How would low-income communities prioritize medicaid spending?

C. Daniel Myers, Edith C. Kieffer, A. Mark Fendrick, Hyungjin Myra Kim, Karen Calhoun, Lisa Szymecko, Lynnette LaHahnn, Charo Ledón, Marion Danis, Zachary Rowe, Susan Dorr Goold

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Context: Medicaid plays a critical role in low-income, minority, and medically underserved communities, particularly in states that have expanded Medicaid under the Affordable Care Act. Yet, the voices of underresourced communities are often unheard in decisions about how to allocate Medicaid’s scarce resources, and traditional methods of public engagement are poorly suited to gathering such input. We argue that deliberative public engagement can be a useful tool for involving communities in setting Medicaid priorities. Method: We engaged 209 residents of low-income, medically underserved Michigan communities in discussions about Medicaid spending priorities using an exercise in informed deliberation: CHAT (CHoosing All Together). Participants learned about Medicaid, deliberated in small groups, and set priorities both individually and collectively. Findings: Participants prioritized broad eligibility consistent with the ACA expansion, accepted some cost sharing, and prioritized spending in areas—including mental health—that are historically underfunded. Participants allocated less funding beyond benefit coverage, such as spending on healthy communities. Participants perceived the deliberative process as fair and informative, and they supported using it in the policy-making process. Conclusion: The choices of participants from low-income, medically underserved communities reflect a unique set of priorities and suggest that engaging low-income communities more deeply in Medicaid policy making might result in different prioritization decisions.

Original languageEnglish (US)
Pages (from-to)373-418
Number of pages46
JournalJournal of health politics, policy and law
Issue number3
StatePublished - Jun 1 2020

Bibliographical note

Funding Information:
The authors would like to thank the Medicaid CHAT steering committee, our community partners, and the Medicaid CHAT session participants. This work received helpful feedback from two anonymous reviewers, Sarah Gollust, and Jacob Hasels-werdt. Dr. Goold, Dr. Danis, and their institutions could benefit from future paid licenses (royalties) for the CHAT tool used in this study. This work was funded by the Agency for Healthcare Research and Quality 1-R21-HS-023566-01.


  • Deliberation
  • Medicaid
  • Public engagement
  • Public opinion
  • State policy making


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