Medical Care Advisory Committees are powerful tools—available in every state—for advancing effective health policies on behalf of children and families. Anyone working on state Medicaid policies needs to know about MCACs!
What is an MCAC?
Medical Care Advisory Committees, known as “MCACs”, are advisory bodies that provide state Medicaid agencies with formal feedback and recommendations for their Medicaid programs. Every state Medicaid agency is legally required to establish an MCAC and consult with it in the operation of its Medicaid program. MCACs are required to include consumer representatives, including Medicaid enrollees, as well as health professionals who are familiar with the needs of lower-income individuals and their health care. Many MCACs also include representation from other stakeholders, such as managed care plans and hospital associations.
States must provide Medicaid agency staff assistance and technical assistance to support committee members and must make financial arrangements as necessary to support the participation of consumer representatives. Financial assistance can cover the cost of travel to and from meetings, lodging, meals, printing and photocopying materials, space for meetings, making conference call or video conferencing platforms available, among other things. Fear not—states can get a 50% federal funding matching rate for MCAC expenditures!
States must provide MCACs with an opportunity to participate in Medicaid policy development and administration, including furthering the participation of enrollees. Although this is a general requirement that CMS has not interpreted through guidance (something we would like to see!), there are some specific requirements CMS has developed, most notably with managed care oversight. Medicaid agencies must consult with MCACs when developing or revising required managed care quality strategies; when pursuing an alternative managed care quality rating system; when reviewing managed care marketing materials; and must provide the MCAC copies of required managed care monitoring reports.
States also may satisfy public notice requirements for section 1115 demonstrations (required when applying for demonstrations and for post-implementation public forums) by using their MCACs.
How Can You or Your Organization Be Involved?
The most direct way to be involved with your state’s MCAC is to directly participate as an MCAC member. (Members are selected by the Medicaid agency director or a higher state authority.) In this role, you or your organization have the potential to receive valuable information from the Medicaid agency, gain access to Medicaid agency staff and cultivate relationships with key Medicaid stakeholders, and of course have an opportunity to make formal recommendations to the agency. Another option for organizations is to support Medicaid enrollees that participate in the MCAC (or other MCAC members). Enrollees may need policy support and public allies on an MCAC committee where they are sitting alongside doctors, hospital executives, and health plan CEOs. Your organization could have a formal or informal role supporting or representing consumers. At a minimum, consumer organizations can attend MCAC meetings, publicize MCAC information, and provide suggestions to the MCAC committee members.
MCACs and the Unwinding of the Public Health Emergency
MCACs could play an especially important role in 2023, if and when the COVID-19 public health emergency (PHE) expires. When the PHE expires, states will begin reviewing the eligibility of millions of Medicaid enrollees whose enrollment was protected by federal law during the PHE. Millions of enrollees may end up losing coverage during this “unwinding” of continuous coverage requirement.
MCACs can play a pivotal role in demanding public information about a state’s unwinding plan, advising the state to implement policies that will reduce coverage losses during unwinding, making recommendations about communications with enrollees and the public about enrollment requirements and resources, and supporting the development of monitoring and feedback loops to identify and respond to problems as they arise. In states that have Medicaid agencies that are disinclined to generally share information or receive input, the statutorily mandated MCAC can be a pathway to force the state to engage.
The Future of MCACs
While MCACs are already valuable tools, we hope CMS takes steps to standardize and strengthen the role of MCACs. Because there are limited details about how states must operate MCACs, there is wide variability across states. Some states have developed empowered and high-functioning MCACs that truly provide an advisory role, while others convene the MCAC infrequently and merely use it to share updates.
CMS should set out additional criteria for MCACs, such as: requiring a minimum of 6 meetings per year; requiring at least half of the MCAC membership to be enrollees and consumer representatives; setting out a more expansive set of minimum functions (for example, all Medicaid notice templates should be reviewed by MCAC consumer members); detailing more specific supports required for consumer stakeholders, including requiring additional and direct meetings between the Medicaid agency and consumer members; and requiring transparency around all MCAC operations, including publicly accessible meetings. CMS should also regularly look for opportunities to use the MCAC as it updates regulations on all Medicaid functions (as it did with managed care oversight, noted above).
The MCAC model is pivotal to the success of Medicaid. It allows states to operate more informed and responsive Medicaid programs, and builds public trust and credibility in program administration. State agency leaders also benefit from strong MCACs as they help obtain valuable information about program function from external sources. All consumer organizations that work on Medicaid issues should monitor and engage with their state MCACs, both to improve their Medicaid programs today and strengthen their state’s MCAC policies for the future.
