I am privileged to let you know that I have formally begun work as NAMD’s new Executive Director. I will greatly anticipate opportunities to connect with you – our esteemed partners – over the coming weeks.
Having worked with and for people served by Medicaid for over 25 years, it’s the honor of my career to join NAMD and to help amplify and elevate the role, influence and relationships of Medicaid directors with our federal partners, policymakers and the larger community of Medicaid stakeholders.
I know that you will join me in expressing grateful thanks to Dianne Hasselman for serving NAMD on both an interim executive basis and continuing role as Deputy Director. She and all of the staff, partnering with our brilliant Board of Directors, continue to do remarkable work.
Truly, NAMD’s principal reason for being is to enable the skills, capacity, and wherewithal of dedicated Medicaid directors across states and territories to serve the almost 84 million diverse, striving, grateful people who are served by Medicaid. Each and every one of the Medicaid Directors embodies strength, capacity, resilience and commitment to civil service. This is the case whether they have served for years, or are just beginning the complex undertaking of leading a program, as is currently the case in 10 states.
Also, fundamentally, NAMD is about the act of partnership – in serving people who need health care, working in concert with federal agency folks including Dan Tsai and all of our other CMCS colleagues and the Medicare-Medicaid office, and collaborating with health providers, plans, contractors, and all of the myriad stakeholders who are working to ensure the success of the program. Each one of you is vital to that effort.
The last several pandemic years have been a crucible for all of us. That experience has starkly illuminated the serious and complex needs of the low-income people served by the program. It has also laid bare disparities of experience, access, utilization and outcomes for people of color and those with disabilities. Finally, it has brought unprecedented public scrutiny as trust in government has ebbed.
While this has been a very tough period for both those served by the program and those who lead it, it has also exemplified what can occur when common aims unite around making things happen as rapidly and flexibly as possible under emergency authorities. Now we are at a vantage point where our federal partners and state programs can take the first steps to migrate to a more historically typical means of operation, but it will require great care, effort and intention.
A very notable, but non-exclusive, example of this is the process of “unwinding” the pandemic Medicaid continuous coverage eligibility requirement. Unwinding is a top priority for Medicaid directors because of their concern for certainty and due process for beneficiaries. It is also commanding attention as states, managed care plans, and health providers plan for future service levels and budget obligations. On that basis, in Fall, 2022 NAMD took a consensus position on timing and process for unwinding, focusing on the need for certainty and a request to decouple this process from the eventual sunset of the federal Public Health Emergency.
It was striking and exemplary to see how closely the provisions of the omnibus spending package signed by the President tracked to NAMD’s position around unwinding. It was also terrific to see other major priorities of the association reflected, including adequate federal Medicaid match for the territories, eligibility protections, permanency for the state option to offer Medicaid post-partum coverage, and companion resources around social drivers of health (SNAP, LIHEAP, assistance for individuals experiencing homelessness).
While navigating the unwinding process in a way that honors the needs of members and optimizes connection of those who are no longer eligible for Medicaid is an urgent priority, states are also grappling with budget constraints and challenges in sustaining pandemic investments as federal support sunsets, workforce shortages, and the not-small task of holding both beneficiaries and staff in hope, confidence and forward momentum, ongoing.
In so many respects, states and territories are the workshops in which innovation and democracy manifest. Within the diversity – of geography, scope, and model design – of Medicaid programs we at NAMD honor and affirm the rights and interests of each to build on the bedrock benefits and protections articulated in federal Medicaid law and also innovate in the manner that best fits local needs and circumstances.
It is in my view inarguable that state Medicaid programs are the seat of the most exciting work that is occurring nationwide around care delivery, payment reform, and interventions to address the interrelated needs of people with very complex life circumstances.
I see this as an extremely important moment in time for NAMD. We are leaping off strengths with NAMD’s policy priorities and multi-faceted leadership agenda. We have extraordinary leadership from a committed Board. We also have new opportunities and obligations as we transition from leadership of the founding Executive Director and define who and what we are, going forward.
From my standpoint, I see those opportunities as focusing on 1) operational emphasis on improving the federal-state partnership, the practice of health equity, and strategic partnerships with lawmakers, MACPAC and other stakeholders in Medicaid; and 2) programmatic emphasis on capital to support Medicaid innovation, behavioral health capacity and integration, and long-term services and supports.
I will rely on insights and advice from many of you to help move those important priorities forward, and know that we can continue to take on these significant, continuing challenges as people of conscience, transcending any partisan divide, and finding and applying locally relevant solutions.