By Courtney Roman, Center for Health Care Strategies
State Medicaid agencies are increasingly seeking to incorporate members’ perspectives into their work through community advisory committees/boards, sometimes called CACs or CABs. These groups enable state agencies to hear directly from Medicaid members in a structured, consistent format. Through regular, open, and honest dialogue, these groups go beyond simply soliciting occasional member input and can instead contribute to tangible, member-directed changes in state Medicaid program policy that promote high quality service delivery and greater equity in health outcomes.
Earlier this year, California’s Department of Health Care Services (DHCS) launched its Medi-Cal Member Advisory Committee (MMAC), a first-of-its-kind group made up entirely of Medi-Cal (California Medicaid) members. This new committee will provide DHCS with feedback to enhance Medi-Cal policies and better respond to member needs.
The Center for Health Care Strategies (CHCS), with support from the California Health Care Foundation, partnered with DHCS to inform the design of the committee. Drawing from a multi-state landscape assessment, literature reviews, a Technical Advisory Group of subject matter experts, and interviews with Medi-Cal members and other stakeholders, CHCS developed recommendations to launch and sustain the new MMAC.
While these recommendations were developed for DHCS, they represent emerging best practices at work across the country. Medicaid member committees like California’s may soon be the norm; an April proposed rule from the Centers for Medicare & Medicaid Services (CMS) would require states to establish Beneficiary Advisory Groups to partner with existing Medical Care Advisory Committees, which are more limited in focus on medical care. The proposed rule suggests Beneficiary Advisory Groups would have robust regulations to ensure they effectively draw on the experiences of members and their families to shape Medicaid programs.
Design Considerations for Effective Community Advisory Committees
As many states begin to consider developing new or enhanced approaches to garner Medicaid member feedback, here are key considerations for developing a successful and sustainable approach:
Be intentional when identifying and supporting membership.
- Composition and size. Ensure composition reflects your state’s Medicaid population. Include a diverse mix of races, ethnicities, gender identities, sexual orientations, physical and intellectual/ developmental disabilities, and uses of Medicaid services (e.g., members on waiver programs, managed care, fee-for-service). Keep size manageable. A group of 10 to 15 allows for a robust and diverse mix of populations without being challenging to convene and facilitate.
- Recruitment. Effective recruitment requires a multipronged approach. Try leveraging provider networks, community-based organizations, managed care plans, and agency staff while using marketing events, social media, and print materials to get the word out.
- Compensation. Members should be fairly compensated for their time and expertise. Offer a stipend or gift card at each meeting, whether virtual or in-person. Plan to cover additional supports as appropriate, such as mileage, parking, public transit, rideshares or taxis, meals, technology support, and childcare.
Thoughtfully plan and prepare for meetings.
- Format. Be consistent in meeting format, length, and cadence. Offer virtual meetings to accommodate members located across the state. Meet every other month to keep up momentum.
- Translation. Real-time translation (in person and virtually) is important — at least in Spanish and American Sign Language (ASL). All translators should be native speakers and/or certified (e.g., ASL certified).
- Meeting facilitation. Facilitation can make or break a meeting. An ideal facilitator for a Medicaid member committee would have rich experience working with the community, a strong understanding of the state’s Medicaid program, and a background and race/ethnicity that reflects the state’s Medicaid membership.
- Meeting materials. Meeting materials should be easy to understand, free from jargon and acronyms, written at a sixth-grade reading level, and translated into members’ primary languages. Materials should be sent to group members at least one week before meetings. Co-create agendas with members to give them the opportunity for input.
Set the committee up for success and sustainability.
- Member support. Connect with committee members before and after meetings. These conversations can be short but are important opportunities to gather feedback and ensure that members feel heard, supported, and valued.
- Trust building. Building trust with members will not happen overnight but it is possible with patience and intention. Help members feel supported at meetings by greeting them individually and ensuring they have reliable transport home. Create space on agendas and in between meetings to provide honest feedback. Acknowledge when a mistake was made, apologize, and commit to make it right going forward.
- Feedback loops. Follow up when members offer recommendations or raise concerns, even with recommendations that cannot necessarily be implemented. Members will appreciate knowing how information is acted on and where their voices are making a difference.
- Impact measurement. Developing an evaluation component is key for ensuring committee sustainability. If the agency and members do not take time to reflect on their work and identify what success looks like, it will be challenging to continue to move forward together. To start, develop a brief, anonymous member survey to gather feedback after meetings. Use time at a future meeting to report on responses and work with members to identify what is going well and what needs improvement. Establish three to four measures of success for the committee at an agency level. If speaking to leadership about the committee two years from now, what would you want to be able to say was accomplished? How did the group help in the process?
Medicaid member perspectives should be at the center of program design and improvement. As state Medicaid agencies begin to form Beneficiary Advisory Groups, these elements will become more important than ever.
For more in-depth findings, including common obstacles and pitfalls, a survey of managed care plans’ committees, literature review, and an interview tool, read the full report.