Friday, May 20, 2016

Medicaid Directors and the Brand New Challenges They Face

By Rene Macapinlac

The most recent State Medicaid Operations Survey, conducted by the National Association of Medicaid Directors (NAMD), shows just how the Medicaid program has changed and will continue to change rapidly in the days ahead.

Topping the list of major Medicaid innovations is payment and delivery system reform. Agencies are moving toward performance-based reimbursement models both within traditional fee-for-service care delivery and managed care. Directors face challenges with staffing, data and systems infrastructure, budgets, and procurement processes.

Difficulties in recruiting and retaining staff are pushing directors to internally shift existing staff resources and step up initiatives for acquiring new skill sets.  On top of the challenges with limited staffing and resources, the directors must deal with higher expectations, increased public visibility, and greater accountability.

Medicaid today has become a complex program covering a wide range of services requiring a broad scope of operational functions. These operational functions often involve contractors, making day-to-day management even more complex. Contractor involvement varies by state, with some agencies contracting key functions while others only do back-office functions.

Despite the persistent and increasing job challenges, Medicaid directors remain committed to building new capabilities in order to meet the needs of more than 72 million Americans. They are implementing new or expanded program integrity activities - conducting various audits, enhancing data resources and analytical tools, strengthening program policies and procedures, and coordinating with other entities.

Rene Macapinlac is the Director of Operations at ManagedCareBiz, an online resource for managed care professionals who need to stay up-to-date on industry news, analysis and commentary.

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