The Role of State Medicaid Directors: A Leadership Imperative

Developing effective Medicaid leadership and organizational structures is one of the paramount challenges facing governors and legislatures. Medicaid has grown from a program that, in 1987, comprised 10% of state budgets to one that in 2013, comprised 25% of state budgets.

The size and scope of these programs raise questions about the way they are run and organized. In this report, Andy Allison, a former Medicaid director in two states, looks at current trends in Medicaid policy, organization, and leadership—including a review of corporate management theory and practice—and examines the program’s organization in state government and the roles, responsibilities, and expectations of program leadership.

Failure to closely examine Medicaid’s organization and leadership will misspend taxpayer contributions, hinder needed health care reform, and compromise the health care of a significant portion of each state’s citizens, explains Christopher F. Koller, President of the Fund.

It is our hope that this report will accelerate the conversation about the effectiveness of Medicaid leadership and contribute to an issue of vital importance to the health of states.