Edward Alan Miller, Ph.D., M.P.A., and Cynthia Rudder, Ph.D.
E. A. Miller and C. Rudder, “Engaging Consumers in Medicaid Nursing Home Reimbursement Policy: Lessons from New York and Minnesota,” The Gerontologist, published online Nov. 2, 2012.
How nursing homes are reimbursed by state Medicaid programs—the main purchasers of nursing home services in the United States—has significant consequences for the quality of care residents receive. Consumer advocates, however, have generally not been involved in the development of nursing home reimbursement policy. The authors of this Commonwealth Fund–supported study note that this lack of consumer involvement could result in reimbursement systems that favor industry and government interests at the expense of vulnerable long-term care residents. In their article, they draw lessons for successful consumer engagement from New York and Minnesota—two states where resident advocates have influenced reimbursement policy to encourage access, care quality, and quality of life.
The researchers interviewed 27 individuals, including state officials, consumer advocates, and nursing home representatives, in New York and Minnesota between February 2 and June 20, 2011. In both states, consumer advocates had formed strong coalitions that focused on using direct contact with government officials as the primary means for influencing policy. These lobbying efforts were supplemented with grassroots strategies that increased public and political support for nursing home issues. The researchers found that identifying and recruiting key legislators who sit on or chair relevant committees and subcommittees, as well as the leadership in each legislative chamber, and educating them on the consumer point-of-view is especially important for influencing Medicaid nursing home reimbursement policy.
Successful strategies in New York and Minnesota have given consumer advocates a strong voice in forming state Medicaid reimbursement policy. Such approaches can be adopted by other states.