A Roadmap to Strong Leadership

Medicaid is a broad and complex program and the leaders who steward these programs wear many hats and juggle seemingly endless competing priorities. The ultimate goal is to deliver the most effective Medicaid program to their Medicaid population, while remaining a responsible fiscal steward of their state’s resources. Their challenge is three-fold:

1. Medicaid Directors develop their own expertise and leadership skills, including maintaining strategic vision over the Medicaid program while also investing in the leadership development of themselves and their teams.
2. Medicaid Directors monitor and manage the internal operations of the Medicaid agency, setting up their senior leadership team to succeed while improving the infrastructure of Medicaid. This includes reliably delivering core functions and obligations of the Medicaid program as well as supporting constituent-driven programming that promotes access and equitable health outcomes.
3. Medicaid Directors nurture partnerships with sister-state agencies, the legislature, and other key stakeholders. Simultaneously monitor the pulse of Medicaid and the health care landscape within their own state as well as nationally.

Medicaid Directors are most effective in their role when they focus on areas that only they as Director can do, whether because of their authority, role within the agency or reach across government sectors. This starts from the first day of their tenure as Medicaid Director and extends through their years of service until they eventually transition out of the position and pave the road for their successor to be successful.

To assist Medicaid Directors in their first year of service and beyond, NAMD offers a New Medicaid Director Roadmap. The Roadmap lays out key areas of focus for a Medicaid Director during their first year of service. It starts with an initial assessment and goal setting, transitions to a discovery phase where they begin to implement program direction and continue to learn and correct, and ends with their transition to a more seasoned Director, where they assess and reflect on their first year of service and set the stage for the remainder of their tenure. The seven areas of focus are:

• Personal Leadership
• Organizational Culture and Staff
• Program Performance and Operations
• Leaders Above and Across
• External Stakeholders
• Legislative and Political Environment
• Health Care Landscape

The focus areas cover the daily tasks — including instigating staffing policies, briefing legislators, and meeting with constituents. The areas also reflect strategic goals of likely interest — including implementing new and innovative programming, developing a workforce recovery strategy, or improving cross-sector collaboration.

Medicaid leaders balance competing demands with the ever-changing landscape of the American health care system. Right now, leaders are staring down the impending unwinding of the Public Health Emergency while simultaneously managing a public-service workforce crisis. Partners of Medicaid and partners of the Medicaid Director can best assist new and more tenured Directors by supporting their investment and prioritization of the above seven focus areas.

NAMD will continue to support Medicaid Directors by prioritizing these areas of focus in our programming and policy work. NAMD and our partners in the Public Sector Leadership Consortium have also articulated critical domains a leader should keep in mind when stewarding a complex public agency like Medicaid. This framework compliments each of the focus areas listed above. You can learn more here.