Kelly Cunningham Q&A: Reflections from Illinois’ Retiring Medicaid Director

Q: What motivated you to pursue a career in public service?

Kelly Cunningham: I started as an intern with Governor Jim Thompson right out of college. I had a political science background and knew I wanted to work in government, but I wasn’t necessarily committed to working in politics.

The opportunity to impact policy that could affect large numbers of individuals really drove me. By working in policy, your decisions might impact a hundred people or a thousand people, or more than that.

After a point, working in state government, particularly in Medicaid, has to become a mission for you. It has to become something that you believe in, because there are other jobs and opportunities.  But I’ve always loved working in state government and feel very passionate about the mission and the opportunity to serve.

Q: What prompted Illinois to undertake the year-long ‘Voices of the Customer’ initiative, and what specific gaps or challenges were you hoping to address through this intensive customer feedback approach?

Kelly Cunningham: Federal CMS has long emphasized the importance of involving stakeholders, particularly Medicaid customers, in policy-making. We wanted to get thoughts and reactions to our programs and given CMS’ termination of the MMAI program, we had a natural opportunity with our dual eligible population.  The Voice of the Customer work was born, in part, from that initiative.

As a Medicaid Director, you always hear from providers, managed care plans, and advocates. Many groups hire people to make sure we hear from them. But customers don’t have that avenue. When we think about who ultimately is at the center of the Medicaid program, we really view customers at the center of our program in Illinois. It’s part of our mission, vision, and values.

We really wanted to hear the customer experience from a broad perspective – their thoughts about Medicaid, challenges in accessing the program, and takeaways to help us improve. The universal tone we heard was overwhelmingly positive. Sometimes what inhibits states from moving into this space is that you fear you’re going to be crushed with negative feedback. But we were gratified to hear a lot of positive words about the program, and then we were able to drill down into pain points they identified – things related to communication, cross-agency involvement, and making our system more customer-friendly.

Q: Based on what you heard directly from Medicaid members during this initiative, what were the most significant insights gathered, and how are you prioritizing which improvements to implement first?

Kelly Cunningham: We’ve identified areas to focus on, for example interagency communication challenges – what is each agency’s role in the process? Some customers experienced delays getting enrollment packets from their managed care plans and found that process difficult. Some individuals also had struggles with care coordination, which is an area we really want to focus on.

But here’s the key: it’s not to get beaten down by some of the gaps or criticism of the program. It’s to keep going. We have this information, so we need to keep going. Let’s identify three or four things we want to work on and talk to sister agencies. The biggest drawback would be that we get this great information from our customers, and then it sits in a report on a shelf and isn’t used.

Q: What is one piece of advice you’d give to other Medicaid leaders who are considering a similar initiative?

Kelly Cunningham: Don’t be afraid of it. Step into this space and keep going, because you’re very likely going to hear things you don’t want to hear. The key is to make a commitment to customer voice, keep going, and look for opportunities to embed that into your organization.

There are lots of different ways to do that. I had a friend who was a former Medicaid director who undertook a series of town halls across the state – in-person town halls. There are also opportunities through federal CMS like the beneficiary advisory committees that are starting up.

Look for opportunities wherever they are in the operation of your program to hear that voice. It’s really important to integrate it into your day-to-day operations.

Q: You’re getting ready to retire at the end of this month. What are you most proud of in your career?

Kelly Cunningham: I’ve been blessed with many opportunities to work on great initiatives and projects. A couple of things come to mind:

We undertook a large nursing home rate reform restructuring program in the state a couple of years ago, really incentivizing nursing homes to staff and invest in quality. We were able to tie new funds appropriated by the General Assembly to specific outcomes in terms of staffing and quality. We learned during COVID that individuals in nursing facilities were very vulnerable because they’re in congregate settings, and how important staffing is to ensuring quality outcomes.

We were able to create a wage scale for CNAs [Certified Nursing Assistants], and I’m very proud of that work. CNA-level staffing is really the backbone of care in any nursing facility.

I’m also proud of the work we’ve done with our home and community-based waiver programs, to grow home and community-based options for individuals as alternatives to institutional settings

Q: What advice would you give partners that want to work more closely with Medicaid?

Kelly Cunningham: There’s room for everybody at the table. We are constantly looking, as are our managed care plans, at expanding access, creating new services, expanding access to services for individuals, and making sure our networks are adequate.

I’ve had some of my best conversations at the NAMD national conferences with non-traditional providers – not just physicians, hospitals, and health plans.

The view of Medicaid now has grown so much beyond traditional medical and health providers. Everybody can play a role. We’re finally getting off the ground with doulas in Illinois, for instance, and community health workers. If we really want to make Medicaid as strong as it can be and keep that focus on the customer and on equitable health care, we have to look to everybody that can contribute to that.