There is no better way for state Medicaid programs to understand the strengths, needs, and barriers faced by Medicaid members than to simply ask them directly. Engaging members is increasingly important to states, plans, and providers to inform their efforts to improve outcomes and advance health equity. The contributions members can make to policy and program decisions is invaluable, as their perspectives come from “on the ground” — not a theory on paper. But, engaging members needs to be done in meaningful and sustainable ways.

The Center for Health Care Strategies recently spoke with Elizabeth Matney, Iowa Medicaid Director, to learn about her agency’s experiences in implementing a town hall program that successfully integrates member and stakeholder perspectives into Iowa Medicaid’s program and policy design. Since August 2021, Iowa Medicaid has held monthly virtual town halls for Medicaid enrollees and stakeholders to discuss topics like maternal health and natural supports and to share information and garner feedback on impending legislation, program implementation updates, and other pressing topics. The virtual town halls draw in upwards of 100 attendees each month.

Q: What was the impetus behind Iowa Medicaid’s efforts to engage members? What were you hoping to achieve?

A: When I came on as Medicaid director and sat down with staff, we talked about our priorities and strategic vision. I heard loud and clear from our staff that we needed to increase transparency and build relationships with the public. With that in mind, we started to think about ways to mobilize quickly. How could we do this in a positive way? We had no idea how we were going to be received — and we did go through growing pains because people felt like they hadn’t been heard in many years.

All of those pent-up voices and narratives had to surface before we could start having other important conversations. And we are still doing the trust building. The continuous effort in building trust is not just creating space to hear from the public and providing updates about our work, but really being committed to creating change based on the feedback. The more they see where their voice translates into action, the more trust they have in the Medicaid program and our team that sits before them in each town hall.

Q: Can you describe some of the recruitment strategies that Iowa Medicaid implemented to engage community members? Has there been sufficient representation across Iowa communities?

A: We have a website that’s specifically dedicated to the town halls. We also leverage social media. I talk about the town halls during regular meetings with advocacy groups who disseminate information through their channels as well. There are several Facebook groups that post the town hall meetings — some of these groups are not necessarily cheerleaders of Medicaid in a positive way, but we’ve embraced that. These watchdog type groups are helpful in spreading the word, and these are the folks we want to engage with to build their voice into our program. Members of these groups haven’t always had the best experiences with Medicaid, so we want to learn from that rather than push it away.

In terms of representation, we tend to have a core group of folks that are the same In terms of representation, about 20 percent tend to be a core group of folks that are the same at every meeting. The other 80 percent rotates among various groups and individuals. We have a goal to do more outreach to weave in perspectives from Iowa’s marginalized populations — we want to ensure we include the voices of all Iowans.

We are aware that the hours of the monthly town halls might be a barrier for some. We are thinking about how we might alternate the time to be more inclusive for people’s different schedules and lifestyles. We are also thinking about whether there are other mechanisms where people feel more comfortable engaging that’s not necessarily a virtual town hall platform. One important thing that we learned early on is that the technology set up needs to be as inclusive as possible — things like closed captioning, the option to call in if high speed internet isn’t available. We have become hypervigilant about avoiding these types of barriers.

Q: How do you measure success of Iowa’s community partnership program efforts? What do you think led to successful member engagement in this work?

A: One of the first metrics of success for me and my team is that people continue to show up. We know they wouldn’t show up if they felt there was no value in the sessions.

From the feedback we have received, we have several products and process improvements that we are working on currently. For instance, in a recent meeting, we heard the need to post policy clarifications that the state gives to MCOs — we’re rolling that out next month. Our project plans incorporate what we’re learning in the town halls, and we have achieved milestones within those projects. Each one of those milestones is a metric of success because we’re taking feedback from the people we serve and making the member experience even better.

This work has helped us create a more customer friendly model. It also constantly reminds us of why we are here. We have a tendency to be policy wonks, but beyond the policy that is on paper, there are real people that we do this work for.  Keeping engaged with our members in the town halls gives us a critical connection point.

Q: Do you see any opportunities to improve this program? How will community partnership be meaningfully sustained in the long term?

A: A key opportunity is to continue to push to reach a broader base of Medicaid enrollees, so that we truly have representation from a multitude of perspectives.

I also try to provide updates on any progress we’ve made at each town hall but sometimes we don’t have the bandwidth to cover everything each month. We have opportunity to create better messaging and visuals that convey the work we have been doing to address issues and what we gleaned from the town halls. If people could track the concerns and progress being made on a dashboard, it would be really helpful and create more transparency.

In terms of sustaining the effort, it needs an investment of time more than anything. Overall, I see it being self-sustaining. We get so much out of it on a regular basis and by the time the next month’s town hall rolls around, we are excited to hear a new set of feedback. It was a heavy lift to launch, but it has sustained itself over time. Medicaid enrollees’ voices have become embedded in our discussions and decisions — they are now part of our Medicaid lifestyle, rather than something to keep up with.

Q: What advice would you give to other states considering strategies for engaging members in decision-making?

A: Just do it. It might seem daunting, and the lift is heavy in the beginning. But once you get past the first several months, it’s hard to imagine life without it. It provides great content that is easy to act on. An example of something we were able to act quickly on happened last fall when implementing rate increases. Through a town hall discussion, we realized there was a disconnect between intent and how it was actually rolling out on the ground. We were able to rectify the process quickly.

I would also advise to stay open to the dialogue. Be willing to sit and hear from members for the first few months before you try to launch into problem solving.

It’s important to debrief with staff as well. Sometimes meetings are emotionally charged and heavy. We take time to check in with one another and process the feedback. Even in a virtual environment, we see the people on the other side of policy and it’s easier for us to connect and build empathy with each other.