Hiring Medicaid leaders is challenging. There is often a limited pool of qualified applicants who have the unique mix of leadership and management skills, subject matter expertise, and political savviness necessary to succeed in these roles. Opportunities exist to overcome this challenge by investing in the development of existing Medicaid staff, especially rising leaders with diverse experiences and identities. Leadership development can help staff build the needed skills for more senior roles at these agencies.
The Medicaid Pathways Program (MPP), led by the Center for Health Care Strategies (CHCS) through support from the Robert Wood Johnson Foundation, is designed to strengthen the leadership capacity of senior Medicaid leaders. This training program supports a diverse cohort of individuals who are new to Medicaid leadership roles and/or are interested in advancing to a senior role in the future, particularly individuals with diverse identities and perspectives — including Black, Indigenous, and people of color; individuals with disabilities; and/or people with personal experience with Medicaid or another publicly financed program (such as SNAP or TANF).
CHCS recently spoke with alumni from the inaugural class of MPP, Olivia Alford, MPH, director of delivery system reform, Office of MaineCare Services; Tony Newman, MPA, deputy director, Division of Senior and Disabilities Services, Alaska Department of Health and Social Services; Ranjani Starr, PhD, MPH, health analytics and informatics administrator, Hawaii Department of Human Services, Med-QUEST Division; and Lauryn Walker, PhD, MPH, senior consultant, Office of the Chief Strategy Officer and Chief Actuary, North Carolina Department of Health and Human Services, who shared their perspectives on why investing in leadership development is important to strengthen the capacity of Medicaid managers.
Why is investing in rising leaders with diverse experiences and identities vital to the success of Medicaid?
T. Newman: It is simply impossible [for an outsider] to grasp the complexity and details around a Medicaid program without having put in the time to learn, observe, and work through one initiative, challenge, project, or change after another. I have become fond of saying, “You can’t learn Medicaid by reading a book. You have to live it.”
O. Alford: Powerful change is generated when people are empowered to push boundaries and teams are asked to consider each other’s perspective or approach. Coming up through Medicaid as a rising leader and bringing your experiences, identity, goals, and passion brings “organizational agility,” which is critical in systems as complex as Medicaid.
R. Starr: Medicaid is such a complex program. The ability to lead teams and work cross-functionally is pivotal to one’s success in a Medicaid leadership position. To be effective, rising Medicaid leaders need to be taught new skills, such as multidisciplinary collaboration, conflict resolution, relationship management, and organizational change management. This gives those of us with ambitions to be Medicaid directors the opportunity to practice these skills earlier and for longer and gives those who remain in other senior leadership roles the tools to be effective.
What’s one thing you wish you knew before you became a Medicaid leader?
L. Walker: I did not fully grasp the resource and staffing capacity challenges — this is the struggle that I was the least prepared for and have found to be universal. Luckily, I found a community in Medicaid, both in my own agency and across the country, willing to help each other. No one knows everything about their own state’s Medicaid program, let alone everything about Medicaid nationally. We’re all dependent on each other to get through a complex, murky world. Share what you know!
R. Starr: As a Medicaid leader, I am dependent upon relationships to accomplish my work. None of the projects I’m assigned can be completed in a vacuum. I’ve come to appreciate that we are all mutually interdependent upon one another for success.
How has your participation in the Medicaid Pathways Program impacted your perspective and approach to inclusive leadership?
L. Walker: MPP introduced me to people doing my job all over the country. It’s easy to get caught up in the daily grind, focus internally on your own state’s context, and the task due at 5pm. MPP made me raise my head up a little and take a look at how other states and other people function in similar roles. People are doing amazing things — engaging staff, members, and stakeholders more purposefully, creatively, and meaningfully. MPP created a space to be conscious of how to engage people that have been left out or under-represented in the past.
O. Alford: The program provided space for discussion and thoughtfulness with an amazing cohort of Medicaid leaders. Slowing down to have important discussions, personally reflect, set goals, and plan reinforced my dedication to partnership and collaboration and strengthened my ability to effectively do critical leadership work. MPP connected me to a wonderful, inspiring group of people, as well as to very concrete tools and strategies to apply to the often-underinvested parts of inclusive leadership.
T. Newman: MPP has given me more confidence in and patience with myself as a leader. The range of attention and lessons I received in MPP and the connections I’ve made with others in the program have enriched my life and given durability to my career.
What challenges and opportunities do you see on the horizon for Medicaid agencies? What will leaders need to navigate these?
T. Newman: The Medicaid program is in an unsettled place, like the country itself. The only sure bet is that there will be changes ahead, and the best thing Medicaid leaders can do is build their leadership skills and pace themselves to meet these changes with confidence and humility, offering themselves as good role models for the leaders that will be right behind us.
L. Walker: Medicaid is today’s hot topic in health care policy. It’s our job as Medicaid leaders to ensure that Medicaid isn’t just a trendy policy topic that fades into the next, but that we create a long-term shift in how our country discusses and invests in the program.
O. Alford: True partnerships! The potential for Medicaid to directly (or indirectly) support societal and financial well-being is enormous. Leaders need to become comfortable and fluent with true collaboration to lead, support, contribute, and listen so that people can be at the table together and address challenges.
R. Starr: It is becoming increasingly evident that our health care system requires substantial structural overhaul to maximize access to care, achieve better health outcomes, and lower health care costs. It is incumbent upon Medicaid leaders to lead a strategic visioning process that challenges a new generation of leaders and focuses on a longer-term view of health and well-being. As the agency that serves individuals with the greatest social and complex health needs, Medicaid is aptly poised to be the leader in such an effort. Medicaid leaders have a difficult but influential role in leading the health care industry toward a much-needed revolution.
