Medi-Cal Member Advisory Committee: Design Recommendations for the California Department of Health Care Services JULY 2023 AUTHORS Courtney Roman, Madeline Steward, Kelly Church, Center for Health Care Strategies About the Authors Acknowledgments Courtney Roman, MA, is senior program officer; The Center for Health Care Strategies (CHCS) would Madeline Steward, MPH, CAPM, is program officer; like to acknowledge the Technical Advisory Group and Kelly Church, MPH, is program associate at the (TAG) for devoting time, energy, and thoughtful Center for Health Care Strategies. insights to this effort. Our team greatly admires the TAG's deep dedication to meaningfully engaging The Center for Health Care Strategies (CHCS) is a Medi-Cal members across California. policy design and implementation partner devoted to improving outcomes for people enrolled in CHCS is also appreciative of the Medi-Cal mem- Medicaid. CHCS supports partners across sectors bers who were interviewed by our team. Your and disciplines to make more effective, efficient, experiences and stories about serving on consumer and equitable care possible for millions of people advisory committees are at the heart of our recom- across the nation. For more information, visit www. mendations and shaped every aspect of what we chcs.org. consider the path forward. Thank you for sharing your expertise with us. About the Foundation The California Health Care Foundation (CHCF) is an independent, nonprofit philanthropy that works to improve the health care system so that all Californians have the care they need. We focus especially on making sure the system works for Californians with low incomes and for communities who have traditionally faced the greatest barriers to care. We partner with leaders across the health care safety net to ensure they have the data and resources to make care more just and to drive improvement in a complex system. CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemak- ers to create a more responsive, patient-centered health care system. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 2 Contents 4 Executive Summary Recommendations Pitfalls to Avoid in Launching the Medi-Cal Member Advisory Committee Conclusion 7 Introduction 7 Methods Landscape Assessment Design 10 DHCS Medi-Cal Member Advisory Committee Design Findings and Recommendations 1. Composition and Size 2. Recruitment 3. Compensation 4. Meeting Logistics 5. Meeting Facilitation 6. Meeting Materials 7. Building Trust 8. Preparing and Supporting Medi-Cal Member Advisory Committee Members 9. Measuring Success of the Medi-Cal Member Advisory Committee 10. Sustainability 23 Pitfalls in Launching the Medi-Cal Member Advisory Committee 24 Conclusion 25 Appendix A. DHCS Consumer Advisory Committee Research and Design: Interview Tool 27 Appendix B. Literature Review: Promising Practices for Community Engagement and Consumer Advisory Committees 37 Appendix C. DHCS Medical Member Advisory Committee Design - Technical Advisory Group Roster 39 Endnotes Executive Summary Recommendations Drawing from this design phase, the following are The California Department of Health Care Services CHCS's recommendations for 10 core elements crit- (DHCS) announced the launch of its Medi-Cal ical to designing and sustaining an effective MMAC. Member Advisory Committee in February 2023, consisting of diverse Medi-Cal (California Medicaid) 1. Composition and Size members from across the state. This group will pro- Ensure composition reflects the Medi-Cal popu- vide a mechanism for the agency to receive robust lation. Include a diverse mix of races, ethnicities, and authentic member feedback and guide oppor- gender identities, sexual orientations, and uses of tunities to shape and enhance Medi-Cal policies Medi-Cal services (e.g., members on waiver pro- and programs to better respond to member needs. grams, managed care, fee-for-service). The Medi-Cal Member Advisory Committee (MMAC) Keep size manageable. A core group of 10–15 to was created following a design phase, supported serve as a pilot for one year will allow for a robust by the California Health Care Foundation (CHCF), and diverse mix of populations without being chal- in which the Center for Health Care Strategies lenging to convene and facilitate. (CHCS) partnered with DHCS and the foundation to develop recommendations to inform the design 2. Recruitment of the MMAC. CHCS conducted a landscape Use a multipronged approach. Effective recruit- assessment of existing consumer advisory com- ment will require a multipronged approach that mittee–type groups in California and other states includes (1) leveraging networks of providers, com- and interviewed stakeholders, including an advi- munity-based organizations (CBOs), managed care sory group of Medi-Cal enrollees and others with plans (MCPs), DHCS staff, and others; and (2) use expertise engaging Medi-Cal enrollees in advisory of marketing events, social media posts, flyers/mail- groups. Drawing from the landscape assessment ers, etc., to get the word out. and interviews, CHCS developed a set of recom- mendations to help guide the design of the DHCS 3. Compensation MMAC. Provide a fair amount. Provide at least a $100 sti- pend per MMAC member per meeting, regardless This report presents CHCS's recommendations and of being virtual or in-person. Let MMAC members summarizes the research and advisory group feed- choose their compensation preference - check or back that informed them. It is intended to provide gift card. Also cover additional supports, including transparency into the design process and outcomes (as appropriate) mileage; parking; public transit, and share insights that could be helpful for other Uber or Lyft, or taxi; meals; technology support; states looking to create an advisory committee of and childcare. Medicaid members. 4. Meeting Logistics Be consistent regarding meeting format, length, and cadence. To accommodate MMAC mem- bers located across the state, meet virtually for two hours every other month. As possible, meet Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 4 in person once or twice per year to build relation- Establish feedback loops. If a recommendation is ships and have more in-depth discussions around made or a concern is raised by a MMAC member, certain topics or when important deadlines are follow up on the status, even for recommendations approaching (e.g., public comment period, legisla- that cannot necessarily be implemented. MMAC tive session, etc.). members will appreciate knowing how information is acted on and where their voices are making a Recognize the importance of translation. Real- difference. time translation (in person and virtually) is needed at least in Spanish and American Sign Language 8. Preparing and Supporting Medi-Cal (ASL). All translators should be native speakers and/ Member Advisory Committee Members or certified (e.g., ASL certified). Create a consistent orientation process. Provide new members with clear information regarding the 5. Meeting Facilitation MMAC's purpose; roles and responsibilities; what Identify a strong meeting facilitator. The ideal to expect before, during, and between meetings; meeting facilitator for the MMAC will have rich list of key terms; how the MMAC will influence pol- experience working with community members, a icy; how to reach the MMAC contact; and other key strong understanding of the Medi-Cal program, details. and background and race/ethnicity reflective of MMAC membership. Conduct check-in calls for MMAC members. Connect with MMAC members before and after Plan the agenda. Keep the agenda light on updates meetings. These conversations can be short but are and allow ample time for questions, discussion, and important to ensure MMAC members have what for MMAC members to offer their own topics. they need before meetings, and to gather feedback after meetings to ask if members feel heard, sup- 6. Meeting Materials ported, and valued. Send clear meeting materials in advance. Meeting materials should be easy to understand, free from 9. Measuring Success jargon and acronyms, written at a sixth-grade read- Measure success for MMAC members. Develop a ing level to ensure readability, and translated into brief survey for MMAC members to complete after MMAC members' primary languages. All materi- each meeting to gather anonymous feedback on als should be sent to MMAC members at least one their experiences. Use time at a future meeting to week before meetings. report on responses and work with MMAC mem- bers to identify what is going well and what needs 7. Building Trust improvement. Treat MMAC members with respect, understand- ing, and kindness. Actions such as individually Measure success for DHCS. Establish three or greeting each MMAC member at meetings and four measures of success for the MMAC. A guiding ensuring everyone has a reliable way home after the question for defining those measures could be: If meeting will help members feel supported. Create speaking to leadership about the MMAC two years avenues for honest feedback; acknowledge when a from now, what would you want to be able to say mistake was made, apologize, and pledge to make was accomplished? How did the MMAC help in the it right going forward. process? Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 5 10. Sustainability Sending meeting materials out too late. Getting Commit to the 10 core elements when build- meeting materials to MMAC members in advance ing the MMAC. Sustainability will naturally occur if must be best practice. Otherwise, members do not the key elements described above are considered have time to adequately prepare and are less effec- when establishing the MMAC. tive during the meeting. Embrace the process. Know there will likely be lots Not providing culturally and linguistically appro- of back and forth with MMAC members on certain priate meeting materials. MMAC members will be projects, but it is necessary to ensure their feedback turned off from the start if the materials do not meet is genuinely being internalized and changes are them where they are. being made as possible. Rattling off statistics and jargon. A steady stream of statistics and jargon can be overwhelming and Pitfalls to Avoid in Launching confusing. Instead, share updates and information the Medi-Cal Member Advisory that will resonate with MMAC members and be Committee explicit about why what is being shared matters to them, and where you need their input. As important as knowing what to do when establish- ing and leading a consumer advocacy committee (CAC) is knowing what not to do. Below are a few Conclusion examples of pitfalls to avoid gleaned from stake- The DHCS Medi-Cal Member Advisory Committee holder interviews, TAG discussions, and the literature. will be a unique space for state leaders to receive meaningful and authentic input from Medi-Cal Overpromising what can be done. Avoid commit- members in real time. For the first time, DHCS ting to plans or changes that DHCS cannot make. will have an ongoing channel to gather member Be open and transparent, but also realistic in what feedback to help shape and advance its policy, may or may not be possible to change. governance, and strategic priorities as well as its program activities. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 6 Introduction states and interviewed stakeholders, including an advisory group consisting of Medi-Cal enrollees and In California, the Department of Health Care others with expertise engaging Medi-Cal enrollees Services (DHCS) has historically worked with com- in advisory groups. Drawing from the landscape munity advocates to help the agency shape and assessment and interviews, CHCS developed a set redesign Medi-Cal policies and programs. The of recommendations to help guide the design of value that community advocates and commu- the DHCS MMAC. nity-based organizations (CBOs) bring to these discussions is critically important to ensure policies This report shares findings from the landscape and programs meet the needs of Medi-Cal mem- assessment and stakeholder interviews and outlines bers. However, there are untapped opportunities CHCS's recommendations for developing a mem- to connect directly with Medi-Cal members as part ber advisory group. It also outlines pitfalls to avoid in of the agency's policymaking and implementation establishing a member advisory group gleaned from process. This effort aligns with a growing trend in stakeholder interviews and the literature. Although which Medicaid agencies across the country are CHCS's analysis focused specifically on designing a increasingly seeking to meaningfully partner with DHCS-led group with Medi-Cal enrollees, this report Medicaid enrollees to help design policies and pro- outlines universal lessons related to designing and grams that better serve program participants.1 building a successful consumer advisory committee that could inform other settings and states. Recognizing this opportunity, in late 2021 DHCS established a Medi-Cal Member Advisory Committee (MMAC). This group is intended to provide a way for the agency to receive robust and Methods authentic feedback from a diverse group of Medi- Cal members and to glean information to shape Landscape Assessment and enhance policies and programs to respond to Between June and October 2022, CHCS con- identified member needs. DHCS is committed to ducted a robust national landscape assessment using the MMAC's guidance in determining how of community member advisory group structures, to advance the agency's policy, governance, and activities, and promising practices - both within strategic priorities with a patient-centered focus.2 California and in other state Medicaid agencies. At the outset, DHCS recognized that establishing The landscape assessment sought to gain an and leading an MMAC would be unlike any pro- understanding from key informants in California cess the agency had undertaken. Building trust with and other states with direct experience with CACs MMAC members would be paramount, and the regarding their design choices, successes, pit- agency would need to actively listen and be open falls, and other important lessons. The landscape to change. assessment consisted of interviews with Medi-Cal enrollees and experts in California and other states With support from the California Health Care and a literature review. Also, representatives of 14 Foundation (CHCF), the Center for Health Care managed care plans (MCPs) in California completed Strategies (CHCS) partnered with DHCS and the a survey that explored their experiences leading foundation to develop recommendations to inform CACs. Survey results are detailed in a supplemen- the design of the MMAC. CHCS conducted a land- tal report, Designing Medi-Cal Consumer Advisory scape assessment of existing consumer advisory Committees: Insights from a Survey of Medi-Cal committee–type groups in California and other Managed Care Plans. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 7 Key Stakeholder Interviews $ State agencies (inside and outside of California) From July to September 2022, CHCS conducted 27 shared insights into the ways they engage com- stakeholder interviews. All interviewees had experi- munity members and the challenges they have ence either serving on or convening a community faced along the way. member advisory group, and the purpose of these $ Researchers described their work and sum- conversations was to identify promising strategies marized findings regarding CACs in Medicaid for leading these groups effectively. CHCS was also agencies. interested in understanding where the challenges lie and potential missteps that can occur in establish- Literature Review ing a community member advisory group. Nearly CHCS conducted a literature review, identifying all interviewees were California-based and included and reviewing 24 articles and resources to under- Medi-Cal members (8) and staff from managed care stand promising practices for CACs. This research plans (6), CBOs (6), California state agencies (3), also informed some of the interview questions. researcher organizations (2), a Federally Qualified Health Center (1), and another state Medicaid pro- The literature review consisted of a compilation gram (1). CHCS received help from staff of DHCS of resources pulled from online search engines, and the California Pan-Ethnic Health Network including Google Scholar, Google, and PubMed. (CPEHN) to compile a list of interviewees and to Search terms included "involving family voices," conduct outreach (see Appendix A for the interview "engaging families in their care," "evidence-based protocol). practices or strategies for consumer engagement," "consumer led/run programs," "community- While CHCS used a standard interview protocol, based organizations led and staffed by patients questions were adjusted depending on the differ- or families," "patient family advisory council," ent insights interviewees could share. For example: "evidence-based consumer engagement within Medicaid," "state-level consumer engagement," $ Medi-Cal member interviewees all serve on a "CACs within Medicaid agencies," "Medicaid con- managed care plan CAC. They offered insights sumer engagement," and "identifying Medicaid on what keeps them coming back to the group; strategies for effective family engagement." CHCS strategies for helping them feel supported, also received resource suggestions from colleagues engaged, and valued; and strong meeting facili- and external partners, TAG members, and inter- tation techniques. viewees. (See Appendix B for a summary and key $ MCPs in California are required to establish and themes of the articles.) lead CACs; thus interviews with MCP staff centered on identifying what works well and what does not doesn't in these groups. Design Technical Advisory Group $ Community-based organizations offered rec- In partnership with CHCS, CPEHN, and CHCF, ommendations for effective recruitment and DHCS convened a "Technical Advisory Group" engagement strategies, and ways to ensure (TAG) of consumer advocates, Medi-Cal enroll- CACs are diverse and representative of the ees (including one parent of a child enrolled in community. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 8 Medi-Cal), and others with deep professional and DHCS MMAC design element (e.g., size, compo- personal expertise in community member advisory sition, meeting facilitation, strategies for building groups. Diverse representation and perspectives trust). The TAG's feedback helped refine CHCS's were important criteria for selecting TAG members. design recommendations and ensure they were (See Appendix C for a list of TAG members and meaningful and relevant for the Medi-Cal popu- organizations.) lation. At the last TAG meeting in October 2022, CHCS presented final DHCS MMAC recommenda- Between July and October 2022, the TAG met tions to the group. four times to review and provide feedback on each Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 9 DHCS Medi-Cal Member With that in mind, interviewees and TAG members recommended including representation from as Advisory Committee many of these groups as possible: Design Findings and $ African American* Recommendations $ Asian American* CHCS examined 10 design elements: $ Black* 1. Composition and Size $ Formerly incarcerated individuals $ Indigenous community members 2. Recruitment $ Individuals experiencing homelessness 3. Compensation $ Individuals with behavioral health conditions 4. Meeting Logistics $ Individuals with chronic conditions 5. Meeting Facilitation $ Individuals with intellectual or developmental 6. Meeting Materials disabilities 7. Building Trust $ Individuals with physical disabilities 8. Preparing and Supporting Advisory Group $ Latina/o/x Members $ LGBTQ+ individuals 9. Measuring Success $ Native Hawaiian 10. Sustainability $ Pacific Islander* The authors' findings and recommendations follow. $ Parents, guardians, and families with children $ Parents, guardians, families, and caregivers of children with special health or complex care 1. Composition and Size needs Findings $ Rural residents The composition of the DHCS MMAC was impera- tive to interviewees and TAG members. Given the $ Seniors or family caregivers, formal caregivers diversity of the 15 million Californians enrolled in $ Teens, youth, and former foster youth Medi-Cal, all the stakeholders CHCS spoke with $ Tribal nations emphasized the need to ensure the DHCS MMAC was inclusive and fully representative of the popula- $ Undocumented individuals tion. Interviewees and TAG members shared that, too often, these types of committees draw from * Please note that Black was intentionally separated the same small cohort and leave other important from African American. It was initially presented to the groups or communities out, resulting in recommen- Technical Advisory Group as African American/Black, dations or changes that do not necessarily apply or but several members urged the authors to present these work for all. The DHCS MMAC, however, was an groups separately, as well as Asian American and Pacific opportunity to represent all Medi-Cal members. Islander. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 10 In addition to these groups, interviewees and TAG $ Native Hawaiian members also noted the importance of geographic $ Pacific Islander diversity, and recommended having representation from throughout the state, regardless of geographic $ Parents, guardians, and families of children with or population size. special health care needs $ Rural residents In terms of the size of the DHCS MMAC, the lit- $ Seniors and family caregivers, formal caregivers erature and interviews uncovered a broad range in the number of participants - anywhere from $ Tribal nations 10–15 all the way up to 100 (for organizations that $ Youth host subcommittees or regional committees). For MCPs that cover a large area, some noted having The MMAC should also include representation from many participants due to leading regional groups different regions of the state and different paths of or subgroups. In probing on ideal size, interview- interaction with Medi-Cal (e.g., members on waiver ees and TAG members noted that large groups of programs, managed care, fee-for-service). While 20–30 can be challenging to convene, facilitate, all the populations on the "composition list" are and gather meaningful input from. While the list of equal importance, CHCS recommends this set of recommended populations to include is large, as a starting place, since these populations were interviewees and TAG members suggested find- the most often elevated in interviews and TAG ing a balance between including as many groups as meetings. possible without creating an unmanageable group. Also, many members may represent more than one Keep size of MMAC manageable. A core group category. of 10–15 DHCS MMAC members to serve as a pilot for one year will allow for a robust and diverse mix Recommendations of populations without being challenging to con- Ensure MMAC composition reflects the Medi- vene and facilitate. After establishing rapport and Cal population. The DHCS MMAC should include building relationships, DHCS can consider expand- a diverse mix of people that fall into as many of ing the group to include four or five more people the "composition list" populations as possible but who represent other populations on the composi- would ideally launch in 2023 with representation tion list and begin to form subcommittees (e.g., from these communities, at least: subcommittees for youth, behavioral health, rural communities, etc.). After three to four years, DHCS $ African American can also consider expanding recruitment signifi- $ Asian American cantly to establish regional MMACs. $ Black $ Individuals with behavioral health conditions 2. Recruitment Findings $ Individuals with intellectual or developmental disabilities Recruitment is a critically important part of the process when establishing a CAC. Interviewees $ Individuals with physical disabilities and TAG members consistently raised this topic as $ Latina/o/x being central to ensure diversity and sustainability. $ LGTBQ+ individuals Interviewees also agreed that recruitment is not a Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 11 one-time activity and instead should be ongoing. It $ Able to participate in virtual or in-person meet- would be easy to underestimate the time and effort ings (or, if barriers are noted, the barriers can be it takes to recruit, conduct outreach, and onboard overcome with the help of DHCS or others) MMAC members; DHCS should ensure that staff assigned this responsibility have sufficient capacity Set term limits. To ensure new perspectives are to do it well. In terms of how long CAC members regularly added to the DHCS MMAC, CHCS recom- may serve, interviewees noted the unforeseen chal- mends instituting a mix of one- and two-year term lenges or changes that can sometimes occur in limits to begin with. This approach ensures ongoing CAC members' lives (e.g., illness or family member and staggered rotation of membership, so an entire illness, relocation, schedule change, childbirth, etc.) cohort is not turning over at the same time. Term and the potential need to cycle members on and off. limits present the opportunity to bring on members To account for this, interviewees suggested ensur- of populations that have perhaps been underrep- ing there is a strong recruitment pipeline so there resented or previously could not participate. Also, is never a lull in identifying new MMAC members. DHCS should seek to establish a strong pipeline of potential MMAC members who could cycle onto Interviewees shared the importance of pursuing the DHCS MMAC to keep sustainability strong and a variety of avenues to recruit MMAC members, representation current. including CBOs, recruitment events, social media, flyers, and mailings. Interviewees also noted the Develop a short application. DHCS should develop need to ensure language in recruitment materials is a short application for interested Medi-Cal members clear, thorough, and translated as needed. to complete for DHCS MMAC consideration. CHCS recommends the application focus on getting to Recommendations know prospective candidates and their interest in Use a multipronged approach. Effective recruitment being an MMAC member. In addition to meeting for the DHCS MMAC will require a multipronged logistics (e.g., dates, times, locations), application approach that includes leveraging contacts and net- questions could include: works of providers, CBOs, MCPs, TAG members, DHCS staff, and others through a combination of $ Have you served on a CAC type of body before? marketing events, social media posts, flyers, mailers, $ How did you learn about the DHCS MMAC? etc., to get the word out as far as possible. $ How long have you been a Medi-Cal member? In addition to the demographic composition dis- $ Would you be able to work closely with DHCS to cussed above, CHCS recommends that DHCS seek advise policies and programs? people with these traits: $ Do you see any potential barriers to participating $ Enrolled in Medi-Cal (or caring for a Medi-Cal in MMAC meetings? member) $ Would you be interested in serving a one-year or $ Able to and interested in working closely with a two-year term? DHCS to advise on policies and programs $ What is your primary language? What language do you prefer to speak? Read? Hear at meetings? Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 12 The application should include the composition list member interviewees shared that they do not par- from the "Composition and Size" section above ticipate in CACs for the compensation, it is deeply and ask that applicants indicate the populations appreciated and helpful in building trust and strong with which they identify. relationships. The application should be provided to the potential Ideally, DHCS MMAC members would be offered MMAC in accessible formats, ideally a PDF that can flexibility regarding the compensation options, be filled in electronically on a mobile device. Other such as choosing between checks or gift cards. accommodations should be considered as well, Interviewees and TAG members urged DHCS (and including large print versions of the application and other agencies that may pay community members) versions translated into other common languages to offer support though eligibility counselors to (e.g., Spanish and Mandarin). ensure the compensation received from participat- ing in the MMAC does not impact benefits that may Invest in dedicated staff. A successful DHCS be tied to income. MMAC will require dedicated staffing and resource investment from the agency. DHCS will need to cre- As for the amount of compensation offered, most ate a position that will be the contact for the DHCS interviewees recommended $50–$100 per meeting, MMAC and be responsible for recruitment efforts, with an equal split between checks and gift cards. meeting planning, drafting and sending meeting (The most popular types of gift cards were grocer- materials, attending all meetings, and preparing ies or Visa.) See the supplemental report Designing and supporting MMAC members. The authors Medi-Cal Consumer Advisory Committees: Insights recommend that DHCS either adjust an existing from a Survey of Medi-Cal Managed Care Plans position to allow for the additional responsibilities for details on compensation averages for MCPs. needed to run a DHCS MMAC or create a new However, compensation is not necessarily only position dedicated to leading the DHCS MMAC. monetary. Interviewees noted they offer transporta- Ideally, this person will have experience in recruit- tion for in-person meetings, meals or snacks during ment, community outreach, supporting individuals meetings, technology support for virtual meetings, with lived experience, etc. and reimbursement for childcare. At the heart of the compensation discussion is removing as many barri- ers to participation as possible for MMAC members. 3. Compensation Findings Recommendations Providing compensation to MMAC members Provide a fair amount. Based on the literature, is essential. MMAC members are offering their interviews, and the MCP survey, CHCS recom- time and expertise and should be compensated mends DHCS provide at least a $100 stipend per for their contributions as professionals would be. MMAC member per meeting, whether the meet- Interviewees and TAG members described pro- ing is virtual or in-person (about six per year). The viding compensation as a "must" and discussed $100 per meeting recommendation is in line with the types of compensation that could be offered, or exceeds examples reviewed for this report but is including stipends and gift cards. While Medi-Cal not too high to impact income levels for eligibility.3 Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 13 Offer flexible payment methods. CHCS recom- communicate upfront with members the time mends mailing checks to MMAC members' home frame in which compensation will be received (e.g., addresses as the most efficient method of payment. checks will arrive within two weeks of the meeting However, as noted in interviews, it is important to ask date), and DHCS MMAC members should reach DHCS MMAC members their preferences around out to their DHCS MMAC contact if there are issues payment. For example, a universal Visa gift card or or questions regarding the compensation. grocery gift card may be a better option for those who lack a permanent address or bank account. 4. Meeting Logistics Consider additional compensation and supports. Findings In addition to the stipend (either check or gift card), Key logistical considerations for MMAC meetings the following supports should also be covered for include in-person versus virtual, meeting location if each MMAC member: in-person, meeting frequency, time and length of meeting, and availability of translation services. In $ Mileage to and from meeting location discussions, interviewees and TAG members mainly focused on virtual versus in-person meetings. Most $ Parking for meeting interviewees (including Medi-Cal members, espe- $ Public transit to and from meeting location cially) appreciated the flexibility and accessibility that virtual meetings allow, as well as the opportu- $ Uber, Lyft, or taxi to and from meeting location nity for the most robust participation. However, a $ Meals (e.g., provided if meeting in person; few important cautions were noted: DoorDash, UberEats, or CraveBox if meeting virtually) $ Do not assume that everyone knows how to join a virtual meeting - take time to provide clear $ Technology support (e.g., hot spots, instructions directions and prep members in advance. for joining a Zoom call, etc.) $ Some areas in California do not have strong $ Childcare could be available on-site for MMAC access to broadband. One health plan noted in members who need to bring children in order to an interview that it mailed out lists of local Wi-Fi attend, or a separate childcare stipend should be hotspots to help ensure MMAC members could provided (e.g., the DHCS MMAC member would connect at meeting times. receive a stipend to cover the expense of hiring a childcare provider for the time needed for meet- When discussing in-person meetings with inter- ing time and round-trip travel). viewees and TAG members, some shared that meeting in person one or two times per year is Related to the above, DHCS could consider having helpful for building relationships and for trying benefits counseling available to ensure compensa- to focus on a particular topic. Some interview- tion related to MMAC participation does not impact ees, however, cautioned that travel and meeting members' benefits. in person may be too difficult or complicated for some MMAC members. Interviewees and TAG Provide timely compensation. Compensation members mentioned several key considerations should be provided to DHCS MMAC members for in-person meetings: promptly following a meeting. DHCS should clearly Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 14 $ Hold meetings when MMAC members will have speaking their native language. This both builds the best chance of participating (e.g., lunch hour, trust and ensures those who may not be as com- after 5:00 PM). fortable conversing in English (particularly about their health or health care experiences) may do so $ Recognize that some members may want or need in their native language. to bring a family caregiver or other caretaker with them to effectively participate, so accommoda- Recommendations tions may be needed for extra people. Be consistent regarding meeting format, length, $ Choose neutral meeting locations within commu- and cadence. CHCS recommends the DHCS nities (e.g., not a government building or space). MMAC meet virtually for two hours every other month. This format, length, and cadence would $ Rotate meeting locations to spread out the travel best accommodate a group of 10–15 members burden for members. located across the state. As possible, meet in per- $ Ensure the meeting space and refreshments are son once or twice per year at a neutral location (e.g., equitable and work for everyone. For example, local community center, conference center, CBO one health plan mentioned that not providing with meeting space) to build relationships and to vegetarian and vegan options during a past have more in-depth discussions around certain top- meeting set the wrong tone. ics or when important deadlines are approaching (e.g., public comment period, legislative session). Findings from the MCP survey and interviews As noted in interviews, it is important to make sure indicate the majority of CAC meetings last about any in-person meeting venue allows enough space two hours (sometimes with lunch for 30 minutes for all to convene (including additional space for before) and occur quarterly (see the supplemen- MMAC members who may want or need to bring tal report Designing Medi-Cal Consumer Advisory a family member or other caregiver to comfortably Committees: Insights from a Survey of Medi-Cal participate). Managed Care Plans for more survey results). In terms of cadence, given what was heard from Also, Medi-Cal member interviewees noted the Medi-Cal member interviewees regarding the CACs they serve on meet quarterly and many felt desire to meet more often than quarterly to main- that was often not enough. With three months tain momentum, CHCS suggests meeting every between meetings, momentum could be lost, and other month. some felt there was just too much work to do to wait. Furthermore, some noted that if a CAC mem- Recognize the importance of translation. Based ber misses a meeting, it will be six months between on interviewee feedback, the need for real-time meetings for that member. translation (in person and virtually) cannot be over- emphasized and is needed at least in Spanish and An additional topic raised in all interviews was that ASL. As the group continues to build rapport and real-time translation is needed at MMAC meetings. relationships, more languages could be added, as One state agency suggested that at a minimum, needed. If subcommittees and regional groups are translation should be offered for American Sign eventually established, DHCS could consider iden- Language (ASL) and Spanish. A health plan rec- tifying translators to participate in the group (both ommended having breakout sessions at MMAC virtually and in person) to build relationships with meetings where members may join a small group DHCS MMAC members. Additionally, all translators Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 15 should ideally be native speakers and/or certified be overwhelming and are not the ideal format for (e.g., ASL certified). Conducting brief premeetings a CAC. Instead, meetings that were lighter on pre- before DHCS MMAC meetings for translators can sentations and updates and focused primarily on ensure they know how to use the platform and can time for discussion and input were considered most seamlessly participate. (Note that translation ser- productive and appreciated. vices will need to be scheduled ahead of time and included in the budget.) Finally, both the literature and interviewees acknowledged that the discussions during CAC Plan for lunch-hour meeting times. Per interviews meetings can be challenging when the feedback and the literature, meeting over a lunch hour is being shared is unexpected or even negative (e.g., preferred (11:30 AM–1:30 PM or 12:00–2:00 PM). a member may share a story about a difficult Medi- If meeting in person, catered lunch should be Cal interaction they had that week because it was provided, making sure all dietary restrictions are top of mind). Interviewees noted that DHCS staff accommodated. If meeting virtually, DHCS could must commit to being active listeners, try to be flex- consider offering either credit on a food service ible, and be open to making changes. delivery app for members to order lunch or have snacks sent to members' homes. Recommendations Identify a strong meeting facilitator. The DHCS MMAC will need a skilled meeting facilitator with 5. Meeting Facilitation deep experience working with community mem- Findings bers. Ideally, the facilitator will have these skills and Meeting facilitation is critical for effective CAC background: meetings. Interviewees and TAG members sug- gested the DHCS should seek to provide neutral $ Have a strong understanding of the Medi-Cal facilitation that respectfully and effectively engages program from a policy perspective or lived MMAC members in ways that cultivate trust and experience with Medi-Cal. (Medi-Cal policy and safety. While facilitation tends to be an internal role program expertise could be supported by hav- taken on by the MCP, agency, or other organization, ing DHCS staff participate in meetings to answer interviewees shared that the meeting facilitator questions and explain programs and policies as needs to be "the right person" and is often the needed.) DHCS MMAC members may ask ques- most important part of CAC meetings. If a facilita- tions beyond the scope of a Medi-Cal program, tor lacks an understanding of and sensitivity to the for example, and a facilitator with a strong knowl- unique needs of the Medi-Cal population or is in edge base - plus staff - can respond without any way unsupportive or insensitive, trust could leading on or setting up DHCS MMAC members be lost before it is gained. The language and tone for disappointment. used when talking about equity and poverty mat- $ Have a background that reflects the racial/ethnic ters - so all must be sensitive in how conversations populations served by Medi-Cal (e.g., the DHCS are framed and worded in ways that are welcoming MMAC members will want to "see themselves" and respectful. in the group and in the facilitator). In terms of meeting format, Medi-Cal member $ Use an affirming and inclusive communication interviewees shared that meetings with packed style. (Traditionally, those in charge often use agendas of presentations, jargon, and statistics can formal titles, lead or dominate the conversation, Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 16 and focus heavily on timelines, deadlines, and As the DHCS MMAC comes together as a group and productivity. Those practices are likely intimidat- builds trust, CHCS recommends moving to a code- ing or offputting for MMAC members.) sign model where members are asked for agenda items in advance, and DHCS ensures those items are $ Know the common power dynamics that appear on the agenda for the next meeting and comes pre- in typical meeting formats. pared to discuss them. For the first few months of $ Convey that DHCS MMAC meetings are a col- the DHCS MMAC, the group may want to ease into laborative space. agenda setting by raising topics within the meeting. $ Codevelop meeting norms with DHCS MMAC Prepare featured speakers. Featured guest speak- members. ers at MMAC meetings are typically appreciated by CAC members, but preparing those speakers in Be intentional about the meeting format. DHCS advance is critical to ensure they feel comfortable should plan to set two or three agenda items but presenting. One recommendation is to work with leave ample open time for MMAC members to staff before a DHCS MMAC meeting to develop raise questions, concerns, and topics of highest a few discussion questions about their program importance to them and be open to the discussion or service as opposed to a long report out (e.g., a that follows. guest speaker would say, "I just described our new planned program regarding smoking cessation. A sample meeting structure may include the follow- Does what we have proposed seem like it would be ing agenda items: helpful to you, your neighbors, your family?"). $ Welcome, introductions, ice breaker Establish meeting norms and procedures. $ Review of meeting norms and agenda Establishing meeting norms and procedures in part- nership with DHCS MMAC members is an effective $ Recap of previous meeting, including the status strategy for convening meaningful and productive of outstanding items (e.g., update on the status meetings. Some CACs follow formal guidelines, of suggestions and recommendations made dur- while others choose fewer formalities. At a mini- ing the last meeting) mum, however, everyone participating in the DHCS $ Two or three new agenda items (e.g., overview MMAC should know the agreed-upon method for of a new program or policy and soliciting input, sharing feedback in and outside of meetings; how to reviewing meeting materials for literacy, accu- indicate wanting to speak (e.g., raising name cards, racy, readability, etc.) hand-raising function in Zoom); and the standard meeting procedures (e.g., meetings will start and $ Open time for questions, discussion, feedback, end on time, a timekeeper will keep the meeting on and other important topics MMAC members track, translation services will be available, questions want to raise are welcome throughout the meeting, etc.). $ Next steps and reminders for the next meeting (e.g., date, location, reminder about point of contact, expecting a debrief call, etc.) Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 17 6. Meeting Materials three major topics to the agenda to avoid over- Findings packing the meeting and overwhelming MMAC members. Thus, focus on items most relevant to the Clear, concise, accurate, and culturally and lin- DHCS MMAC and community members and most guistically accessible meeting materials for DHCS time sensitive. After covering the items mentioned MMAC members are critically important. Meeting above, the rest of the meeting should be open for materials set the stage for the upcoming meet- discussion, and the meeting facilitator and staff ing and play a key role in ensuring DHCS MMAC should engage in active listening. members are ready to participate and know what to expect. For example, one state agency noted Send meeting materials in advance. Meeting the most pushback they ever received from their materials must be sent to DHCS MMAC mem- CAC members was when they sent meeting mate- bers at least one week before the meeting. DHCS rials shortly before the meeting. CAC members MMAC members should be asked their preference reported feeling disrespected and not valued, for how they want to receive meeting materials since the agency did not give them enough oppor- (e.g., mail, email, or both). For virtual meetings, tunity to properly prepare. place links to meeting materials in the chat function or, if in person, copies of meeting materials should Interviewees and TAG members emphasized the be provided to all DHCS MMAC members. need to plan ahead when it comes to meeting materials, and to ensure ample time is set aside Consider readability. To ensure readability and for DHCS staff to think through, draft, finalize, and understanding, meeting materials should be writ- send materials. DHCS MMAC meetings will not be ten at a sixth-grade reading level and distributed in effective or productive if members do not under- formats accessible to those with visual impairments, stand the meeting materials. and jargon and acronyms should be avoided. Check-in calls with DHCS MMAC members are a When talking specifically about agendas, Medi-Cal great opportunity to review draft materials and members shared that the most important part of ensure members' understanding. agenda setting in CAC meetings is to ensure ample time for questions, discussion, and for CAC mem- Allow enough time for translation. Meeting mate- bers to raise their own topics. rials should be translated at least into the languages Recommendations requested by DHCS MMAC members on their applications. Additionally, a native speaker commu- Plan the agenda. DHCS MMAC agendas could nity member should review draft meeting materials start with a couple of standing items, such as review- to ensure accurate translation and clarity. Even with ing meeting norms and providing status updates the best of intentions, professional translation ser- on earlier suggestions. Having standing items will vices can be inaccurate or use terms not used in help everyone know there are certain items they day-to-day conversation. CAC members will imme- can always count on discussing and is a nice way diately pick up on poorly translated materials, which to open or close each meeting. DHCS could add has the potential to damage trust. (Note that trans- two or three items to the agenda (e.g., proposed lating materials will affect meeting timelines and will programs coming out, draft correspondence going need to be accounted for as soon as meeting dates out to members, feedback on implementing an are set.) existing program, etc.). Add no more than two or Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 18 7. Building Trust Avoid implicit bias. Be aware of and acknowledge Findings implicit bias and address it when it affects the conver- sation. Aim to choose an implementation consultant Interviewees and TAG members consistently and facilitator open to discussing potential biases expressed that building trust with CAC members with MMAC members as needed. Additionally, will "make or break" the group. Community mem- strive for the facilitator's background and race/eth- bers may be somewhat distrustful of government nicity to reflect the MMAC membership. agencies and could harbor significant trauma and frustration, making them wary to participate. The Establish feedback loops. If a recommendation guidance CHCS heard was that DHCS should start is made or a concern is raised by a DHCS MMAC its MMAC understanding that trust will need to be member, DHCS should try to follow up on the sta- earned, but there are many ways it can be built right tus of those items, even for recommendations that away and continue to strengthen. Several of those cannot necessarily be implemented in the exact strategies have been mentioned - intentional way they were suggested. One health plan noted meeting facilitation, culturally and linguistically it records all recommendations and concerns in the appropriate meeting materials, and creation of a meeting minutes and reviews them all at the next collaborative space. meeting with either updates or reasons some items may need to change, wait, etc. CHCS recommends One additional critical strategy is establishing a DHCS end each meeting sharing a rundown of fol- strong and purposeful feedback loop. This was the low-up items and start each meeting with a brief most frequently mentioned way interviewees noted status update on each. DHCS MMAC members will to build trust. DHCS MMAC members will want to appreciate knowing how information is acted on be heard and know their input is being used. A cou- and where their voices are making a difference. ple of interviewees shared their own experiences with hearing from frustrated CAC members without Work with community-based organizations. a clear sense of how, or whether, their suggestions CBOs often have long-standing trusting relation- were used. ships with community members. One consistently successful recruitment strategy is to look to CBOs Additionally, ensuring members have a contact they to find community members to participate in may reach out to with questions, concerns, or to CACs. Hearing about the opportunity from a talk with is critical. Knowing there is a trusted per- trusted source within the community can help son they can connect with goes a long way toward some potential CAC members take the first step building trust. in reaching out and applying. CHCS recommends Recommendations partnering with CBOs (e.g., contracting with them and paying to support their efforts), such as the Treat DHCS MMAC members with respect, California Pan-Ethnic Health Network, Asian Health understanding, and kindness. Simple acts of kind- Services, Painted Brain, SCOPE LA, The Children's ness and respect will be paramount for the DHCS Partnership, etc., to recruit, support MMAC mem- MMAC. For example, practices such as individually bers, and identify translators. greeting each DHCS MMAC member at meetings and checking at the end of the meeting to make Establish a contact. DHCS should identify who the sure everyone has a reliable and safe way home will contact will be for the DHCS MMAC before the help them feel welcome and supported. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 19 group's launch, and let all members know who it is Recommendations and how to contact that person. Create a consistent orientation process. To become acclimated to the group and start off on Acknowledge missteps. Particularly initially, mis- a solid foundation, every DHCS MMAC member takes may be made with the DHCS MMAC. A should participate in an orientation process. The comment may be made that could be deeply orientation process should include slides or other offensive to someone. Someone may feel their materials describing the following, at least: feedback was glossed over. Meeting materials may be late or hard to understand. This is a new jour- $ The purpose of the DHCS MMAC ney for DHCS - and some bumps in the road are $ Roles and responsibilities of DHCS MMAC mem- expected. The best way to build trust with DHCS bers and DHCS staff MMAC members, however, is to create avenues for honest feedback and to acknowledge when a mis- $ What to expect before, during, and between take was made, apologize, and pledge to make it meetings right going forward. $ List of key terms or glossary $ How the DHCS MMAC will shape and influence 8. Preparing and Supporting Medi- policy Cal Member Advisory Committee $ Contact information for the DHCS MMAC contact Members Findings $ Overview of key DHCS MMAC details including The literature suggests - and interviewees translation, compensation, term-limits agendas, confirmed - the importance of preparing and sup- timing of meeting materials, etc. porting CAC members before, after, and between meetings. Doing so helps CAC members effectively An orientation session should be offered to DHCS participate and feel comfortable and empowered in MMAC members before the first meeting and could their roles. Preparing and supporting DHCS MMAC be conducted as a small group session if several members will require staff time and resources, ide- new members are joining together, or as individual ally with a dedicated position for this effort, as noted. sessions. The most common support strategy used by Establish a DHCS MMAC mentor system. After interviewees was holding brief prep and debrief the DHCS MMAC has been in place for one year conversations with CAC members. These calls were and new members are being added (either to the typically used to ensure CAC members receive and main group or to subcommittees), CHCS recom- understand meeting materials and to answer any mends establishing a mentor system to help new questions, check in on any logistical or technol- members learn about their roles and the expecta- ogy needs to ensure participation is smooth, and tions of the group. DHCS could pair new DHCS answer questions or discuss concerns after meet- MMAC members with a mentor - ideally, a DHCS ings. Debrief calls in particular allow CAC members MMAC member who has been participating for at an additional opportunity to share any feedback they least one year and understands the details of the may not have thought of during the meeting or were role. The mentor would then consistently check in uncomfortable sharing in front of the entire group. with the new member and help with preparation responsibilities along with DHCS staff. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 20 Check in with MMAC members. The contact for Recommendations the DHCS MMAC should check in with all DHCS Measure success for DHCS MMAC members. MMAC members before and after meetings. The DHCS could develop a brief survey (eight to 10 check-in calls should be placed a few days after questions) for DHCS MMAC members to complete meeting materials are sent out, and the purpose of after each meeting to gather feedback (anony- the call will be to ensure the DHCS MMAC member mously) on their experiences with the group. For understands the materials and the agenda, answer example: any questions, and confirm the meeting date, time, and location. During debrief calls one or two days $ Do they feel heard? after the meeting, DHCS MMAC members should $ Do they feel valued and have a sense of belong- be asked for their feedback on how the meeting ing in the group? went; if they felt heard, valued, and supported; if there are more ways their participation in the meet- $ What are their reactions to the meeting format, ing could be supported; and if they have more facilitator, meeting frequency, etc.? questions or feedback to share. They should also $ Do they feel comfortable in their role? be reminded of the date, time, and location of the next meeting (if known). $ Are they getting the support they need from DHCS and their fellow MMAC mwembers? 9. Measuring Success of the Medi- After gathering this feedback, DHCS could dedi- Cal Member Advisory Committee cate time at the next meeting to report back on Findings responses and work with DHCS MMAC members A noticeable gap identified in the literature - in real time to acknowledge what seems to be also confirmed by researcher interviewees - is going well and to explore solutions for areas of that leaders of CACs rarely consider measures of improvement. success for the group, either for the organization or agency or for the CAC members themselves. Measure success for DHCS. In partnership with the Organizations and agencies are often eager to start DHCS MMAC and select CBOs with experience in their CACs and do not necessarily think about what this area, DHCS could establish three or four mea- success will mean to them. If DHCS could establish sures of success for the MMAC. A guiding question a few key measures or benchmarks for its CAC, that for thinking about those measures could be: If data could be collected and analyzed over time to speaking to leadership about the DHCS MMAC two support course corrections, develop deeper rela- years from now, what would you want to be able to tionships with DHCS MMAC members, and support say was accomplished? How did the DHCS MMAC conversations with leadership and stakeholders help in the process? Then, with those potential about impact and return on investment. measures in mind, DHCS could consider discuss- ing this concept with DHCS MMAC members as an agenda item during an upcoming meeting to solicit the group's feedback on what success means. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 21 10. Sustainability Embrace the process. One CBO noted that once Findings established, CACs can be iterative and take time as they work through projects and issues. There will When asked how to maintain and sustain a DHCS likely be lots of back and forth with DHCS MMAC MMAC, interviewees and TAG members noted members on certain projects, but that is necessary that all the key elements - composition and size, to ensure member feedback is genuinely being recruitment, compensation, logistics, meeting facili- internalized and changes are being made to the tation, meeting materials, building trust, preparing extent possible. Timelines are important, but so is and supporting DHCS MMAC members, and mea- the need to recognize when being patient and flex- suring success - play a role in developing a strong ible is the best approach. MMAC members will be and long-standing CAC. The message CHCS heard more inclined to remain part of a group that agrees from interviewees and TAG members on sustain- that getting it "right" is more important than get- ability was essentially that if the DHCS MMAC is ting it done quickly. established based on these promising practices, the group and its members will continue to thrive. Recommendations Commit to the key elements when building the DHCS MMAC. Sustainability will naturally occur if the key elements described in this report are con- sidered when establishing the DHCS MMAC. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 22 Pitfalls in Launching Providing meeting materials that are not cultur- ally and linguistically appropriate. One health the Medi-Cal Member plan noted the importance of having its Cultural Advisory Committee and Linguistics Team review all meeting materials in advance to ensure they are free of jargon, are at As important as knowing what to do when estab- the appropriate literacy level, are translated correctly, lishing and leading a CAC is knowing what not to etc. MMAC members will be turned off from the start do. Below are a few examples of pitfalls to avoid if the materials do not meet them where they are. gleaned from stakeholder interviews, TAG discus- sions, and the literature. Assuming everyone can easily access and use technology, such as Zoom or Microsoft Teams. Overpromising what can be accomplished. Avoid Do not assume everyone has the same command of committing to plans or changes that DHCS cannot or access to virtual technology. Confirm that mem- make. One CBO interviewee shared that their CAC bers are familiar with the platform being used. One members dedicated their time and energy to part- health plan shared that they made this mistake and ner with them on shaping a project that never came lost a lot of time in a CAC meeting trying to help a to fruition due to lack of funding. The CAC mem- translator join the meeting virtually. bers were disappointed and felt their time had been wasted. Be open and transparent but also realistic Assuming because someone is quiet, they have in what may or may not be possible to change. nothing valuable to contribute. People have dif- ferent styles of communication, and not all people Sending meeting materials out late. Nearly all feel comfortable raising issues in a group setting. interviewees mentioned that sending materials out Offer a variety of vehicles for offering feedback - in advance must be best practice. Otherwise, MMAC one-on-one discussions directly after meetings, members will not have time to adequately prepare debrief calls a few days after meetings, voicemail and could be less effective during meetings. Also, line, email follow-up, survey, etc. sending out materials without ample lead time will send the wrong message to MMAC members (e.g., Rattling off statistics and jargon. Medi-Cal mem- we expect you to come to the meeting but are not bers interviewed noted that a steady stream of giving you adequate time to prepare). statistics and jargon can be overwhelming and con- fusing. Instead, share updates and information that Having multiple leaders of the MMAC. Interviewees will resonate with MMAC members and be explicit recommended that a few staff should lead the group about why what is being shared matters to them and those roles should be clearly defined. There is and where you need their input. value in having one or two strong relationships ver- sus confusing MMAC members with too many staff members, roles, and voices. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 23 Conclusion With the launch of its Medi-Cal Member Advisory adopting the recommendations in this report, Committee, DHCS has committed to creating a which reflect the experience of other consumer unique space for state leaders to receive meaningful advisory committees and incorporate feedback and authentic input from Medi-Cal members in real from an advisory group of Medi-Cal enrollees and time. For the first time, DHCS will have an ongoing stakeholders with CAC experience, DHCS has built channel to gather member feedback to help shape on the experience of others and is laying a solid and advance its policy, governance, and strategic foundation for success. priorities as well as its program activities. By largely Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 24 Appendix A. DHCS Consumer Advisory Committee Research and Design: Interview Tool Definition of Key Terms Interviewee(s): Community engagement. Integrating Medi-Cal Organization: members and other people with lived experience and expertise in navigating public benefit programs, Date of Interview: like Med-Cal, into all aspects of state agencies to shape and drive policy change. Good morning/afternoon. Thank you so much for taking the time to speak with us today. DHCS Consumer Advisory Committee (CAC). To date, DHCS has done well integrating advocates As you likely know, the California Department of into its stakeholder processes but now would like Health Care Services (DHCS) is deeply committed to focus more intentionally on Medi-Cal member to strengthening approaches to engage Medi- voices. Thus, DHCS plans to launch a CAC made up Cal members and people with lived experience of diverse Medi-Cal members from across the state to drive policy change. To that end, the agency who will advise on DHCS policy and programs. has identified the need for a DHCS Consumer The CAC will focus on the priorities cited by the Advisory Committee (CAC) to be housed at DHCS members and will coordinate and inform existing and is aiming to convene its first meeting by the groups such as the current Stakeholder Advisory end of 2022. The Center for Health Care Strategies Committee. (CHCS) and California Pan-Ethnic Health Network (CPEHN) have received support from the California Introductions and Organizational Overview Health Care Foundation (CHCF) to support DHCS in conducting research and developing a proposed 1. Could you share a high-level overview of your design for a DHCS CAC of Medi-Cal members. organization and your specific role? 2. Does your organization have or work with a As part of the research and design phase of the consumer advisory committee? Is your organi- project, CHCS is conducting interviews with key zation engaged in other activities that involve stakeholders in the Medicaid and community consumers? engagement communities to better understand the landscape, where the challenges lie, bright spots of Consumer Advisory Committees: Promising innovation and success, and what is needed when Practices, Lessons Learned, Innovations thinking about designing a CAC at DHCS. 1. How would you define a strong and effective consumer advisory committee? We will talk through the questions below with you but welcome you going "off script" and sharing 2. Have you seen any strong consumer advisory thoughts and insights that may not be included in committees in practice? If so: these questions. We're also happy to focus on the a. What strategies seem to work well? areas where you have specific expertise. We would like to record this call for note-taking purposes b. What hasn't worked? only (and we will destroy the recording after). Do 3. Any bright spots or exciting innovations to share we have your permission to do so? around developing a CAC, promising practices, outcomes and accomplishments, etc.? Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 25 DHCS Consumer Advisory Committee: What Is d. What pitfalls should be avoided? Needed? e. What is most important to consider in design- 1. CHCS is supporting DHCS in designing a CAC ing a CAC that ensures participants feel safe that will be housed at the agency. With that in and supported? mind: f. What elements are needed for a CAC to have a. What do you picture when thinking about a the greatest positive impact on policymaking? CAC at DHCS? g. Are there design considerations for a CAC b. Which populations, communities, etc., should unique to Medi-Cal? be represented? 2. A consultant will be chosen (via an RFP process) c. What is the ideal standard for the following to recruit for and implement the CAC. Do you CAC "must haves": have any suggestions for potential consultants i. Composition, size, and term limits who may have experience in this area? ii. Trust building Wrap-Up iii. Logistics 1. Do you have any other comments, thoughts, or iv. Comensation recommendations we didn't already cover? v. Agenda setting 2. Do you have any reports, research, or resources vi. Sustainability on CACs or community engagement in California or nationally that you'd be willing to share with us? vii. Support and prep for CAC members viii. Governance structure 3. <If applicable> Do you have consumer contacts (e.g., Medi-Cal members participating on a CAC) ix. Measuring success that you would recommend we speak to? x. What else would be on your "must haves" list? Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 26 Appendix B. Literature Review: Promising Practices for Community Engagement and Consumer Advisory Committees The following document is a compilation of research focused on promising practices for community engagement and, more specifically, consumer advisory committees (CACs). The articles are organized in two ways in the charts below: (1) summary of article and best practices and key lessons and (2) key theme and/or CAC design element. The bolded text signifies points in the research that CHCS has heard mentioned in either Technical Advisory Group meetings or key stakeholder interviews. Much of the research highlighted below will strengthen and confirm the recommendations to be made in CHCS's recommendations for the DHCS MMAC. EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Increasing Consumer Engagement in Support for engagement Medicaid: Learnings from States $ States connect with members through technology beneficial for those Summarized key lessons from conversa- hard to reach. tions with 50 leaders of state Medicaid $ Ensure engagement opportunities are accessible. programs across 14 states. $ Provide compensation in return for member participation, along with food, Source: Jane M. Zhu and Ruth Rowland, transportation, and childcare for participants who see these as obstacles Increasing Consumer Engagement in to attendance. Medicaid: Learnings from States (PDF), Oregon Health Sciences University, $ Offer opportunities for member engagement in various formats (e.g., town December 2020. halls, focus groups, committee seats). $ Provide training to members on technical language and policy details. Feedback loop $ Communicate consistently about how their input was used to inform decisionmaking. CA N Partner with community foundations for financial support of engagement functions (technical support, meeting facilitation, and atendee travel and per diem) that cannot be easily provided through government contracting. CO N $ Offers a handbook and is developing a video orientation on Medicaid policy for members participating in its benefits collaboratives to facilitate productive engagement. $ Medicaid agency uses a "benefits collaborative" process to solicit member priorities when deciding on Medicaid covered benefits by documenting input. MN N Leverage community partnerships to provide a neutral, safe space for engagement (e.g., hosting sessions at a community center). One session started with members sharing personal stories before discussing Medicaid program design. This helped to root the policy discussion in the context of members' lived experiences. NY N Conducted 25 focus groups in several languages to understand members' knowl- edge of health systems and experiences with care. The findings were used to design educational messages and to provide insight to shape demonstration projects designed to improve care provided to Medicaid patients. PA N Maintain a member-only subcommittee, focused entirely on members' needs, facilitated by a leader with the Pennsylvania Health Law Project. The group generates member-initiated policy ideas and provides input on state-led policy initiatives. VA N Virginia lets members participate through a telephone town hall in which committee members dial in to ask questions and to offer comments. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 27 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Key Learnings for Strengthening CA N Key lessons: Partnerships $ Leadership commitment is necessary for success. Study highlights key learnings and recom- $ Pay ongoing attention to relationship and trust building. mendations to provide practical guidance to the field for strengthening partner- $ Establish a defined infrastructure. ships with patients and families. $ Work to expand involvement of patient and family advisors (PFAs). Source: Deborah L. Dokken, Pam $ Have planned opportunities for onboarding PFAs, mentoring, and continuing Dardess, and Beverley H. Johnson, Key education. Learnings for Strengthening Partnerships $ Design a mechanism to ensure coordination and synergy of efforts. (PDF), Institute for Patient- and Family- Centered Care, November 2021. $ Stay nimble and adaptable to emerging issues. $ Commit to measurement, evaluation, and reporting. $ Use technology effectively. It Takes a Family CA N $ Maximize the value of family participation at the agency level. Report offers recommendations for how $ Assure that family representation reflects California's diverse population. California could fulfill its articulated $ Provide supports to allow family members to participate (e.g., translation commitment to coordinated, family- services, ability to join meetings by web or phone). centered care by including families in decisionmaking. $ Support activities related to work on the government policy entity, including outreach to gather input from other families. Source: Maryann O'Sullivan, It Takes a Family (PDF), Lucile Packard Foundation $ Consider travel issues when setting meeting locations. for Children's Health, May 2014. $ Reimburse for childcare and travel expenses. $ Provide stipends for attending meetings. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 28 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Working with Patient and Families as IL N Identify and hire a staff liaison - designate a staff member to put in place the Advisors: Implementation Handbook MD infrastructure for advisor engagement: The purpose of this tool was to help SC $ Prepares staff and clinicians to work with patient and family advisors. hospitals implement and develop effec- $ Recruits, orients, trains, and supports advisors. tive partnerships with patients and family members at the organizational level $ Facilitates partnerships. Source: Working with Patient and Families $ Ensures that advisors are ready to participate and that staff are ready to as Advisors: Implementation Handbook engage in partnerships. (PDF), Agency for Health Care Research Staff liaisons have these qualities: and Quality, January 2013. $ Passion for patient- and family-centered care $ Ability to listen and be open to new ideas $ Ability to build a strong rapport with hospital leadership, clinicians, staff, and with patients and family members $ Willingness to both learn and educate $ Well-connected within the hospital $ Patience and perseverance $ Ability to see strengths in all people in all situations and to build on these strengths $ Flexibility and a sense of humor Recruitment process $ Develop a set application and interview processes. $ Advertise; place brochures in easily accessible locations (i.e., discharge packets, informational materials, welcome packets, patient satisfaction survey mailings). $ Most effective method for recruiting advisors is with a personal invitation. Support $ Work with advisors to develop or revise written and audiovisual materials, such as patient and family handbooks, informational videos, or care instructions. $ To get the most of advisor input, bring advisors into the process when their ideas and input can have the biggest impact. $ Ensure a personal understanding of the hospitals culture, policies, and decisionmaking. $ Provide advisory training. $ Pair advisors closely with a mentor. Advisors need to understand the responsibilities associated with the role before they can decide whether they are ready to serve. The staff liaison can hold an information session for potential advisors to cover: $ The role of patient and family advisors, including responsibilities and the benefits of participation Orientation $ Background information $ Organizational structure of the department $ Responsibilities and expectations $ Tips for being an advisor $ How the staff liaison will support the advisor Logistics $ Time commitments, whether reimbursement or compensation is provided, what kind of training and support is available, and how the application process works Term limits $ 1- to 2-year commitment Feedback loop $ Provide feedback to and solicit feedback from patient and family advisors. $ Conduct periodic check-ins. $ For advisors who are council members, staff liaisons may want to schedule a quarterly meeting to talk about how the experience is going and to identify any areas in which the advisor needs or wants to develop their skills. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 29 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Five Top Tips for Engaging Families in CA Top tips Advisory Roles: Advice from a Family 1. Organization values families' time and input Leader 2. Organization offers ongoing training and support to family members Source: Five Top Tips for Engging Families in Advisory Roles: Advice from 3. Organization provides support to committee chair a Family Leader (PDF), Lucile Packard 4. Chair models appropriate facilitation and behavior Foundation for Children's Health, 5. Chair builds community, cohesion, and trust December 2018. Leading by Convening: A Blueprint for GA Yes C.A.F.E. (Circles of Adults Focusing on Education): A diversified group of school, Graduation rate Authentic Engagement family, and community stakeholders were invited to "coalesce" around alarming increased by over This guide revealed three state school data (declining test scores, high absenteeism, little parent involvement, 30% (general popula- approaches to how leaders at the school, low graduation rates). Transparency of leaders (principal). tion); graduation rate district, and state level grapple with the increased by over Practices and strategies 30% (students with challenges of implementing practice change. $ Dialogue Guide process disabilities). Source: J. Cashman et al., Leading by $ Communities of Practice Convening: A Blueprint for Authentic $ By inviting the full range of partners to learn from and with each other, Engagement (PDF), Natl. Assn. of State Meriwether County leaders committed to making the necessary practice Directors of Special Education, 2014.v changes. IN Initial sharing of information, building administrators in collaboration with teach- Primary teach- ers and specialized instructional support personnel, dialogue between parents ers raised concern and community members regarding research, best practice, and The Partnership Way: materials to support $ Coalescing around issues describes a habit of practice in which groups come student acquisition together around shared concerns or problems of practice they want to resolve. and decided they needed more help $ Ensuring relevant participation involves making sure the right mix of stakehold- to research best ers is identified and participating. practice and delinea- $ Doing the work together focuses on the work being done and the interactions tion of appropriate between and among the participants. sequence of skill instruction. CO Colorado Response to Intervention (RTI) Community of Practice brought together State Advisory Colorado Dept. staff and local practitioners to engage in monthly discussions around problems Council for Parent of Education was of practice related to successfully implementing RTI. Involvement in awarded a grant that Education "review gave birth to new best practices and partnerships. recommend to policy makers and educa- tor's strategies to increase parent involvement." Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 30 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES A Guide to Replicating and Adapting an CA $ Youth are paired with coaches to further explore concepts from the trainings Built membership Innovative Youth Development Program and to plan projects for change. base by engaging This guide is designed to provide organi- $ Youth develop relationships with BAYLA facilitators, coaches, staff, guest current and former zations with the information they need to speakers, and externship hosts. foster youth with an replicate, adapt, and implement a leader- interest in advocacy $ At the end of the training period, youth are placed in four-week externships to work. ship academy in their area similar to Bay implement the projects they have developed. Area Leadership Academy. $ Youth, coaches, and externship sites are recruited through outreach. Source: A Guide to Replicating and Adapting an Innovative Youth $ Coaches and externship sites commit to the 10-week program. Development Program (PDF), Bay Area $ Youth leaders complete six full days of training. Leadership Academy (BAYLA), November $ Networking with their coaches, youth leaders plan projects for change. 2018. $ Youth leaders develop their projects for change during their four-week extern- ships. Compensation Youth receive $75 for each training they attend, $45 for each assignment they complete and each meeting with their coach, and $15 per hour (up to 10 hours per week) for working on their projects during that phase. Support $ Coaches have a network of youth to call on to participate in policy initiatives. $ Cultural field trips that connect participants with local events and history provide a visual, one-on-one experience. Partnering with Youth, Families, and CO Y Active engagement Compensation Patients in Research: A Standard of $ Youth, family, and patient partners work with funders to focus on and design shows a commit- Compensation for Youth, Family, and research projects, advising about or recruiting participants, helping to develop ment to excellence Patient Partners materials, carrying out aspects of research such as conducting interviews with in research and Guide provides recommendations to study participants. helps make sure the youth, families, and patients for collabo- findings represent $ CBOs led and staffed by patients or families such as Family Voices and Family- the population being rating with researchers on studies and to-Family Health Information Centers. outlines fair compensation for the work studied. done as part of the research team $ Participating in training events, receiving support, and mentoring around research terms and processes. Source: Charlene Shelton, Clarissa Hoover, and Carolyn Allshouse, $ Interviewing participants or leading a focus group. Partnering with Youth, Families, and $ Coproducting reports, articles, and other dissemination materials. Patients in Research: A Standard of Compensation for Youth, Family, and Representation Patient Partners (PDF), CYSHCNet, 2021. Diversity - in addition to racial and ethnic diversity, socioeconomic status, education, geography, rural/urban, culture, nationality, language, religion, and other aspects of the human Develop a contract or scope of work that outlines duties and compensation. CYSHCNet recommends that payments begin at $25 per hour with a $100 minimum payment. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 31 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Family Engagement in Systems Toolkit: MA N $ Commitment Strategies and Resources $ Transparency The Family Engagement in Systems (FES) $ Engaged families reflect the diversity of the community served (race/ Toolkit can be used as a standalone ethnicity, culture, language, and geography) resource or as a companion document to the Family Engagement in Systems $ Diversity not only in race/ethnicity, but also in socioeconomic status, Assessment Tool (FESAT). The FESAT education, geography, rural/urban, culture, nationality, language, religion, is a tool that organizations can use to and other aspects of the human condition assess and improve family engagement in systems-level initiatives, helping to ensure that the voices of the individuals, families, and communities who receive services are included in the creation of the policies and practices that govern those services. The FES Toolkit and FESAT are based on a framework of four strategic domains. Family Voices encour- ages organizations to use the strategies and resources in this toolkit to promote, strengthen, and improve family engage- ment in systems-level initiatives. Source: Family Engagement in Systems (FES) Toolkit: Strategies and Resources (PDF), Family Voices, June 2020. "Engaging Consumers and Communities CA N Integrating patient experience and voice into health system interventions is to Meaningfully Transform Care" crucial to making sure health care systems design and deliver services that Project gathers best practices for: meet community needs. $ Identifying community priorities $ Obtaining and integrating patient input $ Designing and implementing sustain- able community-based efforts to address patient-identified health and social needs $ Understanding and collectively addressing equity challenges Source: Anna Spencer, "Engaging Consumers and Communities to Meaningfully Transform Care," Center for Health Care Strategies, September 12, 2019. "Convening a Consumer Advisory Board: NJ N $ Laying the groundwork Key Considerations" $ Recruiting members Key considerations to help guide health $ Supporting meaningful participation care systems in creating successful community advisory boards. $ Reducing barriers to participation Source: Anna Spencer, "Convening $ Compensating members for expertise a Consumer Advisory Board: Key Considerations," Center for Health Care Strategies, December 2019. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 32 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Supporting Meaningful Engagement OR Yes; Training Recruiting and Through Community Advisory Councils: case study Staff and consultant-led, in-person training sessions are available on issues supporting members Lessons from the Oregon Health such as the Community Health Assessment (CHA) and the Community Health to serve on CACs. Authority Improvement Plan, areas for which CACs are responsible. Challenges included This case study examines what has varying level of inter- made CACs - and the resulting patient Policies feedback loop est across regions; engagement - successful. ensuring CACs have Coordinated care organizations have an important avenue to learn how their the supports needed Source: Renée Markus Hodin and policies and procedures are impacting members and to make any necessary to meaningfully Madison Tallant, Supporting Meaningful changes. include members Engagement Through Community once they join; and Accessible materials Advisory Councils: Lessons from the properly funding Oregon Health Authority (PDF), Center $ The Columbia Gorge CAC strongly influenced the regional CHAs' develop- supports for CAC for Consumer Engagement in Health ment by creating an 11-page "plain language," more accessible and visual member attendance. Innovation, August 2020. summary that provides key highlights of the 63-page assessment. $ Translated the summary document into Spanish. Key Findings from the Medicaid MCO CA N Managed care organizations reach out to members to provide multiple types of Learning Hub Discussion Group Series important information via mailings, phone calls, face-to-face interactions, text and Roundtable - Focus on Member messages, interactive voice response, and social media. Engagement and the Consumer Voice Compensation Challenges with member and family engagement, strategies for better $ Incentives can include stipends, lunch, transportation, gift cards, childcare, etc. engagement, and how COVID-19 $ Incorporating celebrations like annual dinners and awards ceremonies also affected engagement efforts were encourages participation and shows members and their families that their discussed. After assessing key themes, input is valued. the team convened a roundtable with partners to discuss findings and identify insights and opportunities to address those findings Source: Key Findings from the Medicaid MCO Learning Hub Discussion Group Series and Roundtable - Focus on Member Engagement and the Consumer Voice, NORC at the University of Chicago, January 2021. "Engaging Consumer Voices in Health CA Qualitative To ensure that health centers meet the needs of their patients, they uniquely Care Policy: Lessons for Social Work study engage them in their organizational decisionmaking and policy-development Practice" processes by requiring that their boards of directors encompass a 51% patient To better understand the quality of majority. patient participation. Source: Kristi Lohmeier Law and Jeanne A. Saunders, "Engaging Consumer Voices in Health Care Policy: Lessons for Social Work Practice," Health and Social Work 41, no. 1 (Feb. 2016): 9–16. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 33 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Creating a Consumer Advisory Council N/A N $ Secure buy-in from existing board members and senior leadership to This fact sheet outlines a set of best create a consumer advisory council. practices to help guide you as you create $ Identify council members and together determine roles and responsibilities. any form of a consumer advisory council. $ Formalize the role of the CAC by creating a written document to outline Source: Creating a Consumer Advisory its principal functions. Council: Fact Sheet (PDF), National $ Ensure the CAC is integrated within the greater organization. Partnership for Women & Families, January 2014. $ Orient all stakeholders to the goals of the CAC. $ Orient members of the consumer advisory council to the goals, mission, and vision of the larger organization. $ Designate staff to support and maintain the membership of the CAC. "Engaging Consumers in Medicaid OR Y $ Holding telephonic "town halls" for members who could not attend in person. $ Keeping members Program Design: Strategies from the $ Tapping foundations to fund members' participation costs, meals, and engaged States" meeting facilitation. $ Overcoming Early evidence on how state Medicaid $ Building member research into budget requests for federal programs. resource agencies are integrating members' constraints experiences and perspectives into their $ Using short-term workgroups regarding specific benefits to optimize member interest and impact. $ Ensuring engage- program design and governance. ment is productive Source: Jane M. Zhu et al., "Engaging $ Using advocacy groups to identify representative member participants. Consumers in Medicaid Program Design: $ Implementing application and selection processes for member' committee Strategies from the States," Milbank membership. Quarterly 99, no. 1 (Mar. 2021): 99–125. $ Incorporating activities across different Medicaid subpopulations. $ Educating new committee members on Medicaid and how to use it. $ Encouraging members to start policy discussions via an all-member medical care advisory committee (MCAC) subcommittee. $ Closing the loop: sending out detailed agency responses to all public comments, making sure members see their impact. $ Showing respect for members' input by having Medicaid director attend MCAC sessions. Engagement $ Hold standing meetings with advocacy organizations and other constituents, town halls, and focus groups. $ Partner with a regional nonprofit to gather member experiences as part of the case management service redesign. $ Medicaid leaders highlighted that providing some minimal compensation for participation was a factor in successful engagement. Feedback loop Ensure an effective feedback loop by reporting (through public minutes or reports) how members' feedback was used, invested time and staffing resources to help with effective member interactions. Supports $ Provided training for patient participants to better understand technical language and policy complexities. $ One-on-one orientations for new committee recruits to familiarize them with the Centers for Medicare & Medicaid Services, the role of the council, and the work that it does. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 34 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Engaging Youth with Special Health CO N Trust building Majority of state Care Needs and Families of Children CT $ Systematically checking in (e.g., establishing a consistent feedback loop) Medicaid agencies with Special Health Care Needs: DC with youth and family advisors and representatives, and refining engage- do not meaningfully Recommendations for Medicaid DE ment strategies based on their input. engage youth and Agencies ND teens with special OH $ Reliable feedback loop between Medicaid agencies and family representa- health care needs Key findings from the survey and inter- tives encourages prolonged engagement and mutual trust. views, including engagement themes, OK (focus is more often challenges, and recommendations for RI on parents). Sustainability Medicaid agencies, youth with special TX Offer training, onboarding, coaching, and compensation to ensure members health care needs and families of children understand their roles and can participate effectively. with special health care needs, and funders to strengthen engagement that Engagement can have lasting impact on outcomes, $ Dedicate staff time and resources to conduct intensive recruitment. quality, equity, and cost. $ Conduct outreach and provide a virtual option for participation to help Source: Courtney Roman, Hannah Gears, yield a much more diverse and rich representation. and Madeline Pucciarello, Engaging Youth with Special Health Care Needs $ Consider cultural and linguistic competencies when partnering with youth and Families of Children with Special and families. Health Care Needs: Recommendations $ Understand deeply rooted cultural needs and preferences for participation. for Medicaid Agencies, Center for Health Care Strategies, July 2021. Compensation $ Stipend, childcare, meals Youth Advocates Program CA N $ Support youth in building their advocacy skills. California Children's Trust and California $ Offer youth opportunities to change and influence the systems that impact Coalition for Youth have partnered them. with youth leaders to create the Youth $ Acknowledge the wisdom and experience young people bring to complex Advocates Program. issues by compensating them for their advocacy. Source: "Youth Advocates Program," California Coalition for Youth. Family Engagement and California's CA N Compensation Whole Child Model The health plans provide a stipend of between $50 and $100 per meeting to Source: Caroline Davis, Family their family advisory committee family representatives. Engagement and California's Whole Child Model: Lessons Learned from the Implementation of Family Advisory Committees, Lucile Packard Foundation for Children's Health, September 9, 2021. Y.O.U.T.H. Training Project CA N YTP has trained, employed, and supported more than 140 youth who have in YTP is the first child welfare training turn trained over 7,500 child welfare professionals on the needs of foster youth program developed and delivered and the practices that best support them. entirely by current and former foster youth. Source: "Y.O.U.T.H. Training Project," California Youth Connection. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 35 EVIDENCE- ARTICLE INFORMATION STATE BASED BEST PRACTICES AND KEY LESSONS CHALLENGES OUTCOMES Issue Brief: Framework for Assessing CA Y Representation and recruitment Family Engagement in Systems Change Reflect the diversity of the community (race/ethnicity, language, income, educa- Summarizes barriers to effective family tion level, and geography). engagement and identifying four Collaborate with family-led and community-based organizations for recruit- domains and corresponding key criteria ment, training, and support of participants. that provide a framework for considering how well organizations and agencies are Support engaging families. $ Provide peer mentors to help family leaders learn the skills to participate Source: Clarissa Hoover et al., Issue effectively and address barriers to their participation. Brief: A Framework for Assessing Family $ Make meeting minutes and other key materials available to family leaders, Engagement in Systems Change (PDF), in formats they can access, in language they can understand, and in a Lucile Packard Foundation for Children's timely way. Health, April 2018. $ Provide both families and professionals opportunities for training and support in understanding their roles and the process of engagement. Transparency $ Provide access to relevant knowledge. $ Practice partnership in all parts of the process. Engagement $ Promote engagement as a core value. $ Establish engagement at all levels, in all systems of care. $ Hold meetings that accommodate everyone's schedules to encourage regular attendance. In-person meetings help with relationship building between families and professionals. Diversity Ensure that family participants represent the race/ethnicity, language, income, education level, and geography. Compensation $ Compensate family organizations and family leaders for their time, exper- tise, and the costs of participation, such as travel expenses and childcare. $ Family engagement should be adequately funded and included in the budget. Language $ Spell out acronyms and explain their meaning. $ Use plain language when writing and speaking. Family Voices Matter: Listening to the CA N Engagement Suggestions for Real Experts in Medi-Cal Children's Build a family engagement infrastructure: Provide families financial, trans- improvement: Health portation, translation, child care. Codesign, with This report describes parents' experi- Meaningfully incorporate family input into DHCS decisionmaking. parents, information ences with their children's Medi-Cal materials to be more coverage and their recommendations for relevant, and provide improving children's health care, as well the materials to as how health plans can collaborate with parents with coordi- families on systems change. nators available to Source: Family Voices Matter: Listening to help them navigate the Real Experts in Medi-Cal Children's and understand Health (PDF), Children's Partnership, information they June 2022. receive. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 36 Appendix C. DHCS Medical Member Advisory Committee Design - Technical Advisory Group Roster Participants NAME ORGANIZATION Jimina Afuloa Empowering Pacific Islanders Coalition Seciah Aquino Latino Coalition for a Healthy California Dannie Cesena California LGBTQ Health and Human Services Network Sarah Coombs National Partnership for Women & Families Jack Dailey Legal Aid Society of San Diego Auleria Eakins L.A. Care Health Plan Janette Robinson Flint Black Women for Wellness Tiffany Huyenh-Coh Justice in Aging Kausha King Family Resource Navigators Rod Lew Asian Pacific Partners for Empowerment, Advocacy, and Leadership Nancy Netherland California Children's Trust / Parent and Consumer Partner Hector Ramirez Consumer Partner Andrea Wagner California Association of Mental Health Peer Run Organizations Jevon Wilkes California Coalition for Youth Elizabeth Zirker Disability Rights California Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 37 Staff NAME ORGANIZATION Michelle Baass California Department of Health Care Services Palav Babaria California Department of Health Care Services Alissa Beers Center for Health Care Strategies Kelly Church Center for Health Care Strategies Brian Hansen California Department of Health Care Services Tricia McGinnis Center for Health Care Strategies Chris Perrone California Health Care Foundation Courtney Roman Center for Health Care Strategies Cary Sanders California Pan-Ethnic Health Network Kiran Savage-Sangwan California Pan-Ethnic Health Network Madeline Steward Center for Health Care Strategies Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 38 Endnotes 1. Courtney Roman, Hannah Gears, and Madeline Pucciarello, "Engaging Youth with Special Health Care Needs and Families of Children with Special Health Care Needs: Recommendations for Medicaid Agencies," Center for Health Care Strategies, July 2021; and Jane M. Zhu and Ruth Rowland, Increasing Consumer Engagement in Medicaid: Learnings from States (PDF), Oregon Health and Sciences Univ., December 2020. 2. California Dept. of Health Care Services, "DHCS Launches New Medi-Cal Member Advisory Committee," press release, February 17, 2023. 3. Note that for CAC members paid $600 or more during one calendar year, a 1099 tax form will likely be required and the compensation reported for tax purposes. Medi-Cal Member Advisory Committee: Design Recommendations www.chcf.org 39