By Anna Spencer and Courtney Roman, Center for Health Care Strategies

Medicaid agencies nationwide are gearing up to implement new strategies for involving members more effectively in shaping Medicaid program and policy decisions, in response to new federal regulations. In April 2024, the Centers for Medicare & Medicaid Services (CMS) released new regulations on access and managed care in Medicaid. These changes include a major update to requirements for how states convene Medicaid member advisory groups, elevating the importance of members playing a central role in driving Medicaid program and policy decision-making.

Below, we outline the changes and offer some guiding principles state agencies can use to meet the new requirements and integrate Medicaid members into the policymaking and program design process effectively and equitably.

What are the Changes?

MCAC Name Change and Overhaul

Medicaid agencies are required to convene Medical Care Advisory Committees (MCACs) to advise the state on health and medical care services. These rules, established by CMS in 1978, stipulate that membership on MCACs must include Medicaid members, patient advocates, providers, and other stakeholders. But these rules have not been updated since and give states wide latitude in administering the advisory bodies. As a result, there is considerable variability among states in terms of MCAC composition, meeting frequency, and influence on state Medicaid programs. In introducing the updates, CMS noted feedback that MCACs in some cases “operate simply to meet the broad Federal requirements,” rather than to provide authentic community member perspectives to help inform care delivery improvements.

The regulations reimagine the MCAC, first by renaming it the Medicaid Advisory Committee (MAC), which better reflects the committee’s new purpose and focus. The new rule also creates more robust requirements around composition, meeting frequency, public access, reporting, staffing, and “the principles of bi-directional feedback, transparency, and accountability.” The regulations require participation from at least one other state agency serving Medicaid members, which would facilitate efforts to address health-related social needs, such as housing, education, or nutrition. The goal of the MAC is to more meaningfully engage former and current Medicaid members, making the Medicaid program more responsive to members.

Creation of New, Member-Focused Advisory Groups

The new regulations also require each Medicaid agency to launch a member-only advisory group, called the Beneficiary Advisory Council (BAC). This advisory group will be composed solely of current or former Medicaid members, their family members, and caregivers, and is intended to provide direct, member-informed guidance and perspectives to the Medicaid agency. To ensure that member perspective is represented in the MAC, 25 percent of the BAC members will also serve on the state’s MAC, a requirement which will be phased in over two years.

States will have one year from the final effective date of the rulemaking to recruit members and establish their MACs and BACs. They will then have an additional year to hold meetings and publish their first required annual reports.

These changes are significant and important because they expand the role that Medicaid members can play in shaping all elements of state Medicaid programs beyond the previous, more restricted purview of MCACs to “health and medical care” only. The MAC and BAC structures will allow direct member input across categories including quality of care, communications, eligibility and enrollment, care delivery, and services. Further, both advisory bodies will create formal mechanisms for elevating member concerns and priorities to drive the more equitable and effective delivery of Medicaid programs and services. The changes also include new strategies for recruitment and outreach to expand the reach to potential MAC and BAC members. Medicaid members can expect to hear more about these groups than they have in the past increasing the diversity and geographic spread of membership.

How Can States Prepare for Medicaid Member Advisory Group Changes?

The two new advisory groups offer an important opportunity for state Medicaid agencies to strengthen and expand on what is already underway with their MCACs and other member-facing engagement activities.

Thoughtful planning can help states prepare for these changes. The following six organizing principles can help Medicaid agencies in effectively developing and implementing these member advisory groups:

  1. Trust. Many Medicaid members come from communities that historically have been racially, culturally, socially, or economically marginalized, and have experienced bias and discrimination from the health care system. As a result, building trust between Medicaid members and the state agency is an essential first step to gaining meaningful input and feedback. To build trust, Medicaid agencies should consider making explicit and ongoing commitments to their Medicaid member advisory groups that their input is valuable and will play a role in agency decision-making. External messaging should consistently and clearly communicate the goals and value of understanding member experiences, particularly for more effective, member-informed policymaking.
  2. Inclusion and diversity. Medicaid agencies should ensure that member advisory groups reflect the full diversity of their member population. This includes people from different racial and ethnic backgrounds; non-native English speakers; LGBTQ+ individuals; parents of young children; young adults; people with disabilities; individuals with behavioral health conditions; and residents across different geographic regions. To achieve this goal, Medicaid agencies can develop culturally and linguistically tailored outreach strategies to secure broad and inclusive representation on their advisory boards.
  3. Accessibility. Medicaid members should feel welcomed, valued, and included when serving on Medicaid member advisory groups. Understanding and addressing barriers to participation is critical, including incorporating translation and interpretation services to ensure language accessibility.
  4. Equitable compensation. Compensating community members for their time ensures that those most impacted by Medicaid programs and policy can be active participants in engagement activities, including advisory groups. Medicaid agencies should establish clear compensation guidelines, as well as provide additional supports such as meals and onsite childcare, technology support, and transportation assistance.
  5. Thoughtful planning and preparation. Advisory group convenors should provide participating members with clear information regarding the group’s purpose, roles, and responsibilities; what to expect before, during, and between meetings; a list of key terms; and how the Medicaid member advisory group will inform policy and program development and implementation.
  6. Trauma-informed approach. Advisory group activities should empower community members. To build trust and encourage open sharing, activities should incorporate trauma-informed approaches, including safety, trustworthiness, peer support, collaboration and mutuality, empowerment and choice, and an understanding of cultural, historical and gender issues. States should consider providing training for convenors and participants on trauma-informed principles.

What’s Next?

Medicaid agencies across the nation are in various stages of operating Medicaid member advisory groups. Some have had experience standing up and maintaining these groups, others are in earlier stages, and some could be new to the process. The new CMS rules present a unique opportunity for Medicaid agencies to connect with members in a more systematic and meaningful way. It will be important for agencies to take a thoughtful approach creating these advisory boards and ensuring that Medicaid lived experience is fully integrated in program and policy decision-making.

This blog post has been updated from an original version, published April 9, in advance of the final rule.

Posted: June 2024