How frontline professionals can influence policy and protect access to care.
By Susan Plough, MSN, RN, PHCNS-BC, CCM, FCM
Why Advocacy Matters
Case managers see firsthand how policies affect real people. Whether it is access to healthcare, a lack of affordable housing, gaps in mental health services, or restrictive eligibility criteria for public benefits, these systemic issues cannot always be solved one case at a time.
Advocacy allows case managers to address root causes, not just symptoms. When case managers step into the realm of public policy advocacy, they transform lived experience into systemic change and become powerful voices for those who might otherwise go unheard.
The 2025 Budget Reconciliation Act
Recent federal legislation, including the 2025 Budget Reconciliation Act, proposes deep cuts to Medicaid, up to $880 billion over 10 years. These changes include:
• Restrictive work requirement
• Frequent eligibility redetermination
• Reduced federal matching rates.
• Limits on provider payments and optional services
These policies disproportionately affect low-income families, people with disabilities, and rural communities, many of whom rely on case managers to access care.
Practical Strategies for Advocacy in Case Management
You do not need to be a policy expert to make a difference. Here are actionable ways case managers can integrate advocacy into their practice:
1. Document and Share Trends
Track recurring issues clients face and share both data and stories. Legislators need to connect with the people behind the numbers.
2. Engage in Legislative Processes
Participate in public hearings, submit testimony, or join advocacy days like CMSA Hill Day. If high-level advocacy is not your style, send emails or voicemails to legislators, attend town meetings, or meet with them locally. Even brief stories from your caseload can make a big impact.
3. Educate and Empower Clients
Help clients understand their rights and how policies affect them. Guide them on how to share their stories with legislators and become advocates for themselves.
4. Collaborate Across Disciplines
Partner with legal aid, public health agencies, or coalitions to amplify your impact. Your insights as a case manager are invaluable.
5. Use Professional Associations
Get involved in committees or contribute to policy position papers. CMSA offers several advocacy tools:
- CMSA Advocacy Center: Learn about legislative priorities and how to get involved.
- CMSA Advocacy Hub: Access resources on telehealth, mental health, and workforce development
- CMSA Advocacy & Grassroots Resource Guide: A practical guide to understanding the legislative process and getting started.
- Visit CMSA’s Public Policy page: https://cmsa.org/advocacy/public-policy/
6. Leverage Social Media
Use LinkedIn, X (formerly Twitter), or Facebook to share stories, data trends, and policy concerns. Social media can amplify your voice and connect you with advocacy networks, journalists, and policymakers.
7. Train Future Advocates
Mentor new case managers or students. Advocacy skills can be taught and modeled. Encourage them to see advocacy as part of their professional identity.
8. Integrate Advocacy into Team Meetings
Make advocacy a regular agenda item. Discuss trends, brainstorm solutions, and identify opportunities to act collectively.
9. Create Advocacy Toolkits for Clients
Develop simple guides or handouts explaining how to contact legislators, write letters, or attend public meetings. Include sample scripts or templates.
10. Highlight Success Stories
Share examples of advocacy that led to change both big and small. These stories inspire others and demonstrate that advocacy works.
11. Advocate Within Your Organization
Push for internal policy changes such as better documentation systems, inclusive practices, or trauma-informed care. Internal advocacy can have a ripple effect.
12. Stay Informed
Subscribe to policy newsletters, attend webinars, and follow legislative updates. Being informed helps you act quickly and effectively.
13. Ethical Considerations
Advocacy must be balanced with ethical responsibilities. Case managers should:
- Ensure client confidentiality when sharing stories.
- Avoid conflicts of interest
- Stay within their professional scope.
Conclusion: From Case to Cause
The 2025 Medicaid cuts are a stark reminder that policy decisions have real consequences. Case managers are uniquely positioned to respond, not just with compassion, but with action.
By integrating advocacy into case management, we can help shape a more just and responsive system. Because every case tells a story, and every story can shape policy.
Advocating for better policies is not just a professional enhancement, it is a moral imperative. When case managers advocate, they are not just helping one client. They are helping thousands.
Let us bridge the gap between individual support and systemic change and turn our cases into cause.
Bio: Susan Elaine Plough, MSN, RN, PHCNS-BC, CCM, FCM is a distinguished nursing professional with extensive leadership experience across both large multi-hospital healthcare systems and smaller community hospitals throughout the Midwest. She is a Board-Certified Clinical Nurse Specialist in Community Health and a Certified Case Manager, recognized nationally as a Fellow in Case Management. Currently serving as faculty at the Indiana University School of Nursing, Ms. Plough is deeply engaged in advancing the nursing profession through education, advocacy, and organizational leadership. She is actively involved in professional organizations at both the state and national levels, including Case Management Society of America, Indiana State Nurses Association and Sigma Theta Tau International Honor Society of Nursing. She is a Past Chair of the National Public Policy Committee for the Case Management Society of America, where she contributed significantly to shaping healthcare policy and practice. In addition to her academic and professional roles, Ms. Plough serves as Vice President of the Indiana Center for Parish Nursing and is a dedicated Parish Nurse, integrating faith and health in community-based care. Her contributions to the field include national publications and presentations on case management, delivered at both local and national forums. Her career reflects a commitment to excellence in nursing leadership, education, and advocacy, with a focus on improving patient outcomes and advancing the role of case management in healthcare systems. Susan received the FCM designation at the 2025 CMSA Annual Conference in Dallas, TX.
Consider becoming a Case Management Fellow. Applications for the Class of 2026 are now open. Learn more here: https://cmsa.org/about/fellow/
References
Congressional Research Service. (2025, August 18). Health provisions in P.L. 119-21, the FY2025 reconciliation law (CRS Report R48633). Retrieved from https://www.congress.gov/crs-product/R48633
Case Management Society of America. Public Policy Advocacy Resources. Retrieved from https://cmsa.org/advocacy/public-policy/