With over 85 million individuals enrolled, Medicaid and CHIP serve as the nation’s public health insurance program for children, adults, and seniors living with low incomes and individuals with disabilities. In managing this vital program, Medicaid leaders must administer necessary services that support the health needs of these individuals while balancing other federal and state operational priorities.

The role of Medicaid leaders is critical — and challenging. The Medicaid Pathways Program (MPP), a leadership training initiative led by the Center for Health Care Strategies (CHCS) with support from the Robert Wood Johnson Foundation, aims to bolster the capacity of diverse senior Medicaid leaders, including individuals with lived experience. Supporting Medicaid leaders by investing in their development can help states and territories improve the health and well-being of people served by publicly financed care. MPP participants, including leaders from 16 states, recently discussed the tension of setting and managing strategic direction for their agencies, while also being prudent of the ever-changing political landscape at the federal and state level.

At a recent MPP meeting, Estelle Richman, CHCS board chair, shared lessons from her more than 30 years’ experience as a public servant at the federal, state, and local level. Estelle has held several positions, including Chief Operating Officer at the U.S. Department of Housing and Urban Development, Secretary of the Pennsylvania Department of Public Welfare, Managing Director for the City of Philadelphia, and Philadelphia’s Commissioner of Public Health. Following are key tips from Estelle for leading in a complex government environment, like Medicaid.

1. Fill the void.

Learn what the gaps are and step in to lead when the opportunity arises. Too often, leaders are told to “stay in their lane.” But, even if you are not the accountable person, you have a responsibility to best serve your clients — even if that means stepping out of your comfort zone. And, it’s important to empower your team to do the same.

2. Always have a plan b, plan c, and plan d.

Often, things don’t always go as expected. It’s wiser to be prepared with contingency plans. These contingency plans should be developed by a diverse team that is closest to the issue. These individuals are usually impacted by the outcome and can make effective recommendations.

3. Use data to inform decision-making.

At a time where information is at our fingertips, it’s important to do your research and to build support for your position. Organizations collect data all the time but are not always savvy with analyzing and using the data to inform policymaking. An effective leader understands the role of research and teaches their staff to leverage data for education, planning, and implementation purposes.

4. Build relationships and find a common thread.

This is particularly valuable when you’re trying to garner support from colleagues. Before joining a meeting with someone you don’t know, take the time to learn something about them first that you can connect with before getting to the hard stuff. Spending a few minutes on that shared connection upfront can relax everyone and help us recognize our humanity.

5. Be accessible to your team.

Never sacrifice or short-change 1:1 time. Taking the time to meet with your team builds trust and helps to foster meaningful relationships. Always make sure that your team knows how important they are to the success of the organization. One way to do this is to meet them where they are — don’t always make them come to your office. Make yourself accessible on their grounds.

6. Encourage risk-taking and create a culture of innovation.

Change is never easy but moving towards excellence is critical. As a society, we are often risk averse. We lean towards safe decisions and predictability so that we know the outcome of our choices. But, this can sacrifice creativity and innovation. Always consider a new idea. When it doesn’t work out how it was intended, analyze why, move on, and try again. If you keep trying, you’ll get a touch of successes.

7. Never compromise your values.

This is critical even when it means taking professional risks that are not favorable. Spend time understanding yourself — know where you stand on issues, how far you are willing to go, and how far you are willing to push others. Have some sense of what you will do when asked to push your boundaries.

8. Don’t let the perfect be the enemy of the good.

Leaders are sometimes fixated on perfectionism and forget that progress is key. Taking small steps can do a lot of good. We are so focused on achieving the gold standard that we tend to forget that small steps in the right direction may get us closer to our goal. The key is to keep the small steps moving until the broader goal is accomplished.

Ultimately, leaders should trust themselves — believe in their ability and fight the good fight. The opportunity to discuss leadership development and share strategies to effectively navigate the Medicaid environment, particularly in the current pandemic environment, is an invaluable resource.

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