Nebraska’s Medicaid Director talks about bridging the gap between federal policy and on-the-ground operations, his focus on behavioral health, and data ownership.
Nebraska’s Medicaid Director talks about bridging the gap between federal policy and on-the-ground operations, his focus on behavioral health, and data ownership.
Q: What motivated you to pursue a career in public service?
Much of my career had been focused on evaluating the impact of legislation and policy on Medicaid programs. Over time, I kept noticing a disconnect between what was being proposed at the policy level and what it would actually take to operationalize those changes — and ultimately, that gap can directly impact the people Medicaid serves. I realized that the perspective I’d built could be put to better use in a public service role, where you have to be able to connect federal policy all the way down to the membership and make it work in practice. When someone asked if I’d ever considered becoming a Medicaid director, it just made sense. We loaded up the family, moved across the country, and I’ve been here 16 months now.
Q: You have extensive experience conducting quantitative research and building models to examine health policy and entitlement programs. What has surprised you most about translating your research background into the operational reality of running a state Medicaid program?
The biggest surprise was data availability — specifically, how differently states are positioned to access and use their own data. In Nebraska, I can sit down and pull claims data myself, down to the member level. I just assumed that was standard. What I found is that in many states, that capability has been outsourced to third-party vendors, meaning directors have to request prepared data rather than query it directly. When you’re on the outside looking in — at the federal level, say — you tend to attribute data gaps to research access or IRB limitations. I just figured that if you were at the state level, you had access to your data and could jump right in — and that turned out not to be the case everywhere. The moment you don’t build structures around owning and working within your own data, you’ve effectively outsourced your mission, because you have to make a request, and a request is a point where you might not get exactly what you need.
Q: You’re relatively new in your tenure as Nebraska’s Medicaid Director, and behavioral health became a top priority. Walk us through how you’re approaching that work.
Nebraska is having some important conversations around autism services — specifically applied behavior analysis. Our approach centers on the bread-and-butter work of Medicaid — making sure quality services and appropriate care are getting to the members who need them. That means getting into the details on clinical best practice, building guardrails around services to support that practice, and ensuring payment and reimbursement rates are in line with where they should be nationally.
Q: You’ve talked about data and analytics being central to your mission as Medicaid Director. Where do you see the biggest opportunity?
Program integrity is where I see the most immediate opportunity. A lot of that work comes down to asking the right questions at the service line level — understanding what best practice looks like for a given service and then checking whether that service is actually being delivered that way. Sometimes the finding is fraud, but often it’s waste or gaming within what’s technically allowable.
Data and analytics are essential for understanding how your program got where it is by tracing spending trends, identifying what drove changes, and being able to articulate whether those were the result of legislative action or program decisions. That institutional knowledge matters a lot when new federal environments shift the landscape, and you need to move quickly. Being able to build a clear, credible narrative around your program is just as important as having the numbers.
Q: What advice would you give partners that want to work more closely with Medicaid?
Come in with data, come in with facts, and come in prepared for a genuine conversation about the best path forward. Medicaid programs want to do collaborative work — that’s almost universal across the country. What makes those partnerships productive is good-faith engagement. An adversarial approach rarely gets anyone where they want to go, on either side. In Nebraska, we’ve made a commitment to show up to every room transparently and openly — with our federal partners, state partners, and stakeholders. I think that’s how you build a program that can sustain itself and advocate for itself over time.
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