When Medicaid leaders mirror the identities of the people they serve, they can relate to the challenges and strengths of enrollees and more intuitively design equitable policies that address members’ specific needs. Although 25 percent of Medicaid members identify as Black women, this diversity is not reflected across Medicaid leadership. But, Black women leaders continue to make strides in their Medicaid agencies, including breaking barriers to achieve executive positions within organizations.

The Center for Health Care Strategies (CHCS) recently invited three Medicaid leaders to share how state agencies can better support Black women pursuing leadership roles. Adrienne Fegans, deputy director of programs and operations, Virginia Department of Medical Assistance Services; Nicole Harris, executive director, Children’s Health Insurance Program, Commonwealth of Pennsylvania; and Shanique McGowan, behavioral health program manager, New Jersey Division of Medical Assistance and Health Services all generously offered experiences from their careers in Medicaid.

This blog post highlights key themes from our roundtable with these three inspiring leaders about the importance of mentoring, engaging, empowering, and celebrating Black women in Medicaid to support their career development. All three women were participants in the Medicaid Pathways Program, a national initiative led by CHCS with support from the Robert Wood Johnson Foundation, designed to bolster the leadership capacity of Medicaid staff.

Mentor Black women.

In Medicaid, a mentor can share resources and historical knowledge about important roles and responsibilities, guidance in managing relationships with internal and external stakeholders, and tips on how to collaborate with colleagues in a matrixed organization. Without a trusted mentor, it can be difficult to navigate and grow in a complex environment like Medicaid.

Adrienne Fegans: I’m an introvert, and I wasn’t looking to be a leader. I was comfortable with my role implementing projects. I didn’t even see a leadership pathway for myself. I have worked for the same director my entire Medicaid career as she, herself, has progressed in the agency — from manager to deputy to now agency director. During my career, she was able to see that I was not only a project manager but a leader. She noticed my work with project teams and agency staff and encouraged me to take a leadership role. She encouraged me to apply for higher level positions and challenges. She continues to mentor and motivate me to learn and invest in my leadership development. She tells us that we need to be the CEO of our own careers and encourages us to learn new skills. Lastly, she reminds staff that it’s not the role of leaders to develop followers, but instead to develop other leaders.

Nicole Harris: When I first started working at Medicaid, I was content with my role as a case worker. During my first year, my boss saw something in me and told me that I was going to lead. I’ve served with my deputy for the past three years. To me, she is not only my boss but a mentor. She motivates me to step out of my comfort zone and is always available to support me. The skills and value she sees in me inspire me to continue to do this work. To this day, she always encourages me to participate in mentorship and leadership development programs. Similarly, I’m excited when Black women reach out to me and want to learn more about working in Medicaid and the public sector. Through these conversations, I learn about their interests and try my best to connect them with others who can help them with their careers.

Engage Black women.

Engaging Black women leaders requires inclusion. Simply inviting a Black woman to a meeting for her perspective is not effective, especially if she does not feel engaged during the discussion. It is important to seek individuals with different perspectives and ensure that their contributions are elevated in conversations and decisions.

Shanique McGowan: Feeling tokenized can inhibit participation during meetings. Many times, folks who share their experience don’t want to be perceived as the one who speaks for every person who identifies like them (i.e., every Black woman who has engaged with the Medicaid system). People of color often go through a cycle of trying to prove themselves, which usually results in a heavier workload, increased responsibility, and more tokenism. This may lead to burnout or resignation from spaces where their voices are needed the most. Having intentional conversations about the power of their perspectives can increase engagement and lead to more meaningful connections.

N. Harris: Because of my identity and position within the organization, I was often asked to be part of interviews, even if the position was unrelated to my work and expertise. It was time consuming. When I voiced my concern, I was told that I was “needed,” but I didn’t feel valued. My boss intervened and made sure that I was only included in hiring processes for positions that interfaced with my team and where my expertise could be most valuable. In addition, when I first started working in Medicaid, I realized that most interns were not people of color. Some state agencies have nearby historically Black colleges and universities yet rarely go to their career fairs. We need to do better at advertising these jobs, especially to communities of color.

Empower Black women.

Empowering Black women builds confidence and trust. When staff have support from their managers and colleagues to learn and grow, they feel more secure in their ability to lead.

N. Harris: A Black woman on our team was often overlooked, and it was difficult for her to leverage her expertise. I asked her more about her interests and supported her in doing work that she enjoys. She is more productive and excited about her contributions to projects. My manager is grateful that I took the time to ask, listen, and empower her. 

S. McGowan: As an immigrant from Jamaica, I always struggled with assimilation and being my authentic self. I’ve learned to hold both identities as a Jamaican-American woman, and it’s impacted how I approach my work. Even when there are a lot of leadership changes, I am resilient. I do my best to keep projects moving forward and stay grounded in my values and purpose. I embrace my position as a way to empower enrollees’ voices and my own voice.

A. Fegans: I was recently promoted and dealing with an inner battle of performing like my manager, who was in my current position before she was appointed as the agency director. I shared this challenge with her, and she told me, “I expect you to be you. You have the skills to do this job and that’s why we hired you.” Her trust empowered me to authentically be me in this role.

Celebrate Black women.

Celebration looks different for everyone, but is necessary for nourishment. Congratulating a colleague, acknowledging strengths, and prioritizing wellness can all be forms of celebration. Medicaid agencies can examine how they recognize their leaders, particularly those of color. Often, these leaders are in spaces with others who do not look like them or have similar lived experiences. Staff feel valued when they’re appreciated for their contributions, and it is important for organizations to explore how they can bolster their celebratory efforts.

A. Fegans: I always tell my daughter to remember that she is smart enough to be in the room and at the table. We need to encourage other Black women of all ages to be authentic in the skills and knowledge they bring and not feel as though they always have to prove themselves. As I’ve often stated, “I am who I am.”

N. Harris: When I was promoted to my current position, my colleagues told me that I deserved it. I was flooded with kind emails and congratulatory phone calls. It feels good to be celebrated and acknowledged for what you bring to the table, especially when Black women are often overlooked.

S. McGowan: I celebrate by traveling, prioritizing self-care, and spending time with my family, friends, and husband. I allow myself the time and space to live a soft life because I deserve it.

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