paper provides insights and a framework to support community trust-building.
Beyond the above resources, the Playbook’s Community Engagement Interventions to Improve Health Equity Collection offers additional resources describing practical strategies for health care professionals to improve health equity through more effective member and community engagement. See also the Community Member Engagement Resource Center, a resource developed by the Center for Health Care Strategies that provides practical guidance for engaging Medicaid members in policy and program design development.
Share Your Member and Community Engagement Resources and Tools
Do you have a resource or emerging best practice related to engaging communities in program and policy design? Share your experience with the Playbook. We are interested in growing our library of evidence and implementation best practices to help those in the field strengthen and build successful community engagement approaches.