Addressing Challenges, Creating Opportunities: Fostering Consumer Participation in Medicaid and Childrenʼs Health Insurance Managed Care Programs

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Abstract
With more than half of the Medicaid population enrolled in managed care and with enrollment in Medicaid managed care and Children's Health Insurance Programs continuing to accelerate, policy makers and program administrators must quickly come to consensus on the role of the consumer in the planning, implementation, and oversight of Medicaid and S-CHIP managed care. This article explores the barriers to consumer participation and makes concrete policy and programmatic recommendations to increase consumer participation in public managed care programs. To fully comply with existing federal and state requirements for consumer participation and for this participation to have an impact on the quality of managed care programs, states need to provide more education and support to consumers on: how to choose a health plan; how to access the health plan services and out-of-network benefits; and how to use grievance procedures. In addition, more work needs to be done to make the growing availability of health plan and provider performance data meaningful and available to Medicaid and S-CHIP consumers. Finally, states must address the lack of resources, lack of information, and lack of training that prevent many consumers from being able to sustain their involvement in system-level advisory and oversight bodies.

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