The first few months of any new job can be exciting and overwhelming — and stepping into a new role as a Medicaid director is no different. These jobs are tough, but critical to ensuring that millions of people across the country have access to quality health care services. Learning to navigate the nuanced and complex environment of state government can be challenging, even for individuals who rise up within a Medicaid agency over the course of their career.

The Center for Health Care Strategies (CHCS) spoke with Lee Grossman, Wyoming’s Medicaid director, current Medicaid Leadership Institute Fellow and former Medicaid Pathways Program participant, to learn about his experience as a new Medicaid director. During this conversation, Lee, who started as Wyoming’s Medicaid director in February 2023, shared perspectives about his first 90 days and tips for others starting in a new Medicaid role.

Q. After 90 days in the Medicaid director position, what has surprised you the most?

A. I’m sure this is not a surprise to most people, but even though I’ve worked at the agency for 12 years, I still have so much to absorb. For example, I am not as familiar with our operations division as I am with our policy unit. It’s been a learning curve, but I appreciate the challenge.

Q. How did you build rapport with your staff during the first few weeks in the new role?

A. I did a few things that were key:

• First, I simply trusted the leaders we have at the agency. I have a wonderful team — they keep me updated on state and federal regulations and priorities, evidence-based policymaking and programming, and organizational needs. I continue to lean on appreciative inquiry and give the staff an opportunity to shine and teach me what I don’t know.
• Second, I explained my commitment to staff retention. I want to help people grow professionally and personally because that’s how people stay excited about their work. I am aggressive about supporting emerging leaders, so I try to learn about their interests, gather the needed resources, connect them to desired projects, and introduce them to subject matter experts on our team. Building positive work relationships is critical to improving staff morale and engagement.
• Lastly, I presented a structured, personal introduction to all staff. My goals were simple: I wanted people to know who I was, and I wanted to be transparent about my leadership style and strategic priorities. I received positive feedback about this presentation, and it helped ease my transition into the role.

Q. What experiences prepared you for this role?

A. I have worked in different roles across the agency, which allowed me to build comfort with managing direct reports and project teams, testifying at the legislature, and engaging with stakeholders. Over the years, I’ve become a trusted voice in the agency, which has helped me to become a more effective Medicaid director. I’m also grateful for leadership development programs and national networking groups. The opportunity to connect with others across the country has helped my personal growth and the agency’s advancement. On the other hand, I’m learning to navigate new challenges, such as how to effectively manage up to the Governor’s office and delegate to colleagues while still providing needed support. I’m figuring out the balance of empowering staff and wanting them to know I’m available and care about their success.

Q. What is the policy issue that keeps you up at night?

A. Behavioral health is a clear priority for Wyoming, and we are investing significant time and resources. We have troubling suicide rates, especially for veterans and older adults. To address this, we are redesigning our behavioral health system to leverage our information technology infrastructure for our Community Mental Health Centers, and incentivizing providers for positive outcomes, such as ensuring that the person is employed, housed, and engaged with the community. Ultimately, we want to see involuntary hospitalizations and suicide rates decrease. We are working with several sectors — sister agencies, the Governor’s office, and hospitals — to improve our efforts, and I am responsible for how the Medicaid agency effectively partners with them.

Q. What advice would you give a new Medicaid director on day one of their role?

A. This is such a unique and tremendous public service opportunity. Don’t look at this as a burden, but rather a privilege. Be intentional about the impact you want to make, especially since the tenure in this role is typically quite short. You can’t fix everything but think about your legacy and have a short list of what you want to accomplish. Be clear about your guiding principles so that you can foster buy-in. The sooner you think about this, the more purposeful and effective you will be in building a team that believes in your mission. Also, show up and listen, especially to communities and advocates who have been marginalized. That’s how people will know you care.

Q. How do you recharge and bring your best self to work?

A. I give myself permission to step away and refrain from evening work as much as possible. I encourage staff members to do the same, so I model the behavior. I just came back from camping with my family, and it’s really what I needed to recharge. I love spending time in the outdoors. I also find it beneficial to connect with the community because it reminds me of why I do this work. I’m lucky to be in this position, and I’ll always be grateful that I’m Wyoming’s Medicaid director.