Consumer Engagement Strategies Among State Medicaid Agencies

Abstract

Research ObjectiveTo understand how state Medicaid agencies engage consumers in programmatic and administrative decision making, including motivations behind these efforts; perceived benefits; and barriers and facilitators.Study DesignSemi‐structured interviews with 50 Medicaid program leaders across 14 states were conducted using a stratified purposive sampling method based on US census region, rurality, Medicaid enrollment size, total population, ACA expansion status, and Medicaid managed care penetration. Interviews were audiorecorded and professionally transcribed, and content and thematic analyses were conducted using an inductive approach.Population StudiedState Medicaid agencies.Principal Findings States vary in approaches to consumer engagement. All states reported a federally mandated Medical Care Advisory Council (MCAC), but a number of states customized these standing committees and adopted multi‐pronged approaches to engage different Medicaid populations. Common mechanisms of consumer engagement included standing committees for specific Medicaid topics (eg, long‐term care) or specific programmatic changes (eg, implementing a new managed care program); advocacy group meetings; town halls; and a variety of survey, focus group, and online input‐gathering mechanisms. Motivations for engaging consumers included identifying problems proactively; utilizing enrollee perspectives to improve health prevention and services; and assessing program efficacy, consumer experience, and impact of policy or care delivery changes. Few states linked consumer engagement with the mission of Medicaid; those that did emphasized goals like improving program value, enhancing “patient‐centered” care, and strengthening health equity. Active states formed partnerships with advocacy groups, foundations, and community organizations to support consumer recruitment and participation, facilitate meetings, and provide transportation or travel reimbursement. Strategies for meaningful consumer engagement included ensuring a feedback loop to communicate how consumer feedback is being used; investing time and staffing to facilitate effective interactions with consumers; aligning agency goals with consumer expectations; and training consumer participants to better understand technical language and Medicaid policy complexities. States with less‐robust engagement efforts described a number of common barriers, notably budget and staffing constraints, difficulty recruiting a diverse group of consumers, and sustaining participation over time. While many states could point to theoretical and anecdotal benefits of early consumer engagement, none collected data or monitored its effects. Few states knew of consumer engagement efforts occurring elsewhere in Medicaid, and none reported formal mechanisms for sharing experiences and learnings with other states. States with managed care plans described requiring plans to implement consumer engagement efforts, but none had systematic mechanisms to bring MCO level feedback back to state agencies. ConclusionsThere is significant heterogeneity in states’ efforts to involve consumers in Medicaid policy and programmatic decision making. States with robust efforts tended to be proactive, using diverse approaches and partnering with community organizations. While most states ensured minimum public‐ and consumer‐advocate representation on oversight committees, representation alone was insufficient.Implications for Policy or PracticeAs Medicaid programs grow in size and complexity, leaders face increased expectations to include input from consumers when making programmatic and administrative decisions. Sharing best practices across states could help strengthen consumer engagement efforts despite varying resource constraints and Medicaid program characteristics; identify opportunities for program improvement that reflects community needs; and increase public engagement among a population that has traditionally lacked political voice.Primary Funding SourceThe Robert Wood Johnson Foundation.