Recommendations for Making the Consumers? Voice Heardin Medicaid Managed Care:
A Guide to Effective Consumer Involvement
Acknowledgments
The extent to which consumers are being involved in the design, implementation, monitoring, and evaluation of Medicaid managed care
programs has not received a great deal of attention. As an organization working on behalf of Medicaid beneficiaries and other low-income
individuals, the National Health Law Program has explored both the need for and the possibilities of various consumer involvement mechanisms as part of a project entitled, Making the Consumers? Voice Heard in Medicaid Managed Care.
The goal of the project was to take an in-depth look at how consumers are being involved in the design, implementation, monitoring, and
evaluation of Medicaid managed care programs and to make recommendations for effective consumer involvement. This guide represents the culmination of the project, offering a catalogue of suggestions for stakeholders to consider as Medicaid managed care programs are implemented and improved.
We are very much indebted to The Pew Charitable Trusts and the Center for Health Care Strategies for making this project a reality. We also are extremely grateful to the Consumer Involvement Working Group participants who have shared so much of their valuable time, energy, and resources with this project. While many people have contributed to this project and we are grateful to all of them, we particularly wish to acknowledge and thank Elisabeth Benjamin, New York City Task Force on Medicaid Managed Care; James Jackson, Health Action New Mexico; Gene King, Ohio State Legal Services; Richard Seckel, Kentucky Legal Services; and Janet Varon, The Children?s Alliance (Seattle, WA). In addition, we would like to express our gratitude to the Medicaid administrators who not only saw the value of consumer involvement, but who worked with us to find the best mechanisms. Thank you also to Tonya Pate for her research assistance. It is safe to say that this project could not have been accomplished without the help of everybody involved.
Contents
Instructions for using this guide …………………….. 1
Section I: Background and Methodology ………………. 3
Why consumer involvement? ………………….. 5
Project methodology ………………………… 9
Section II: Recommendations for Consumer Involvement …. 15
Guiding principles ………………………… 17
Outreach and education …………………….. 21
Public meetings and community forums ………….. 27
Boards and committees …………………….. 31
Focus groups ……………………………. 37
Recipient employees ……………………….. 43
Member advocates ………………………… 47
Consumer surveys ………………………… 51
Hotlines ……………………………….. 57
Consumer assistance programs ……………….. 61
Complaint processes ……………………….. 67
Section III: Legal Requirements and Model Provisions …… 71
Boards and committees …………………….. 73
Recipient employees ……………………….. 75
Member advocates ………………………… 79
Hotlines ……………………………….. 81
Consumer assistance programs ……………….. 83
Complaint processes ……………………….. 87
Section IV: The Consumer Involvement Action Plans …… 105
Kentucky ……………………………… IV-3
New Mexico …………………………… IV-65
New York City …………………………. IV-87
Ohio ………………………………… IV-93
Washington …………………………… IV-121
Instructions for using this guide
The reader should use this guide in conjunction with the first report of this project, Making the Consumers? Voice Heard in Medicaid Managed Care: Increasing Participation, Protection and Satisfaction. The first report provides an in-depth discussion of the various consumer involvement mechanisms, including an assessment of the legal requirements for implementing these mechanisms.
This guide is organized into four sections:
Section I provides the background and methodology. It discusses why consumer involvement is needed and explains the process through which the recommendations in this report were developed and tested.
Section II is organized as a catalogue which the reader can use to consider a range of consumer involvement mechanisms, including:
- Guiding principles
- Outreach and education
- Public meetings and community forums
- Boards and committees
- Focus groups
- Recipient employees
- Member advocates
- Consumer surveys
- Hotlines
- Consumer assistance programs (ombudsprograms)
- Complaint processes
The discussion of each mechanism includes specific recommendations, sample illustrations, and a reference list of ?how-to? guides and resources.
Section III contains legal requirements and sample legislative and contract language for various mechanisms.
Section IV reproduces the ?Consumer Involvement Action Plans? which were developed as part of this project.
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