Engaging consumers in medicaid nursing home reimbursement policy: lessons from New York and Minnesota

This study draws lessons for successful consumer engagement in Medicaid nursing home (NH) reimbursement policy from New York and Minnesota. In these two states, resident advocates have influenced reimbursement policy to better encourage access, care quality, and quality of life.

Twenty-four semi-structured interviews were conducted, including consumer advocates, state agency officials, legislators/legislative staff, and NH industry representatives. Transcripts were coded to identify recurring themes and patterns in responses. Related documents were reviewed as well.

Interviewees report that consumer advocates should participate in NH reimbursement policy making to provide a unique perspective distinct from other stakeholder groups. Skills necessary for successful participation include developing, demonstrating, and sharing expertise to gain credibility as a legitimate actor. Effective strategies include participating on state workgroups and taskforces and developing and accessing relationships with key legislative and executive branch officials. A division of labor may be useful with those consumer advocates possessing expertise in NH reimbursement policy partnering with other organizations with the experience and resources necessary to marshal grassroots support.

State and federal reimbursement reform provide opportunities for consumer advocacy influence during the design and implementation process. The experience of consumer groups in New York and Minnesota provide lessons for advocates looking to influence these and other reimbursement initiatives.