Engaging Medicaid Members: New Requirements in the Medicaid Access Rule

Support for this expert perspective was provided by the State Health and Value Strategies program, a grantee of the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

On April 22, the Centers for Medicare & Medicaid Services (CMS) released the Ensuring Access to Medicaid Services final rule (the “Access Rule”), which establishes new requirements for states regarding the engagement of people enrolled in Medicaid to inform policy and program design. Under the Access Rule, states will need to create and support a Beneficiary Advisory Council (BAC) composed solely of current and former Medicaid enrollees, their family members, and paid and unpaid caregivers. The Access Rule also calls for the creation of a Medicaid Advisory Committee (MAC), comprising a diverse array of stakeholders, including members drawn from the BAC. The BAC and the MAC will replace the current requirement that states establish a Medical Care Advisory Committee (MCAC) and will take effect July 9, 2025, with some requirements phased-in over a longer time period (described in more detail below).

The new requirements provide states with the opportunity to engage community members in a way that builds and maintains trust and strengthens the Medicaid program. To date, few states have sought to engage Medicaid enrollees, their family members, and caregivers as prescribed by the BAC. Implementation of the BAC and MAC requirements offers states an opportunity to shift from a transactional to a transformative relationship with the community served by the Medicaid program, which will not only build trust, but generate insights and feedback that can improve the state’s Medicaid program.

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