Survey of Medicaid directors finds ACA, care reforms are transforming program, agencies

November 03, 2014

The implementation of the ACA along with payment and delivery system reforms are transforming how Medicaid is provided, as a result, FY2014 was a year of change for Medicaid directors and their programs, according to this report from the National Association of Medicaid Directors. Some of the key findings include:

  • The directors' ability to manage relationships with a host of critical partners is key;
  • Directors and their agencies are taking on multiple and varied payment and delivery system reforms simultaneously, including include episodic payment, ACOs, dual eligible demonstrations and initiatives in managed care;
  • Even with modest growth, directors face major capacity constraints; and
  • Despite variation, the priorities for Medicaid are increasingly coherent across programs.  

Directors noted that their administrative capacity to take on the growing list of Medicaid responsibilities was impacted by two major factors. First, the average vacancy rate remained relatively high at 9% - meaning one in 10 jobs in a Medicaid agency was unfilled. Vacancy rates have been an ongoing issue for Medicaid programs, with some programs facing vacancy rates as high as 30%. Second, directors regularly cited resource constraints in their ability to recruit, hire, and retain particular skilled and professional positions for their jobs. When asked for their top three priorities for 2015, directors across the country answered similarly:

  • Implementation of the ACA;
  • Planning or standing up new payment and delivery system reforms; and
  • Upgrading systems - both eligibility and enrollment and Medicaid Management Information Systems.