Human services group says defection of Medicaid directors inconsequential

The recent decision of some Medicaid chiefs to leave the National Association of State Medicaid Directors (NASMD) and form their own lobbying group will have "no immediate effect" on NASMD's operations, according to the head of the human services association overseeing the group.

"We'll continue to do the work that we do," Cari DeSantis, interim executive director of the American Public Human Services Association (APHSA), said in a phone interview Wednesday. NASMD's annual conference in November, for instance, is still on, she said. "Not really anything has changed."

Still, DeSantis conceded that APHSA officials are scurrying to evaluate the long-term significance of the breakup, as they install new leaders and reach out to states with the message that it's still business as usual in Washington. 

"I don't know what's real and what's not real," DeSantis said of the new group.

Since 1979, NASMD, an APHSA affiliate, has represented the nation's Medicaid directors in Washington. But NASMD's 12-member executive committee voted this month to split from APHSA and create a separate organization, the National Association of Medicaid Directors (NAMD).

Led by Carol Steckel, head of Alabama's Medicaid program, the new group says its independence from APHSA will be an asset as states move to implement the many changes contained in the Democrats' new healthcare reform law.

"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," Steckel wrote last Thursday to colleagues seeking support for NAMD.

But DeSantis says NAMD's flexibility will come at the price of losing access to the resources of the other affiliates under APHSA's umbrella. State child-welfare programs, disability services and food-stamp initiatives all intermingle with Medicaid toward the common goal of keeping vulnerable populations healthy, she said.

"There's a lot to be said for the interconnectedness of health and human services," DeSantis said. "There are so many places where medical and human services intersect. We can't lose sight of that." 

Steckel did not respond to requests for comment this week.

Some Medicaid directors said the push for an independent Medicaid group has lasted for more than a decade, fueled (at least in part) by a perception that NASMD's resources are used to fund some of the other APHSA affiliates — something DeSantis said is "flat-out not true."

It's yet unclear how the independent NAMD group has been received by states not represented by members of NASMD's executive committee, who voted unanimously to defect.

APHSA officials are quick to note that many state Medicaid directors are not their own bosses, but instead work within state human services departments. With that in mind, APHSA says, it will be difficult for those Medicaid programs to join the new group, even if their leaders prefer the stand-alone model.

Amid the turmoil, NASMD has fired its director, Ann Kohler, and replaced her with Rick Fenton, a 31-year veteran of the Centers for Medicare and Medicaid Services. 

It's not the only shake-up at APHSA this month. In an expected move, the group announced Thursday that DeSantis, who's been interim executive director since February, will step down late next month. 

Tracy L. Wareing, now a senior adviser to Department of Homeland Security Secretary Janet Napolitano, will replace her.

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