Q & A with Jen Strohecker: Leading Through Crisis and Closing Cracks in Care

Utah Medicaid Director Jen Strohecker shares insights on managing a cyberattack crisis, building sustainable funding for adult expansion, and implementing one of the nation’s first Section 1115 waivers for pre-release incarcerated populations.

Q1: What motivated you to pursue a career in public service?

About 30 years ago as a college student studying pharmacy, I realized chemistry and textbooks didn’t satisfy the “why” inside of me. I wanted to see life through a different lens, so I committed to choosing one volunteer project a year.

I volunteered at a children’s hospital holding babies born with cocaine addiction. I played checkers with an 8-year-old hospitalized with sickle cell disease who would cry out in pain. I taught third graders how to read, which opened my eyes to health literacy challenges. And at 23, I witnessed a 24-year-old die from a preventable asthma attack simply because he didn’t have his medication.

These experiences gave me a deeper understanding of humanity, resilience, and the complexity of challenges that the most vulnerable face. Later, working face-to-face with patients as a pharmacist, I saw how even in Utah’s highly evolved health care system with vertically integrated care, the most vulnerable still fall through the cracks.

As Medicaid Director, I realized the enormous scope of influence I could have on people struggling to access care. The cracks in our systems and policies are big and impact service delivery at every level. My work is deeply personal—motivated by my desire to help those whose voices aren’t heard.

Q2: Utah’s Medicaid reinvestment account is a distinctive approach to program sustainability. Can you walk us through what was involved in getting it off the ground, and what benefits have you seen since its implementation?

When our adult expansion benefit launched in January 2020, the Utah Legislature established the Adult Expansion Fund—now called the ACA Fund—protected in state statute. It’s funded through state income tax, general fund allotment, and a hospital tax.

This was visionary. We knew the expansion population would have complex physical and behavioral health needs that may have been unmet before. The dedicated fund let us be comprehensive in our approach without competing against traditional Medicaid for general fund resources.

The fund enabled us to add dental services, develop a housing program, and support reentry work for incarcerated individuals. All these policies became possible because of this sustainable funding structure.

It also includes accountability. If we used up the dedicated investment, other stakeholders like hospitals would have to contribute more, or the expansion program could potentially. So it incentivizes efficient management while ensuring comprehensive care.

Q3: Utah Medicaid navigated the Change Healthcare cyberattack during a critical time for the health care system. What did responding to that crisis teach you about leadership and preparing teams for the unexpected?

This was a once-in-a-career occurrence we hadn’t anticipated. Utah is one of a handful of states using Change Healthcare as our pharmacy benefit administrator, so when they experienced a cybersecurity attack, we were directly affected.

Our staff couldn’t access systems. Pharmacy providers couldn’t process or get paid for prescriptions. Medicaid members couldn’t get life-saving medications.

That first weekend, not knowing how long it would last, we brought together 350 staff from Medicaid and Workforce Services. We worked the entire weekend, made more than 30,000 outbound calls to high-risk members, and set up daily communications with pharmacy providers. We asked pharmacies to provide 3-day supplies and trust that we’d make interim payments.

Three days turned into three weeks. During that time, we filled 85,318 prescriptions and served 35,111 Medicaid members—all while pharmacy providers couldn’t bill Medicaid. They were literally working on faith, trusting we would make them whole.

The key lessons? First, it’s because of how we function every day as a team. Our core value of serving the member as a guiding principle means immediate problem-solving is in our DNA.

Second, working respectfully and collaboratively with providers and recognizing that they’re the frontline resource, helped to build needed trust. When the crisis hit, they trusted us enough to continue providing care even when they couldn’t get paid.

Q4: Utah is among the pioneers implementing Section 1115 waiver services for incarcerated individuals in the 90 days before release. What lessons would you share with fellow Medicaid Directors pursuing similar initiatives?

This policy is near and dear to my heart because it addresses those cracks I mentioned earlier—the gaps in care during critical transitions.

The data is grim. Mental illness rates in Utah jails are six times higher than the general public. Individuals who are or have been incarcerated experience disproportionately higher rates of physical and behavioral health diagnoses. Rates of injury and death from trauma, violence, overdose, and suicide are substantially higher.

In 2024, we received first-time approval to provide comprehensive ambulatory services in state prisons, county jails, and juvenile justice facilities for up to 90 days before release. Utah Medicaid can now provide proper diagnosis within the four walls , establish treatment regimens, stabilize people, and create warm handoffs to community care.

We’ve already gone live in our juvenile justice setting and going live with our first two county jails at year-end. We see this as building a bridge to community-based care for incarcerated individuals by helping them stabilize their conditions and breaking the cycle of repeated incarceration.

Q5: What advice would you give partners that want to work more closely with Medicaid?

First, find common ground. There are a lot of competing demands in Medicaid. But we can all align around commitment to serving members, improving access to care, and helping people navigate a very complex system. Being member-focused is where we find common ground.

Second, understand the context. We have constant change—system updates, state and federal legislation, program improvements, new initiatives. We’re always very busy. Approaching collaboration with awareness of this context is essential for initiating and sustaining meaningful change.

Third, embrace incremental change. The value of incremental change cannot be understated. These are big, complicated programs, and sometimes we’re facing decades-old problems. Partners often say, “This is a problem and we want it completely fixed.” But incremental steps can translate to powerful, foundational change over time.

Fourth, think differently. Don’t get stuck in “we’ve always done it this way.” Approach solutions with fresh perspectives. Make sure all voices are heard and that the diversity of people we serve informs how we navigate barriers and improve systems.