Beneficiary engagement has been a federal statutory requirement in Medicaid since 1971 with varying degrees of effectiveness, but beneficiary engagement in Medicare is still new, relatively speaking. The Centers for Medicare & Medicaid Services took a significant step in advancing engagement of dually eligible beneficiaries when it required that Dual Eligible Special Needs Plans (D-SNPs) establish and maintain enrollee advisory committees (EACs) in January 2023.
Luckily there are already examples of effective EAC design and beneficiary engagement through demonstrations under the federal Financial Alignment Initiative. EACs are described in the Calendar Year 2023 Medicare Advantage and Part D proposed rule as an initial step in “enrollee participation in plan governance.” This is an important distinction because historically beneficiaries have been given opportunities to participate in plan guidance, but governance carries more weight. So how do states and health plans assist beneficiaries on their journey from guidance to governance?
In this Health Affairs blog post, Center for Health Care Strategies (CHCS) board member Henry Claypool, policy director with the Community Living Policy Center, Heller School for Social Policy and Management at Brandeis University and former director of the U.S. Department of Health and Human Services Office on Disability, and CHCS staff members Courtney Roman and Sarah Triano explore the central questions states and health plans should consider when seeking to meet the new requirement. They describe innovative examples from several states and present a range of ways dually eligible beneficiaries can engage in the governance of D-SNPs to shape policy and better serve enrollees.