Medicaid has come a long way from its inception over 50 years ago. From a stigma-ridden afterthought at the creation of Medicare to a true bulwark of the American health care system, it is now in many states serving nearly a quarter of the population, while covering half of all births and roughly 40 percent (and in some states, closer to 75 percent) of the children that represent our nation’s future. Its role is often hidden, but it has grown significantly over the years. Today, it provides the bulk of care for those with serious mental illnesses, substance use disorders, and developmental disabilities. And the U.S. would not have a system of long-term care without it.

When Kate McEvoy, Connecticut Medicaid director and the new incoming president of the National Association of Medicaid Directors, recently asked us for thoughts on the value of Medicaid and the critical role of Medicaid directors, we gladly obliged. Following are some of our top-of-mind perspectives on the broad influence and critical role of Medicaid directors.

The Influence of Medicaid Directors

A few themes stand out in terms of the value and impact of Medicaid directors themselves, including:

• Directors are captains at the helm of a great health insurance vehicle that impacts the lives of at least one in five Americans at any point in time, giving them a direct impact not only on the health of these individuals, but also on the health of the overall population now and for generations to come.
• Directors are drivers of innovation not just within Medicaid, but frequently, given its growing role as a public good, within the larger health system and beyond.
• Directors build leadership teams for organizations that play a central role in state economies, influencing an increasing percentage of state and national GDP, and providing a crucial support to employment for millions of Americans.

Medicaid’s Role in Cross-Sector Transformation

With the burgeoning attention to the social determinants of health, it is not surprising to see Medicaid directors expanding their radar screens and their direction to state social service agency peers and other non-health care stakeholders, such as community-based organizations. Particularly striking over the past several years is the degree to which Medicaid leaders are increasingly investing their dollars as far upstream as possible in cross-system efforts to improve well-being, prevent disease, and stabilize chronic conditions so that they can avoid downstream, expensive, and avoidable hospitalizations and institutionalizations. State Medicaid directors are taking the initiative to partner with their counterparts in child protective services, nutrition, transportation, housing, criminal justice and other social services, because they realize that it ‘takes a multi-agency village’ to secure the health of the American public.

Coming Soon

Since 2009, the Medicaid Leadership Institute, a program of CHCS made possible by the Robert Wood Johnson Foundation, has provided a unique opportunity for Medicaid directors from states across the political spectrum to develop the skills and expertise necessary to successfully lead and improve their state programs in an ever-changing policy environment. Over the last decade, the Institute has trained 47 Medicaid directors and numerous state staff from 35 states plus the District of Columbia. In July, look for an announcement of state Medicaid directors who will join the Medicaid Leadership Institute Class of 2020!