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California's 2010 Medicaid Waiver Stakeholder Process: Impact and Lessons Learned

Barbara Masters, Karen Linkins, Jennifer Brya, Gigi Barsoum, and Astrid Hendricks

State health officials and foundations came together to help shape California's Medicaid waiver request. How effective was the process, and what lessons were learned?

CHCF commissioned an independent evaluation of the Section 1115 Medicaid Waiver Stakeholder Process, which occurred during the first six months of 2010. The purpose was to determine what the outcomes and benefits were and to identify recommendations for future efforts.

After analyzing three dimensions of the work — effectiveness, usefulness and benefits to participants, and impact — the authors found that the stakeholder process appears to have been very successful. The authors also identified 10 characteristics of a successful stakeholder process and provided recommendations to foundations and state agencies that may be considering similar initiatives.

Among the findings:

  • Overall, participants expressed a high degree of satisfaction with the frequency and size of the meetings, and gave very high marks to the facilitation. The three areas receiving the lowest satisfaction ratings across most of the groups were data availability to inform discussions, openness and opportunity for input, and productivity.
  • Participants reported benefiting personally and professionally from the process, noting the value of gaining a better understanding of the issues from different perspectives and the opportunity for information exchange among diverse stakeholders.
  • The extent of participants' previous experience working in a policy environment strongly influenced their perceptions about the waiver process, with the more experienced participants tending to express more satisfaction.

The authors concluded that a meaningful stakeholder process can provide many benefits. They also noted that this stakeholder process required an enormous investment of time, staff, and resources. Going forward, it will be important to determine the circumstances under which such an effort can make the greatest contribution to the policy process.

The full report is available as a Document Download.

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