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Reflections on the COVID19 Pandemic from Matt Salo

A blog with reflections from NAMD’s founding Executive Director Matt Salo on the COVID19 Pandemic.


The pandemic brought real, and potentially lasting, changes to the American health care system. An integral piece of the U.S. response came from the country’s largest health insurance program, Medicaid. With nearly one in four Americans using Medicaid to access the health care they need, the impact of the global health emergency was real and sustained.

As Matt Salo, the founding Executive Director of the National Association of Medicaid Directors prepares to leave his post, Gretchen Hammer, former Medicaid Director in Colorado and current consultant for NAMD, sat down with him to ask him a few questions about his time working with Medicaid and at NAMD during the COVID19 pandemic and Public Health Emergency. You can listen to the full podcast here as well as read Matt’s general reflections here.

Gretchen: As we look at the Medicaid program and the role it plays in the health care system and in providing access to vital services, what do you think has evolved the most during your tenure as Executive Director of NAMD? Where has the program changed or grown, not from a size perspective even though we certainly know it has grown in size, but in terms of its impact on people’s lives and the healthcare delivery system writ large?

Matt: So, I think the answer to that question is complicated, in that the program has been undergoing steady but also significant growth and changes throughout its almost 60-year history. I mean, the Medicaid program was created essentially as an afterthought to Medicare. But now it is a much larger but also much more meaningful program.

I think the ways that has come true over the past decade has been first and foremost most recently through the COVID19 pandemic, where we have seen Medicaid solidify that it is a significant first responder for this country. That had already begun to happen before the pandemic, but I think the role has solidified during the pandemic.

When this country faces a crisis, whether that be natural such as a hurricane, man-made such as 9/11, or pandemic-related, Medicaid has stepped up to provide the insurance and assurance that millions of Americans physical, mental, behavioral, and yes, even fiscal health will be supported and strengthened through a time of crisis

Medicaid has stepped up and, in many ways, become more visible, in part because of its growth. Medicaid pretty soon will be covering almost 1 in 4 Americans and possibly because of that there is a greater appreciation and understanding of the vital role Medicaid plays.

For too long in this country people have been able to dismiss Medicaid as a “low-income” program, “poverty” program, or just generally not fully appreciate it because they think it benefits someone else. But, what we’ve really learned in the past decade and during the pandemic is that Medicaid is all around us. Medicaid is us. Medicaid is the backbone of our country. The greater appreciation of that we see, from citizens and from policy makers at state and federal and local levels, the more important and more vital conversations are going to be to ensuring the lifelong stability and support for the Medicaid program.

Is there a throughline for Medicaid? There are certainly times when the Medicaid program responds to disasters, public health emergencies, or other things, but there are also the foundational components. When you think about the value of the Medicaid program and what Medicaid leaders, the members of the Association, show up every day to deliver, what do you think are the foundational parts of the program that are critical to the healthcare infrastructure of the country?

The stable Medicaid, the throughline in Medicaid, is that it is and has been for a long time a true safety net.

I think about in many ways the Statue of liberty, standing there in the harbor with the message of “give me your tired, your poor, your huddled masses yearning to be free.” In many ways, that is the bedrock of what Medicaid is and what it promises.

Medicaid is going to be a program that will serve the poorest, the frailest, the most medically complex, the oldest and the youngest Americans. Those who have nowhere else to turn and increasingly, over time, Medicaid has evolved to serve people and populations and provide services that other parts of the health care system just don’t want to deal with.

What do we think about when we think about Medicaid today? Medicaid is the largest provider of behavioral health services in the country. Medicaid is the nation’s long-term services and supports system. Medicaid provides more than 40 percent of all birth coverage in this country. It didn’t start out that way in any shape or form back in 1965. It has evolved because Medicaid embraces many of these services and many of these key functionalities that other payers have walked away from.

So, Medicaid is going to continue to be a really important throughline for those who the “normal health care system” can’t handle or doesn’t know how to do a very good job with.

When it comes down to what gets Medicaid directors up out of bed every morning, it’s the ability to stand up to the challenge and the opportunity to ensure that the poorest, the frailest, and the most medically-complex American citizens have the best possible health care that we can possibly deliver.

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