By any measure, 2023 has been an extraordinary year 

There is something about the end of an old year and the beginning of a new year that encourages us to look backward into the past and forward into the future simultaneously. At NAMD, either view inspires us to reflect on the value of our partnerships with you and so many other trusted allies who represent the millions of Americans who use Medicaid to access the health care they need.

As we consider all that has happened in 2023, it is fair to call the year “extraordinary.” It has, in fact, been beyond the ordinary for every person who is connected to the Medicaid program, whether they are members, state and territory agency leaders and staff, federal partners, advocacy partners, or academic and research partners. Our shared central focus on the value of the program to the health and wellness of so many people is something that we deeply value and never take for granted.

The most significant watershed event of the year was the sunset of the federal Public Health Emergency. Among other important work, this launched the enormous, complex effort of unwinding Medicaid continuous coverage requirements by renewing the eligibility of each one of the millions and millions of people served by the program. And while unwinding has continued to be the central area of focus throughout the year, state and territory Medicaid leaders and their federal, state and community partners have also continued to move Medicaid forward by making structural changes and process improvements in eligibility and other systems, investing in the urgent behavioral health needs that were illuminated during the public health emergency, implementing new options to address maternal health, grappling with workforce constraints, and pursuing innovative 1115 waivers to address health-related social needs.

In each facet of this important and dynamic work, NAMD has endeavored to learn from, represent and advance the needs and interests of Directors and their staff, as well as to take an active role in promoting the value of Medicaid itself. This benefits from and necessarily involves the myriad partnerships that have enabled Medicaid to persevere and evolve over time. As NAMD welcomed Kate McEvoy as the new Executive Director, our approach has been to center on partnerships in four key areas of work: supporting and elevating state and territory Medicaid leaders, promoting the value of Medicaid, advancing key policy priorities, and furthering the practice of federal/state-territory collaboration.

Supporting and elevating state and territory Medicaid leaders

NAMD has continued to collaborate with many trusted partners, notably including the Center for Health Care Strategies (CHCS), our sister associations ADvancing States and the National Association of State Directors of Developmental Disabilities Services (NASDDDS), and State Health and Value Strategies (SHVS), to support, convene and connect Medicaid leaders. This has involved supporting directors along a lifespan continuum, from their first days in service to transitions to alumni status. Significantly, we welcomed 20 new state or territorial Medicaid Directors over 2023, many of whom took on the position temporarily as interim or acting Medicaid Director. These leaders have been profiled on NAMD’s social media channels. NAMD celebrates the wonderful work that CHCS and ADvancing States are doing, respectively convening the longstanding Medicaid Leadership Institute and Pathways Program, and a much-needed new leadership program for long-term services and supports leaders. We also continued to partner with CHCS on season four of the Medicaid Leadership Exchange podcast series, which focuses on leadership-themed issues of common interest and concern. NAMD also maintained standing connections with affinity groups for key leaders on Medicaid state and territory teams, representing deputy directors, finance, eligibility, and communications. These groups typically met monthly and provided regular opportunities for candid sharing of information and strategies. We also built a new NAMD Alumni Network that is placing emphasis on value and connection with folks who formerly served as a state or territorial Medicaid directors. Their support for those who are currently serving as Medicaid Directors, whether through offerings as “on-demand” consultants, faculty for NAMD’s conferences or informal peer support, is invaluable. We deeply appreciate so many of our partners, such as Americas Health Insurance Plans (AHIP), Medical Health Plans of America (MHPA), and the National Academy for State Health Policy, for featuring Medicaid Directors on panels and as subject matter experts throughout the year. And last, but definitely not least important, we deeply value the learning that we gleaned from participants of Medicaid, who contributed to panels at NAMD’s Spring and Fall meetings, and podcasts including How Do Members Experience Medicaid?, which highlights insights from a Colorado Medicaid member who serves on that state’s member advisory council.

 Promoting the value of Medicaid

Over 2023, NAMD has been actively involved in championing the value of the Medicaid program and promoting awareness of and literacy around operation of the Medicaid program at the state and territory level. This has included authorizing this Health Affairs Forefront article on the need for stable funding and continuity in the Medicaid program as well as topical pieces like How Medicaid Programs are Building on Postpartum Extension. With the aim of helping our many partners to understand the nuts and bolts of implementing Medicaid on a state and territory level, we also continued to produce the “Medicaid: The More You Learn” series, through which we’ve tackled the overall policymaking process and factors influencing it and the eligibility process, and provided profiles of who Medicaid serves. Finally, we recognize and celebrate all that entities such as SHVS has done, through its States of Unwinding series, to profile the important and dynamic work that states continue to do on member engagement, systems improvement and collaboration on very local levels.

Advancing key policy priorities

As noted above, the unwinding of continuous coverage requirements remains front and center for Medicaid leaders, our federal partners, managed care organizations, health care providers, community-based organizations, and advocates. NAMD held targeted weekly forums with its affinity groups, created a dedicated repository of resources and, with SHVS, convened a major summit on unwinding, each of which focused on sharing best practice, partnering with the federal government through this process, and collective problem-solving. This remains a dynamic work-in-progress. In addition to this work, NAMD collaborated with many other national peers on specific topics of interest. A notable example of this is our work with Advancing States and NASDDDS to advance understanding of the sunset of pandemic long term supports and services authorities and related state options, as well as to advance awareness of leading issues around Medicaid home and community-based services: workforce, sustainability of pandemic-related federal investments and implementation of the proposed federal access rule.

Furthering the practice of federal/state-territory collaboration

Medicaid is by structure and design a federal/state-territory programmatic and equity partnership that both establishes national standards and also preserves substantial flexibility for states and territories to implement the program on a locally relevant basis. Throughout 2023, NAMD continued to advocate for state and territory interests as an intermediary with the Centers for Medicare & Medicaid Services, through standing meetings, rapid cycle translation of and summaries of federal policy and proposed rulemaking, and bidirectional communication on a broad range of issues, including responding to major rules on access, managed care, systems interoperability, nursing home staffing and quality, and more. In total, we submitted 14 comment letters on proposed rules and requests for information. NAMD also contributed to advancement and refinement of the annual Medicaid and Children’s Health Insurance Program Scorecard. Not least important, we also intentionally broadened our relationships with other key federal agencies including the Administration on Community Living, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration and the Office of National Drug Control Policy. This is enabling a broader policy lens that reflects the broad scope of Medicaid innovation around health-related social needs, behavioral health integration, maternal health, and the needs of justice-served people.

Our work is dynamic, evolving, and certainly never done. Leaping off all that is profiled above, we look forward to all the new opportunities to link arms with like-minded partners in 2024.