Lauren Moran, MPP

December 7, 2020

Medicaid plays an essential role in providing health care services for millions of people across the U.S. — the need for which has only been amplified by the COVID-19 pandemic. Developing strong leadership in state Medicaid programs is critical to ensuring equitable care while addressing day-to-day challenges and balancing federal and state priorities around controlling costs while ensuring high-quality care and improving outcomes.

Over the last decade, the Medicaid Leadership Institute (MLI), through support from the Robert Wood Johnson Foundation, has worked with Medicaid directors and their senior teams across the nation to strengthen their capacity to successfully lead their Medicaid agencies and improve health outcomes. Since the program’s inception, 59 Medicaid directors in 40 states, the District of Columbia, and the U.S. Virgin Islands have participated in MLI — representing 75 percent of all Medicaid enrollees nationally.

As MLI welcomes its 10th anniversary class, CHCS spoke with three former MLI fellows who reflected on the program and its impact on their leadership. Below we share perspectives on Medicaid leadership and key lessons for success from Linda Elam, PhD, MPH, CEO, Amerigroup District of Columbia Health Plan, (former District of Columbia Medicaid director); Judy Mohr Peterson, PhD, Medicaid director, Hawaii State Department of Human Services (former Oregon Medicaid director); and Sandeep Wadhwa, MD, global chief medical officer, 3M Health Information Systems (former Colorado Medicaid director).

Q: Why is it important to invest in the leadership development of Medicaid directors and their teams?

Medicaid leadership teams must be technically strong and politically savvy in order to maximize the impact of their work on behalf of some of the nation’s populations with the greatest health needs.

A: L. Elam: Medicaid is a vital, complex program operating in a very politically charged environment. It is a large part of state budgets, making it vulnerable to proposals for programmatic and economic changes that are not always optimally informed. Medicaid leadership teams must be technically strong and politically savvy in order to maximize the impact of their work on behalf of some of the nation’s populations with the greatest health needs. Additionally, given the fairly rapid turnover of Medicaid directors, it’s important to invest in institutional and bench strength to allow for more seamless operation of the program in the event of political changes or other personnel actions.

J. Peterson: Medicaid, as the largest health insurer in most states, is the strong fabric of the social safety-net — or trampoline, as I like to think of it — and its leadership is essential to these programs’ effectiveness. A strong leadership team ensures the continuity of the strategic direction when directors change. No leader, no matter how visionary and competent, can do the work on their own, which is why investing in both the director and the team is critical.

Q: How did your experiences in MLI impact your tenure as Medicaid director and beyond?

A: J. Peterson: My experiences in MLI are foundational to who I am as a leader today. When I was in Oregon, the ideas discussed in MLI became the building blocks of Oregon’s Healthcare Transformation efforts and the Coordinated Care Organizations. I learned to be a more dynamic speaker and to communicate strategic vision clearly. Ed O’Neil’s leadership formula was a particularly helpful framework when I moved to Hawaii to be the new Medicaid director. It helped me get my arms around how to start over in a completely new place. Those are just a few examples of how the experiences in MLI have impacted my career.

S. Wadhwa: I received formal training on effective public communication, which served me particularly well when interacting with stakeholders. The personalized coaching identified blind spots and weaknesses in my leadership and management style that I was able to at least mitigate, if not turn into strengths.

Q: How can we help prepare the Medicaid leaders of the future for success?

Medicaid leaders are poised to play a crucial role in addressing the nation’s health inequities and disparities.

A: L. Elam: Technical and policy expertise is essential, but a good understanding of the politics of Medicaid at the federal level, and within a given state, is critical to success. In addition, the ability to distill complex information and make it understandable to a wide audience is extremely important. Providing training and support around those elements is central to the success of Medicaid leaders wherever they serve.

S. Wadhwa: Medicaid leaders are poised to play a crucial role in addressing the nation’s health inequities and disparities. Leadership skills in collective action, multiparty negotiation, and coalition building can help ensure future success in this area.  

Q: If you could give advice to a new Medicaid director, what would it be?

Being Medicaid director is a lot more complex and challenging than anything else that you’ve taken on – but that’s okay. Medicaid IS complex and no one knows it all.

A: S. Wadhwa: Prioritize and incorporate the voices of clients you serve. It’s tempting to give primacy of time and thought to providers, plans, and suppliers, rather than the clients and the public.

L. Elam: Begin with a service mindset, and let that be the foundation of your policy proposals, hiring decisions, contracting arrangements, and even your disputes. While you have to stay connected to the work within the agency, be sure to preserve enough time to be outward-facing so you can stay attuned to what’s going on at the executive and legislative levels with your providers and, most importantly, with the populations you serve. Hire well and invest in your staff — they are the root of your success. And, speaking of success, be sure to celebrate wins and share the credit widely.

J. Peterson: Oh my gosh — so many things!

  • BREATHE! Being a Medicaid director is a lot more complex and challenging than anything else that you’ve taken on — but that’s okay. Medicaid IS complex and no one knows it all. I’ve been a Medicaid director for years and am still learning every day!
  • Remember to delegate — you are now the leader, not the chief doer.
  • Reach out to your colleagues — most of us are happy to listen and at the very least, let you know that you are not alone.
  • Take time for the strategic important things, otherwise, you will be consumed by the “tyranny” of the urgent.
  • One of the important things to take care of is yourself! It is very easy to be consumed by the job as there is always a ton more work to do, emails to respond to, meetings to take, etc. A burned-out you is not helpful to anyone, least of all you.

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