How Wisconsin Built a Smooth Medicaid Director Transition

This year, 36 states are holding gubernatorial elections, and many of those races will bring new administrations and new Medicaid Directors with them. Leadership turnover isn’t unique to election years, though. It happens through promotions, retirements and planned succession, too. States and territories that plan for it tend to come out the other side with less disruption.

Wisconsin is one of them. In a recent conversation hosted by NAMD, Amanda Dreyer, Wisconsin’s current Medicaid director, and Bill Hanna, her predecessor and now the president of Chorus Community Health Plan, walked through how they planned and carried out that handoff. Bill led Wisconsin Medicaid for several years before stepping down; Amanda, who was the deputy for two years, moved into the role about six months ago. Their conversation covered what they did to prepare, and what they’d tell other states facing the same moment.

Their approach isn’t a formula every state can directly copy. Wisconsin had an advantage: months of advance notice. But the underlying principles hold regardless of timeline, and Amanda and Bill were clear that they apply to leadership transitions well beyond the Medicaid director’s chair.

The Real Disruption Comes From Uncertainty

Bill opened with the idea that framed everything else.

That distinction shaped the whole transition. Instead of leaving staff, advocates and partners to guess, Bill and Amanda tried to be explicit early and often about what would stay the same and what wouldn’t, so there was less room for people to fill in the blanks with worst-case scenarios.

Amanda added that keeping the team anchored to the program’s purpose helped carry that certainty through the transition. Focusing on what the Medicaid program does, who it serves, and why the work matters gave staff and partners a steady reference point, even as the person in the director’s chair changed.

A Structure That Gave Them Room to Plan

In Wisconsin, both the Medicaid director and deputy director are appointed positions, which meant both could turn over with a new administration. Bill had asked Amanda to join as deputy near the start of his tenure, and she credits that early, close working relationship with preparing her for the director role two years later.

A few structural choices made the eventual handoff smoother:

• Bill was able to let others know well in advance that he was preparing to leave, which opened a real conversation about succession.
• Wisconsin backfilled Amanda’s deputy position immediately, so she wasn’t trying to do both jobs at once. Bill called this one of the harder problems to solve without lead time: “There’s nothing harder than becoming Medicaid director and still trying to do your old job at the same time.”
• Bill and Amanda mapped out, project by project, what he would see through to completion versus what she needed to own going forward. This reduced ambiguity about who was responsible for what during the handoff.

The Six-Week Handoff

Once the transition was announced, Bill and Amanda built a deliberate, six-week glide path rather than handing off the role on a single date.

• Weeks one and two: Bill stayed actively involved and leading, but with more intentional conversation afterward, walking Amanda through his reasoning: why he made a particular call, why he asked a particular question.
• Weeks three and four: The two got explicit about who would lead which conversations. Sometimes Bill would say he was staying on point for a specific project; other times he’d tell Amanda directly that she should lead and that he’d stay quiet, even if someone in the room called on him.
• Weeks five and six: Bill deliberately stepped back, describing it as consciously keeping his mouth shut so the room could adjust to Amanda as the decision-maker. Amanda said that stretch took discipline on both sides: for Bill to stop filling a role people were used to him filling, and for her and the rest of the team to stop deferring to him out of habit.

Both were careful to note that the goal was never to have Amanda lead exactly like Bill did. The point of the six weeks was to transfer trust in the process and the team’s shared values, not to replicate one person’s style.

Leadership Principles

Amanda described a set of focus areas she and Bill worked through before he left, and that she still returns to regularly as director:

• Purpose: Keep the program’s mission front and center to guide day-to-day decisions and priorities.
• Priorities: Stick to the small number of major initiatives set before the transition.
• The current moment: Stay aware of the broader environment and what it calls for right now, rather than trying to make the role into something it isn’t.
• People: Make sure staff have what they need, and that state government partners are positioned to help.
• Partner relationships: Bill and Amanda did deliberate partner mapping — who he’d been talking to, what mattered to them, and what history Amanda needed to know to pick those relationships up.
• Role expectations: Regularly ask what the program, staff and partners need from the director right now, and what the director needs from the team to make that possible.

Advice for Shorter Timelines

Not every state or territory gets the luxury of time. Asked how they’d prioritize with less time and less certainty about who’s coming next, Bill and Amanda pointed to the same starting place: the permanent staff who will stay through the transition.

Bill said he’d focus on bringing the senior staff that are staying in their roles up to speed on everything he and Amanda have worked through together including the organization’s values, where key relationships stand, and current priorities.

Both agreed the core, day-to-day work of running a Medicaid program holds up regardless of who’s in charge or which party controls the governor’s office. Keeping that core steady, they said, is what ultimately serves the state’s Medicaid members.

The Bottom Line

Wisconsin’s transition worked because Bill and Amanda treated it as something to plan, not something to just get through. They gave themselves time where they could, were explicit about what was changing and what wasn’t, and leaned on the values and staff that outlast any one director.