Medicaid Insights: How Directors and Their Senior Leaders Are Focusing Their Time

The National Association of Medicaid Directors regularly engages our members to gain insights into their experiences and focus as leaders of the nation’s largest provider of health care and long-term services and supports. This month we engaged with Medicaid Directors and senior program leaders to understand where they are currently focusing their time given the incredible workload facing Medicaid agencies as they manage day-to-day program operations, continue to respond to the changing pandemic, pursue long-term program innovation and performance improvement and support, and manage their staff. Key insights from senior Medicaid leaders include:

1. Medicaid Directors and senior leaders are currently focusing their leadership and programmatic time in five key areas of work.

• • Program Innovation and Strategic Initiatives,
  • Stakeholder Engagement,
  • Program Operations,
  • Staff Management, and
  • COVID Response.

2. Currently, Directors and senior leaders are continuing to spend significant amounts of their time on COVID response. Because of the complexity and length of the pandemic and public health emergency, COVID related work now permeates through all areas of focus for Medicaid leaders including stakeholder engagement, program operations, staff management and even program innovation and strategic initiatives. Medicaid leaders identified their current priority issues and challenges related to COVID response to be:

• • Vaccine related issues including vaccinating eligible Medicaid and CHIP members, tracking vaccination data, and ensuring vaccine equity.
  • Eligibility and enrollment issues including preparing their systems, personnel, and stakeholders for the end of the public health emergency and end of the eligibility maintenance requirements, and managing increased enrollment due to the eligibility maintenance requirements.
  • Provider and nursing home support during the continuing pandemic.

3. Directors and senior leaders are spending nearly 30% of their time engaging with stakeholders on key issues. Directors and senior leaders reflect that the time that they spend with stakeholders has increased since the beginning of the pandemic, and that they have found real benefit from the new virtual engagement opportunities. Directors report that the virtual engagement tools and opportunities have allowed them to reach new stakeholders and engage with people in rural communities or in communities that are a great distance from the state capital. Currently, directors and senior leaders are most engaged with stakeholders to explain federal and state legislation impacting Medicaid and CHIP and managing budget and policy expectations related to federal and state COVID response investments. Medicaid leaders are specifically focused on two key Medicaid issues in the American Rescue Plan Act: the enhanced federal investment in home and community based services and the opportunity to extend coverage to women in the postpartum period. Finally, state and territorial Medicaid leaders are continuing to engage with members and providers to understand the impact of the last 18 months on their lives and their operations.

4. Medicaid and CHIP Directors and senior leaders are spending a lot of time on staff management and office operations. Many Medicaid agencies continue to operate nearly 100% virtually, while some have had program and policy staff back in the office for some time. As COVID infection rates continue to vary regionally and change rapidly, state Medicaid leaders are continually adjusting and modifying return to office and remote work plans. Another key area of staff management has been managing retirements and turnover among staff. This work includes capturing the knowledge of staff before they retire, honoring staff that are leaving the agency, and finding ways to strategically hire and appropriately onboard new staff.
5. Like many senior leaders, Medicaid and CHIP Directors and senior leaders wish they were spending more time on strategic initiatives and program innovation. Today, Medicaid Directors estimate they are spending about a quarter of their time focused on strategic initiatives and program innovation. However, in an ideal world they would like to spend 40% of their time focused on strategic initiatives and program innovation. The key strategic issues Medicaid leaders are working on include:

• • Advancing diversity, equity, and inclusion within their staff and state agency and within the Medicaid and CHIP programs.
  • Core program administration including value-based purchasing and quality improvement, system interoperability and data and data analytics, managed care oversight, restructuring and procurement.
  • Addressing critical population health issues including maternal and child health, behavioral health and the social drivers and determinants of health.
  • Stabilizing and re-designing long-term services and supports.
  • Strengthening sister state agency partnerships including public health agencies, behavioral health agencies, housing and employment agencies and human services agencies that administer food security benefits and manage child welfare prevention and response programs.