Unsung Heroes: How Medicaid Systems Leaders Engineer Program Innovation

When we speak of innovation in Medicaid—improving access to and continuity of coverage, ensuring that people receive the services to which they are entitled, program integrity – an image of the folks who lead enterprise systems work at the federal and state/territory level isn’t necessarily top of mind. But after this past month’s extraordinary experiences at the New England States Consortium Systems Organization (NESCO) Medicaid Enterprise Systems Conference (MESC) and also the inaugural U.S. Territories Medicaid Enterprise Systems Summit, which was convened by U.S. Virgin Islands Medicaid Director and NAMD Board member Gary Smith, I want to both celebrate and draw your attention to some of the integral ways in which they are literally engineering the next phase of growth and development for the program.

As we emerge from the herculean nationwide effort to redetermine the eligibility of each and every person who is served by Medicaid, systems leaders have been the fulcrum point of major advances in smoothing renewal processes for members. Notably, we have seen dramatic increases in the rate of ex parte renewals, and many creative uses of AI and other technology features to help triage support for people who need more support.

Systems leaders have also continued to balance a complex and ever-evolving pipeline of projects that include important legacy obligations (Affordable Care Act eligibility standards, implementation of Electronic Visit Verification and Asset Verification processes, changes related to resumption of provider enrollment and utilization management standards that were modified during the COVID-19 public health emergency) and the significant array of new obligations related to documentation, transparency around and reporting of rates and quality measures that will arise under Spring, 2024 federal rulemaking related to eligibility, access and managed care.

Cheers for their great work.

In addition to billboarding the work of these amazing people, I also want to underscore the tremendous opportunities and value of partnerships in getting maximal value out of our systems work. This has been abundantly manifest in four notable recent examples: the incredible work of the United States Digital Service (USDS) in supporting states with ex parte and other process optimization efforts, launch of the joint NESCO/NAMD Chief Information Officers affinity group, participation by Medicaid teams in NESCO’s MESC, and the phenomenal success of the territory systems summit. Briefly:

• Have you heard of USDS? Until this past year, the answer may have been no, but during the intense early stages of the unwinding, USDS was closely and instrumentally involved with extraordinary advisory work with states such as Hawaii and Wisconsin to streamline their processes, increase the rate of automatic renewals, and reduce administrative burden. Truly a kind of cavalry, you can learn a bit more about this work here.
• We at NAMD have been so proud to partner with NESCO to stand up the CIO affinity group, which helpfully builds on our existing framework of closely-held, discipline-specific cohorts for senior members of state and territory Medicaid leadership teams. Fortuitously timed—we convened the first meeting shortly before the Change/Optum cyberattack—the CIO group has been a rich source of strategic reconnaissance on day-to-day needs, directly contributed to a rapid cycle CMS information bulletin on state payment options during the aftermath of the cyberattack, and recommendations for ways in which the federal government may help states and territories to scale solutions and control costs.
• Also significant was the extent to which state and territory Medicaid directors and their teams were vitally represented at MESC, showcasing groundbreaking systems work and profiling their working partnerships with major vendors. NESCO has engendered an amazing forum that is increasingly connecting the dots between Medicaid policy and systems work.

From left to right: Tom Wallace of Florida, Traylor Rains of Oklahoma, Dinorah Collazo of Puerto Rico, Jay Ludlam of North Carolina, NAMD Immediate Past President Cindy Beane of West Virginia, Emily Ricci of Alaska, NAMD Board member Henry Lipman of New Hampshire, Kim Sullivan of Louisiana, NAMD Board President Lisa Lee of Kentucky, and Matt Ahern of Nebraska.

• And last, but definitely not least, NAMD Board President Lisa Lee of Kentucky, Immediate Past President Cindy Beane of West Virginia, Jack Rollins and I were very privileged to represent NAMD at the inaugural U.S. Territories Medicaid Enterprise Systems Summit, which was held on St. Thomas and was conceived of and led by Gary Smith, Medicaid Director for the U.S. Virgin Islands and member of NAMD’s Board of Directors. Notable highlights of this catalytic and connective meeting include a panel of territory leads including Chris Carillo of Guam, Sandra King Young of American Samoa and Gary profiling the territories’ major strategic planning initiative, and a panel of our esteemed Center for Medicaid and CHIP Services Data Systems Group colleagues Brent Weaver, Ed Dolly, and territory leads Dion Summerville and Jessica Dunlap. As Ed put it, “we are here to solve problems.” Federal civil service and applied partnership at their very best.

From this Medicaid policy wonk to each of you, there is amazing, instrumental, transformative work going on among federal, state and territory teams and their vendor partners that is centrally focused on improving experience and continuity of coverage and care for Medicaid members.

In partnership,

Kate