• Safety net health plans are increasingly using health equity committees and councils to involve internal staff, providers, community partners, Medicaid members, and others in the community in the design of equitable programs and policies. 
  • While health equity committee and council structures vary across health plans, a common set of organizational factors contribute to their impact in advancing health equity.
  • This brief outlines promising practices to guide successful implementation of health equity committees and councils drawn from a survey of 12 safety net health plans.

Safety net health plans are using health equity committees and councils to align internal and external stakeholder priorities and to drive progress on health equity goals across their plans. The goal of health equity committees and councils (referred to in this brief as health equity groups) varies widely across plans depending on the needs and opportunities of the organization and the communities they serve. This brief explores how safety net health plans are using these advisory groups to help them reach their health equity goals, including state and federal priorities. While findings are plan-specific, the factors and considerations addressed can also inform stakeholders at other health care organizations, including state Medicaid agencies.

To better understand how safety net health plans are using health equity groups to advance their health equity efforts, the Center for Health Care Strategies (CHCS) and the Association for Community Affiliated Plans (ACAP) surveyed health plans participating in the ACAP-CHCS Health Equity Learning Collaborative. This brief shares survey findings from 12 Medicaid safety net health plans that have implemented health equity committees and councils within their organizations. It highlights factors that increase the efficacy and impact of these health equity groups and offers considerations for working to strengthen and sustain these groups.


CHCS and ACAP conducted an online survey of 15 Medicaid plans participating in the Health Equity Learning Collaborative in August and September 2023. Of 15 plans that received the survey, representatives from 12 plans responded (an 80 percent response rate).

The survey sought to identify:

  1. Implementation and experiences of health equity committees and councils;
  2. Relationships between the health equity committees and councils and the individuals within the organization leading health equity work;
  3. Accountability and decision-making processes used by health equity committees and councils; and
  4. Position and governance of committees or councils within health plan organizational structure.

Defining Health Equity Committees and Councils

For this brief, a health equity committee or council is defined as a formal group or team within a managed care organization tasked with advancing strategies to address health disparities and/or inequities, and may or may not include individuals external to the health plan. Organizations may use different terms to describe these groups, e.g., “health equity workgroups.”


Of the 12 plans that responded to the survey, 11 indicated they have one or more health equity council and/or committee. With some variation, most plans used the term “council” to refer to an internal advisory body that provided strategic guidance, while “committees” were more often responsible for operations and implementation (see Exhibit A below).

Membership in health equity groups varied. Some plans have groups comprised of health plan staff only, while others reported a mix of internal staff and external stakeholders, such as plan members, providers, and community partner organizations. For example, one plan shared: “the Community Health Equity Committee intentionally convenes a group of diverse members representing several key stakeholders within health care including health plan staff, community partners, network providers, and enrollees in the health plan.

Several plans shared the responsibilities and reporting structure of their health equity groups, shedding light on how they operate. For example, one plan’s committee charter states “the Committee is responsible for approving and prioritizing health equity initiatives and strategies brought forth by work groups, committees and councils defined within the Health Equity Governance Structure.” Another plan describes its health equity council as being “responsible for providing direction and overseeing [their] strategy, priorities, and opportunities to help advance [their] goals as an organization, improve the health and lives of [their] members, and reduce health inequities.”

Exhibit A provides additional details on the structure of these health equity groups and differences and similarities between what plans label as “councils” and “committees.”

Exhibit A: Health Equity Councils vs. Health Equity Committees

Table with four columns and two rows. Columns are purpose, participants, governance, and accountability. Rows are health equity council and health equity committee. For councils, purpose is: An advisory body that provides strategic guidance and oversight to advance organizational health equity goals. Participants is: Senior and executive plan leaders and external stakeholders, which may include plan members and/or community members. For committees, purpose is: A workgroup or team that works to develop and operationalize organizational health equity goals. Participants is: Senior leadership, managers, and frontline staff at the plan. May also include plan members and/or community members. For both councils and committees, governance is: Typically housed in quality, population health, or operations departments.  Accountability is: Led by managerial and senior-level staff in designated department who report the group activities to the plan’s executive leadership and/or board of directors.

Health equity committees and councils provide a way for plans to partner with plan members and community members to reduce health inequities and develop community-informed solutions to programmatic challenges. Almost all plans surveyed shared a desire to incorporate more plan members and community members into their health equity groups. To recruit these individuals, surveyed plans use the following approaches:

  • Promoting in quarterly member newsletters, paired with outreach from designated staff to engage with interested individuals;
  • Tapping into existing networks such as member advisory councils and community partners (e.g., local health departments, school systems); and
  • Partnering with an organization that has expertise in member and community engagement to help recruit and support members interested in participating.
An icon showing two speech bubbles.

SURVEY QUESTION: What types of decisions have been influenced by plan members?

Health Plan Answer: Members have given feedback on the types of articles they would like to see in the member and provider newsletters and types of services that are lacking in their communities. A recent example of a decision influenced by Member Advisory Council members, was language being used in internal documents. The members were asked to provide feedback on an internal cultural competency document. They did not like the term “special populations” and suggested using “diverse populations.” The document was revised using the suggested language.

Key Factors for Effective Health Equity Committees and Councils

Plans reported a variety of strategies for designing and implementing these groups. Below are four key factors that contribute to these groups having a meaningful impact on health plan efforts to advance health equity and in ways that are operationally sustainable.

1. Leadership Buy-in and Participation

Plans highlighted the importance of leadership buy-in and participation. One plan noted “having our leadership represented on the council to bring a voice and provide direction to the organization’s health equity strategic plan helps us advance our goals.” Senior leadership participation includes: (a) attending meetings and being active members of the committees or councils; (b) holding teams accountable for progress metrics; and (c) communicating the work to internal and external key partners and stakeholders (e.g., boards of directors and community-based partners).

2. Health Equity Focus Woven into Existing Structures

Many plans noted the value of integrating health equity work into existing organizational structures. However, one plan identified the challenge of “continually ensuring that all business areas recognize health equity is not just one person’s role [but rather] is the responsibility of all to integrate into daily responsibilities.” Several plans reported addressing this challenge by incorporating and pursuing health equity goals through various workstreams and across departments. One plan noted “the majority of our [health equity-related] work plan items impact multiple departments that work together to achieve our [shared] health equity strategic goals.” Many plans reported success with establishing cross-departmental health equity-focused projects, which makes it easier to operationalize health equity goals and ensure they are explicitly embedded in the work of all teams. Health equity groups can support this work by collecting and sharing information about cross-departmental projects, giving input and feedback where requested, and tracking actions that help the plan move forward on overall health equity strategic goals.

Exhibit B illustrates a plan’s reporting structure where it incorporates health equity activities into existing committees.

Exhibit B. Health Plan Organizational Chart

Organizational chart with four levels. Level 1: Board of directors. Level 2: Quality assessment and performance improvement committee. Level 3: Board of directors and quality of clinical care committee. Level 4: Under board of directors are three committees: administrative appeals and grievances committee, CLAS health equity and quality committee, and community advisory committee. Under quality of clinical care committee are two committees: pharmacy and therapeutics committee and medical appeals committee.

3. Clear Accountability Mechanisms and Decision-Making Processes

When asked about accountability mechanisms to support progress by the committees and councils, many respondents mentioned a common set of strategies, including:

  • Annual work plans that detail the tasks and activities that the health equity group commits to pursuing;
  • A well-defined governance structure and reporting criteria; and
  • Regular written or verbal reports of updates on key activities and metrics to members, senior staff, and board members.

One plan shared that members of the health equity committee are “required to attend the meetings and meet with the Director of Health Equity between meetings to determine work plan items and measure progress. The Director of Health Equity subsequently presents progress on our health equity strategic plan at each committee meeting.” Exhibit C provides an example of a plan’s governance structure for their health equity activities.

Exhibit C. Health Equity Governance

Governance structure with four levels entitled governing body, strategic decision making and oversight; program/strategy monitoring, and program/strategy development. Level 1 includes service quality oversight committee (SQOC). Level 2 includes health equity steering committee and service excellence committee. In Level 3, under the health equity steering committee is an external community health equity committee and health equity work group. Also in Level 3 under Service excellence committee is the health equity work group. In Level 4, under the health equity work group is a health equity data collection work group, SOGIE health advisory council, and other internal work groups/committees integrating health equity.

Participant plans’ committee charters also outline decision-making processes and authority of the health equity groups. Exhibit D is an example of a decision-making process of a plan health equity committee.

Exhibit D. Decision-Making Process of a Health Equity Steering Committee


An icon of a person speaking into a microphone.

1. Chair clearly defines the decision point with a motion to approve.

An icon of a speaker pointing to their presentation in front of two audience members, one of whom is raising their hand.

2. A committee member must second the motion to proceed to a vote.*

An icon of a pie shart showing a 51% majority. The slice representing 51% has a blue checkmark in it.

3. A quorum of 51% of committee members is required to take a vote. Voting may take place via email. Delegates may also vote by proxy with prior notification to the Chair.

An icon of a thumbs-up hand that is green, and a thumbs-down hand that is red.

4. A majority vote will determine if the motion is approved. Any electronic votes shall be recognized at the next committee meeting and the results of the vote shall become part of the record.

*Voting committee members are determined by the committee charter. In the event that a member departs, the Chair will identify a replacement.
Source: Adapted from a CHCS-ACAP Health Equity Learning Collaborative survey respondent.

4. Communication Strategies

Survey respondents shared mechanisms that their health equity committees and councils developed to help break down silos and function effectively across teams, including robust internal communications channels. Sample communications strategies shared by participant plans included discussions of the group’s work in recurring cross-departmental and internal staff meetings and posting health equity-related updates on their organization’s intranet. A few plans mentioned strategies to inform external stakeholders and partners of their organizational health equity efforts, such as sharing updates through the plan’s website, provider portals, and town hall meetings.

Key Recommendations for Implementation

The survey results offer a variety of insights that can inform implementation for safety net health plans interested in establishing or strengthening health equity groups. Following are four takeaways:

  1. Seek participation at all levels of the organization. Develop structures that facilitate input from plan staff who work directly with members, as well as those with a broader strategic purview and decision-making power. One way to do this is to have two types of committees with distinct functions. For example, one plan surveyed has a steering committee made up of senior leaders who have a broad view of the organization and strategic decision-making authority, as well as health equity workgroups comprising staff at all levels who have detailed operational knowledge and are engaged in daily efforts to advance health equity. Combining the efforts of multiple committees and workgroups can increase buy-in and effectiveness of health equity efforts.
  2.  Incorporate plan members into health equity committees and councils. Safety net health plans surveyed currently incorporate plan members in advisory council structures, rather than operational workgroups, however they aim to increase member participants in health equity committees and councils overall. Plans looking for avenues for member involvement can start by defining a specific function for a member advisory council. For example, a Member Education Advisory Board can provide feedback on member-facing documents and policies. To expand participation, plans can also include external community stakeholders such as representatives from state or county health departments, the state’s department of social services, clinical family advisory committees, and affiliated providers, in their health equity advisory councils.
  3.  Plan for ongoing strategic communications. Establish processes for how health equity work and results are communicated both inside and outside the organization. One plan noted that it uses monthly status updates that are simple, direct, and fit on a single slide to facilitate ongoing communications.
  4. Build accountability by incorporating health equity work into existing structures and processes. It is easy for staff and leadership to view health equity work as extraneous when it is seen as something outside of their job descriptions or additional work on top of existing responsibilities. Integrating a health equity focus into all aspects of a plan’s efforts can help build internal health equity capacity and enhance results. One promising example comes from a plan that is including a health equity component in state-required health plan performance improvement projects. The plan will use existing data sources, stratified by different factors, to identify and address disparities greater than 10 percent.


Safety net health plans are using health equity groups to build sustained opportunities for improving health equity. Plans have found that leadership buy-in, cross-organizational collaboration, and incorporating the voices of members are important factors in this work. To support successful health equity efforts, plans can seek broader inclusion and participation from internal and external plan stakeholders, plan for ongoing internal and external communications about health equity efforts, and look for ways to build accountability into their existing processes and strategies.


CHCS and ACAP would like to acknowledge the contributions of the 15 safety net health plans participating in the Health Equity Learning Collaborative that have informed this resource.


The Center for Health Care Strategies (CHCS) is a policy design and implementation partner devoted to improving out comes for people enrolled in Medicaid. We support partners across sectors and disciplines to make more effective, efficient, and equitable care possible for millions of people across the nation. For more information, visit www.chcs.org.


The Association for Community Affiliated Plans (ACAP) represents 80 health plans, which collectively provide health coverage to more than 25 million people. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly sponsored health programs. For more information, visit www.communityplans.net