Medicaid Member Engagement in State Policymaking: Medicaid Advisory Committees (MACs) and Beneficiary Advisory Councils (BACs)

Centering the voices of Medicaid members in policymaking reflects a key principle that prompted the development of Centers for Medicare & Medicaid Services (CMS) requirements in the Ensuring Access to Medicaid Services Final Rule (Access Rule), which introduced requirements for Medicaid Advisory Committees (MACs) and Beneficiary Advisory Councils (BACs). Historically, many advisory committees, such as Medical Care Advisory Committees (MCACs), have lacked significant representation from Medicaid members. This gap in representation has often resulted in Medicaid policies that do not fully reflect the needs or experiences of people receiving services. For additional background information on these requirements, read our previous blog: Advisory Committee Requirements in the Access Rule: What’s Next for Implementation?

CMS developed the Medicaid Advisory Committees & Beneficiary Advisory Councils - Implementation Considerations to support states in implementing the new requirements outlined in the Access Rule, which details how MACs and BACs should operate, define expectations for committee members, and identify key areas of focus to inform Medicaid policies and programs. The publication offers practical guidance and promising practices for structuring committees, recruiting Medicaid members from various populations, and enhancing meeting accessibility and transparency. This blog outlines key strategies referenced in the publication that states can use to enhance and/or establish MACs and BACs.

Why Beneficiary Engagement Matters

Improved and authentic engagement with people receiving services can lead to stronger policies, better programs, and increased trust between Medicaid members and state agencies. States must engage people with lived experience to truly understand the challenges Medicaid members  may face, better identify gaps in care and services, and develop policies that are responsive to member needs. This engagement can help states be responsive to real-world experiences and work to improve the effectiveness and accessibility of Medicaid programs, which may ultimately lead to better health outcomes.

Strategies & Best Practices for Effective Engagement

Despite its benefits, meaningful member participation faces several challenges, including limited representation, access barriers, lack of awareness, and distrust. It is important for states to build and maintain trust to overcome these challenges, particularly in communities with a history of distrust toward government agencies. Creating safe engagement practices can foster trust, encourage participation, and ensure that people feel heard and valued.

To ensure advisory committees effectively represent populations served, states must take active steps to remove barriers. Several states have taken various approaches to ensure MACs and BACs effectively engage Medicaid members. The Medicaid Advisory Committees & Beneficiary Advisory Councils - Implementation Considerations highlights promising practices, including formalizing requirements to actively engage members , families/caregivers, and advocates, incorporating effective planning and facilitation of engagement meetings, promoting transparency of meetings, and offering resources for further learning.

Below are examples of how states have developed and/or enhanced their MACs and BACs:

• California maintains a robust stakeholder email list that sends alerts with programmatic updates and information on upcoming stakeholder meetings and webinars to help beneficiaries, advocates, families/caregivers, community organizations, and other interested parties stay informed and engaged.

• Nebraska simplified the application process by only asking two questions about Medicaid affiliation and interest in serving on the committee.

• North Carolina increased accessibility by alternating in-person and virtual meetings and covering travel costs.

• Virginia partnered with community-based organizations to identify potential advisory committee members and randomly selected individuals from that pool to promote fairness in the selection process.

• The Office of the Assistant Secretary for Planning and Evaluation’s Methods and Emerging Strategies to Engage People with Lived Experience identifies emerging methods for engaging people with lived experience in federal research, programming, and policymaking.

These and other examples highlight how states can increasingly center member voices in policymaking. By leveraging strategies outlined in CMS’ Medicaid Advisory Committees & Beneficiary Advisory Councils - Implementation Considerations, developed with support from Aurrera Health Group in partnership with the MITRE Corporation, states can build stronger and more effective avenues to include member voices. Contact Megan Thomas or Kristal Vardaman at Aurrera Health Group to learn more about how we can support your MAC and BAC implementation efforts.

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Authors

Reatha Conn [Policy Consultant]