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Medicaid: Lots of responsibility but little power

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This piece discusses how Medicaid has great responsibility but surprisingly little power.

The  article notes:

For “all of its growth, Medicaid hasn’t really improved its governance or increased its power. State Medicaid leaders have seen their responsibilities and influence grow exponentially, but extra resources — like more administrative positions, pay raises and better technical assistance — haven’t followed, according to a recent report by the Milbank Memorial Fund. “The Role of State Medicaid Directors: A Leadership Imperative” calls for states to re-evaluate how their programs are run and how their directors are compensated.”


“For all their responsibility…{state} Medicaid directors often don’t have much control over services like substance abuse, mental health and long-term care. This fragmentation of responsibility was especially frustrating for Deborah Bachrach, the former Medicaid director of New York.

“Eligibility and enrollment went through county offices, and those people didn’t even report to me. States need to rethink where Medicaid falls on the totem pole of government.”




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