State Medicaid directors defect from larger association

A group of state Medicaid directors has formed an independent lobbying organization, breaking away from the larger association that represented them for 31 years.

The National Association of State Medicaid Directors (NASMD) — an affiliate, since 1979, of the broader American Public Human Services Association (APHSA) — has historically acted as the liaison between state Medicaid programs and the federal government. 

But NASMD's 12-member executive committee, consisting of Medicaid directors from around the country, voted recently to break away from APHSA and create a stand-alone group.

Supporters argue the independent spin-off — dubbed the National Association of Medicaid Directors (NAMD) — will be a leaner, more nimble organization that is capable of implementing the new health reform law more effectively than NASMD. 

"Health care reform moves us, in hyper-speed, into a new and challenging world that will require each of us and our national organization to be more flexible and to develop relationships with organizations such as the National Association of Insurance Commissioners (NAIC) among others," Carol H. Steckel, head of Alabama's Medicaid program and president of the new NAMD group, wrote last Thursday in a letter addressed to "Medicaid Alumnus and Friends."  

Steckel was head of NASMD's executive committee when the panel voted to break from APHSA.

Some Medicaid directors say healthcare reform is not the only reason for the defection. Chuck Duarte, head of Nevada's Medicaid program — but not a current member of NASMD's executive committee — said the movement is derived from a long-standing sense among some stand health officials that they "need to focus more of the dues and resources to Medicaid, and not to other affiliates."

Aside from Medicaid programs, APHSA also represents a host of different human services interests, including food stamp, child welfare and disability programs. 

Duarte said the creation of a separate Medicaid group has been under discussion since 1996, when President Clinton enacted welfare reform. The idea, he said, is to treat healthcare as a separate entity and "not another income-based welfare program."

It's not the only shake-up to hit APHSA this month. Hearing the news of NAMD's formation, APHSA leaders fired NASMD Executive Director Ann Kohler, the former head of Medicaid in New Jersey. In her place, the group has appointed Rick Fenton as the acting director of health services. 

Steckel's office did not return calls for comment this week, and a number of other NASMD executive committee members declined comment as well.  

The shake-up has led to a recruiting battle, as NAMD leaders race to convince Medicaid directors nationwide to join the new group, and APHSA leaders are fighting to have them stay with NASMD.

"We will be working to bring on staff, find reasonably priced office space and equipment, all in a very short period of time," Steckel wrote last week.

It remains unclear which side is winning. Steckel's letter indicates that, as of Aug. 19, "many state directors have expressed their support, and we have only had one state that is not interested in participating in the new organization."

But Duarte said Nevada's program hasn't signed on — not least because it's already paid 2010 dues to NASMD.

Meanwhile, members of APHSA's board are scheduled to meet Tuesday afternoon. The purpose of the gathering is to fill the director spot for the larger human services group. But issues surrounding the shake-up at NASMD will surely be a focus as well.