Member feedback is critical to effective Medicaid programs. States have created a range of formal ways to hear from members — from federally driven Beneficiary Advisory Councils to listening sessions and community partnerships — which play an important role in elevating member voices in structured and sustainable ways. While formal mechanisms are important, they work best when paired with an agency culture that explicitly values listening and learning. That culture is set by leadership — where leaders show up, how they listen, and what they do with what they hear.

To better understand what this looks like in practice, the Center for Health Care Strategies spoke with Medicaid leaders in three states — Pennsylvania, Nevada, and Wisconsin — about how they stay connected to the people their programs serve. They described day-to-day, intentional, and often low-resource practices that keep them grounded in the realities of the communities they serve. Together, these examples show how leaders can foster a culture that values member feedback and turns listening into action.

Centering Dignity in Pennsylvania

Sally Kozak, Pennsylvania Medicaid Director, stays connected to members by listening to customer service calls and, at times, personally stepping in to help resolve difficult cases. The practice began after she saw poor customer satisfaction ratings and wanted to understand what was driving them. Listening to calls revealed a more complex picture than a simple performance issue. While the member service team was often doing a good job, individuals were sometimes getting bounced between contacts — calling one number listed in a letter, being referred elsewhere, navigating phone trees, reaching voicemail, and eventually dialing random numbers in hopes of reaching a real person.

Additionally, because Sally’s name and title are publicly available, members also sometimes contact her directly. If someone takes the time to find her, she believes they deserve a response. Sometimes that means connecting them with the right staff. Other times, it means picking up the phone herself. For Sally, these conversations are not outside the role of a Medicaid leader — they are part of it. Listening directly to members helps her understand not only the problems they face, but also how it feels to navigate the system and where it is breaking down.

These interactions have helped her better understand member and family frustrations, provider challenges, and gaps in coordination across systems and agencies. Sally described how insights from these conversations helped inform efforts to streamline processes for children with complex medical needs and improve transitions as youth age out of services. Some changes have been structural, others smaller — such as improving how calls are routed and creating clearer points of contact for complex cases. In each instance, the insight came from listening closely enough to see where families were hitting roadblocks and refusing to let those issues remain buried at lower levels of the system.

Throughout this work, Sally emphasizes the importance of dignity — making people feel valued, rather than overwhelmed by a complicated system. This commitment has also shaped agency culture. By staying personally connected to member experiences, she has reinforced a broader expectation that leaders stay close to the people their programs serve.

Tuning into Rural and Frontier Communities in Nevada

As Nevada expanded managed care into rural and frontier communities, Medicaid Director Ann Jensen and her team set out on a statewide tour to hear from providers and members about what the transition meant on the ground. The scale of Nevada’s geography can be hard to grasp from a state office — in one week alone, Ann and her team drove 930 miles to visit six hospitals.

Spending time across the state made rural health care challenges more tangible, from traveling long distances for care to limited access to birthing hospitals and other essential services. The visits also challenged common assumptions about rural communities. While resource constraints are real, Ann was struck by the creativity and pride of rural hospitals, providers, and community members who are deeply committed to meeting local needs.

The tour shaped how Ann and her team approach their work at the Nevada Health Authority. The conversations helped bring local realities into agency discussions and created opportunities to ask more practical questions about feasibility: how a policy would work in rural areas, what front-line providers need to implement it, and where additional support may be necessary. Showing up in person strengthened relationships with providers and communities, creating space to address confusion or frustration in real time. It also highlighted the innovative solutions already emerging in rural areas and reinforced the importance of ensuring that local perspectives inform agency decisions.

Listening on the Ground in Wisconsin

Bill Hanna, former Wisconsin Medicaid Director, stayed connected to Medicaid members by getting out of the office and into the communities where policy is experienced. Over time, this practice spread to his senior leadership team, who established quarterly site visits to hear firsthand what was happening across the state and understand how state-level decisions were landing locally.

Visits took place in a range of settings, including hospitals, dental clinics, community action organizations, school districts, and organizations working at the intersection of health and social needs. During visits, the team asked questions about the community itself — what outsiders needed to understand, what members were experiencing, and what local context might otherwise be missing.

The visits gave leaders a deeper understanding of community experiences than formal reporting alone could provide. Insights from these visits often resurfaced later in policy discussions. A conversation about a fiscal or administrative change could prompt someone on the senior team to recall a small county provider and ask how a new requirement might play out there. In other cases, staff returned with examples of strong local partnerships that could inform work elsewhere. The value is not just what leaders learn in the moment, but what they carry forward into decision-making.

The visits also revealed barriers that may be easy to overlook from within the agency but can have an outsized impact on providers and communities navigating a complex system. Nearly every visit brought up technical questions that agency staff could answer on the spot, resolving confusion and highlighting opportunities to make the agency a more accessible partner. It also led to concrete results. Bill shared that ideas from these community visits informed the state’s Rural Health Transformation proposal, including strategies to expand dental access in rural communities. Over time, the visits became a practical way for Wisconsin Medicaid leaders to understand how agency decisions are experienced across the state and to bring those insights back into their work.

What These Stories Show

These examples differ in form but point to a shared lesson: staying connected to member experience is shaped not only by formal engagement infrastructure, but also by the everyday choices leaders make to stay close to the people and communities they serve. Whether visiting communities, traveling to rural hospitals, or responding directly to member concerns, these practices surface what routine reporting can miss — where people get stuck, what feels confusing or intimidating, what communities are already doing well, and where the system needs to improve.

These practices shape agency culture. When leaders show up, ask questions, and carry what they hear into decision-making, they signal that member experience belongs in both formal engagement processes and day-to-day policy and operational decisions. For leaders looking to deepen member-centeredness, the takeaway is simple: meaningful connection does not always require a major new initiative. Sometimes, it starts with showing up, making the call, asking a different question, or creating space for people closest to the work to be heard.