HHAeXchange was proud to have been a Gold Sponsor of this year’s National Association of Medicaid Directors (NAMD) Conference, which was held virtually November 9-11.  The conference reflected three major themes that have characterized work this year: Flexibility, Innovation, and Resiliency.

While the NAMD Conference is always a great way to understand state concerns, share areas of focus, and learn about new innovations and collaborations, this year’s event served as an essential opportunity for state Medicaid officials, federal officials, and vendors serving Medicaid programs to share insights and information on their 2020 experience while looking ahead and planning for 2021.


2020 was an unprecedented year in which multiple factors including a global pandemic, nationwide economic crisis, and widespread calls for justice reform impacted every state.  As states will continue to face economic shortfalls in 2021, Medicaid enrollment projections are expected to increase by 8.2% over FY20 (Kaiser Family Foundation). Specific ways many Medicaid programs have risen to 2020 challenges include:

  • Changes in where members receive care. There has been a shift to keep members in their homes and communities initially by actively transitioning members out of residential living facilities and back into home care environments.

  • Changes in how members receive care. More Medicaid members than ever before can now receive services via tele-health.

  • Changes in behavioral health care. Within the context of the year, Medicaid programs have seen increased utilization for substance abuse, stress and anxiety, ADHD, and depression, and have adopted new ways to deliver services for these conditions.

  • Changes in administration and an urgency to move toward value-based payments. This type of payment structure will help support health equity and individual health by basing reimbursement on health and quality outcomes.

  • Changes in innovation collaboration between states and Centers for Medicare & Medicaid Services (CMS). States have submitted a record number of waiver and state plan amendments to provide more flexibility to support both service delivery and reimbursement during the pandemic.  In turn, CMS has offered states toolkits to provide assistance and expedited reviews and approvals.

Although there is great hope around a return to normalcy with the development and deployment of a COVID-19 vaccine, Medicaid programs forecast 2021 challenges to include:

  • Continued growth in Medicaid enrollment in an environment of shrinking state budgets.

  • Growing need for strengthening and increasing Home and Community Based Services (HCBS) and Long Term Support Services (LTSS) as the population ages and we shift away from long term care being focused in facility settings.

  • Continued challenges in training and retaining workforce for home care services.

  • Continued need for behavioral health and substance abuse services due to high unemployment, social isolation, and increased stressors.

  • Continued urgency in addressing social determinants of health and creating health equity.

In the months to come, states plan to remain focused on the challenges presented in 2020 while proactively planning for 2021. Items such as growing Medicaid enrollment despite shrinking state budgets; institutionalizing waiver services; continuing tele-health and other innovations; transitions from long-term care to community and home-based care; the move to value-based payments and impacting social determinants of health; workforce development and retaining workers; and dealing with health equity highlighted by the pandemic will continue to be top of mind.

While it is impossible to predict each of the obstacles that lie ahead of us, continued practice of the core themes of flexibility, innovation, and resiliency will enable us to adapt to potential changes and better ensure health and quality outcomes for all members.