Announcing NAMD’s Inaugural HRSA Cooperative Agreement to Strengthen Medicaid-Public Health Partnership

We at NAMD are thrilled to share that we have been awarded a three-year National Organizations of State And Local Officials (NOSLO): State Health Services And Financing cooperative agreement with the Health Resources and Services Administration (HRSA). This first-ever federal funding opportunity for NAMD is a watershed event and full of exciting potential to continue to engender strong working partnerships between Medicaid and public health. We are proud to join sister organizations that include the National Academy for State Health Policy (NASHP) and the Association of State and Territorial Health Officials (ASTHO) in fulfilling HRSA’s NOSLO portfolio, which over and above this new award to NAMD reflects commitments to local public health systems, targeted support for policymakers, health policy innovation and effective and coordinated state governance.

Why is this such important news to us as an organization? Despite a lot of effort and good will, Medicaid agencies and public health departments continue to be challenged by longstanding structural, funding and operational silos, and lack of routine, enduring relationships and integrative systems among sister agencies (e.g. Medicaid and departments of public health, behavioral health, and insurance). This inhibits maximal collaboration and optimization of the use of Medicaid and public health funding.

I think back to my own experience as a newly minted Medicaid director in Connecticut, as the Affordable Care Act was being implemented. Among other new opportunities, I was particularly excited about moving forward with Medicaid coverage of smoking cessation. Why? Because a high incidence of our Medicaid members used tobacco, and this coverage seemed especially material to help people manage chronic conditions and prevent adverse health outcomes. So, we went rapidly ahead with the necessary State Plan Amendment process, with support from our human services department leadership and the legislatively convened Medicaid oversight council. All of that felt like a strong positive, until I was contacted by our state department of public health, to cue me to their longstanding, successful oversight of many tobacco cessation-related activities, including a quitline, public education campaigns and local health department supports. All far from my immediate radar. A too-near miss around shared interests and alignment, and in my experience, all too indicative of the need for continued attention and intentionality around connecting the Medicaid and public health leaders who do these types of instrumentally related work.

Acknowledging that cautionary note, we are all uniquely positioned by shared work during the COVID-19 public health emergency (PHE) to recommit and help this work to flourish ongoing. Medicaid and public health demonstrably partnered in historically unprecedented ways with their public health colleagues during the PHE. The marquee example of this was standing up means of delivering testing, treatment and vaccine services to Medicaid members, but that was by no means the extent of the collaboration. Medicaid and public health leaders also advanced:

• Extensive direct engagement with Medicaid members, enrolled providers such as Federally Qualified Health Centers, local community-based organizations, and advocates. Specific examples of this include PHE public education campaigns, and testing and vaccine campaigns that prioritized grassroots experts with lived experience.

• Routine means of collecting, rolling up and broadcasting public health and Medicaid data. This enabled states and territories to maintain both a world view of pandemic response and also to illuminate disparities in access, utilization and outcomes, most notably for people of color and those with disabilities.

• In direct partnership with HRSA and CMS, development of new means of rapidly pushing out financial relief for health care providers.

Taken together, these activities demonstrably fulfilled a broad range of health needs of Medicaid members that would certainly have gone unmet. This significant, multi-faceted evidence of success is particularly noteworthy given the historically unprecedented attrition from civil service and provider workforce, as well as erosion of public trust, with which Medicaid and public health leaders contended across the country. We should not let this post-pandemic opportunity pass to solidify the relationships that make the essential, bread and butter work of collaboration possible.

Under the terms of our new NOSLO funding with HRSA, NAMD will aim to build literacy among state Medicaid directors and other health care payment officials about HRSA priorities and initiatives; to establish strong, routine connections among Medicaid officials, other health care payment officials and state public health leaders that transcend projects and endure over transitions of federal and state administrations; and to identify and act on opportunities to align strategies and interventions, as well as to braid and optimize the use of HRSA and Medicaid funding, to ensure sustainable impact. Specifically, we will focus on shared interest with public health in:

• access to and continuity of Medicaid coverage, for eligible people;

• workforce interventions and partnerships with health care providers; and

• improving access and experience, reducing duplication of effort, and ensuring a whole person and family systems approach for youth who are involved with multiple health and human services systems, including Medicaid, the educational system, child welfare, behavioral health and/or juvenile justice.

To do this, we will engage with the over 500 senior state and territory Medicaid leaders who participate in our affinity, interest groups and learning exchanges. These groups support closely held, candid, discipline-specific dialogue and sharing of best practices among new directors, deputy directors, chief financial officers, eligibility leaders, chief information officers and public information officers. We will also continue to collaborate with sister organizations including the National Conference of State Legislatures (NCSL), the National Association of State Mental Health Program Directors (NASMHPD), NASHP and the American Public Human Services Association (APHSA), which share interests with us in this vital work.

We are very grateful for HRSA’s investment in solidifying the working relationships between Medicaid and public health leaders and excited about launching this important new strand of work for NAMD.