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The top 3 challenges facing the Medicaid program

Medicaid directors have tall order as the politically divisive program seeks a way forward

Holding a leadership position in a program as complex and controversial as Medicaid might be the toughest job in healthcare--and with even more challenges looming, it's likely to get even more difficult, healthcare policy expert Paul Keckley writes in a new blog post.

Keckley, the managing director for the Navigant Center for Healthcare Research and Policy Analysis, points out that enrollment in Medicaid is growing faster than in any other health plan, and with that its cost to state budgets is "significant and increasing." Medicaid beneficiaries are also uniquely challenging to coordinate care for and treat.

Given these challenges, Medicaid directors are charged with a wealth of responsibilities, including: securing funding for programs and services; building and improving efficient operations; recruiting and attaining quality managers; cultivating provider and public support; and measuring and monitoring results. Medicaid directors also are at the forefront of innovation in clinical processes and payment strategies, including the federally funded State Innovation Model (SIM) program.

Looking ahead, Keckley notes that even though Medicaid expansion remains a high-profile debate, the program actually faces even more pressing issues that will frame its future. These include:

  • The sustainability of leadership. As a September report from the Milbank Memorial Fund points out, Medicaid directors' low compensation relative to corporate CEOs may be holding the program back. Indeed, as Keckley points out, the average tenure of a Medicaid CEO is only 3.5 years, and 23 directors left between 2013 and early 2015.
  • The handling of private managed care organizations. Medicaid programs must figure out not only how to acquire and compare data from contractors to improve private MCO efficiency, but they also must exact greater accountability from their contractors, according to Keckley.
  • The innovation of care coordination. The SIM grants were "a start," Keckley writes, but Medicaid still must strive to build clinical programs to coordinate care amid headwinds such as challenging social determinants of health and funding restrictions.

To learn more:
- read the blog post

Related Articles:
Survey of Medicaid directors shows innovations in state programs
Medicaid directors' inadequate pay may hurt program's success
AHIP experts weigh in on value of Medicaid managed care
What policymakers can learn from Medicaid managed care innovations