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Reflections on the ACA Anniversary While Preparing for the End of the PHE

In her monthly commentary, Kate McEvoy pauses to reflect on the anniversary of the Affordable Care Act during ongoing state, federal and partner activity to conduct member redeterminations and prepare for the sunset of other public health emergency (PHE) provisions.


Dear colleagues:

On a rainy Saturday morning, I am reflecting on a month of truly intense activity for Medicaid programs across the nation and also zooming out a bit to gauge where we are at this watershed moment in time.

We at NAMD remain in awe of the investment of time, insight and ingenuity that Medicaid directors, teams and their many community partners have invested in the unwinding process. It is deeply heartening to hear status reports from CMCS that illustrate such momentum around communications with members and community partners, mitigation plans, and thought and care around how the further systems modernization that will bring all states into full compliance with eligibility requirements can best wrap around the needs of those whom we serve. We also acknowledge that this remains an active, iterative process with implications for millions of people and rely on you, our partners, for candor in sharing information, best practice and observations about the lived experience of members as the unwind unfolds over the course of the year.

While the necessary, urgent focus must remain fixed on the unwind, we also aim to promote a comprehensive view of all of the implications of the sunset of the federal PHE declaration. An important example of this is the array of long-term services and supports-focused authorities (e.g. Appendix K) that must either expire or, where permitted, be extended. NAMD State Program Director Lindsey Browning is collaborating with Camille Dobson at Advancing States to release an important guide to both the technical particulars of those choices and also the need for advance communication with members, caregivers, providers and advocates. That document will be released very soon.

We at NAMD are also acutely conscious of the emerging challenges to financing for Medicaid that are wrapped up in the impasse over the federal budget. NAMD will take an active role over the course of the year in connecting with Congressional staff and reinforcing the many strengths and contributions of the program in serving people across family systems and the age continuum, as well as the need for continued federal investment and sharing of financial risk for the program as between the federal and state governments

Many of our members remain active in national forums, contributing the benefit of their lived leadership experience and expertise as content experts to the larger health policy community of which we are a vital part. Special kudos to all those who were recently featured as speakers for the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum – Allison Taylor of Indiana, Jay Ludlam of North Carolina, Liz Matney of Iowa, Jason McGill of Washington, and Jenn Jacobs of New Jersey. I was so privileged to moderate the panel on which Jenn spoke, and NAMD alumna Kristin Thorn of Accenture moderated the session during which Jay, Liz and Jason presented. I’d also like to recognize Cheryl Roberts of Virginia, Jenn and Jay for serving as panelists for a session for the American Health Law Association Institute of Medicare and Medicaid Payment Issues.

In the vein of elevating both the program and the many contributions of directors, I also wanted to share that I had the privilege of representing NAMD at a White House event this past week in celebration of the 13th anniversary of the ACA. It was great to connect there with federal partners including CMS Administrator Chiquita Brooks-LaSure, Acting Administrator of the Administration for Community Living Alison Barkoff, and also folks including Hemi Tewarson of NASHP, Meg Murray of ACAP and Heather Howard of State Health Value Strategies. Such evidence of alignment of aims and interests! I am enclosing two pictures to share a sense of the event.

It is really staggering to think about how much all of us have accomplished under the ACA over this period of time. Yes, expansion where that has been possible, but also such profound and meaningful investments and improved outcomes with preventative care, management of chronic conditions, and choice and self-direction in long-term services and supports through the primary care rate bump, enhanced behavioral health services, health homes, state plan options including 1915i and Community First Choice, and a deep commitment to meeting members where they are and addressing their priorities. In a word, cheers!

In context of all of the above, I am tremendously excited about our path forward under the passionate, person-centered Executive Team of our Board of Directors – President Cindy Beane of West Virginia, President-Elect Lynnette Rhodes of Georgia and Immediate Past-President Allison Taylor of Indiana. All of the incoming Board members are listed here.

Heartfelt thanks for all you continue to do to support Medicaid members.

In partnership,


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