Twenty-one incoming governors taking office on Jan. 1 must address healthcare as their largest budget item by hiring experienced health secretaries, Medicaid directors, and public health officers. These administrations face urgent obstacles, including Medicaid work documentation rules taking effect in 2027 and federal scrutiny over provider revalidation that has already frozen funds in one state. Additionally, leaders must confront a 2026 measles spike that reached its highest point since 1991 and threatened national elimination status. Success relies on establishing clear, state-controlled objectives early enough to be funded in initial executive budgets.
Key points
Appointing proven operators to lead Medicaid, health departments, and social services is…: Appointing proven operators to lead Medicaid, health departments, and social services is critical to managing state healthcare spending.
Upcoming Medicaid reporting rules and twice-yearly eligibility reviews present major admi…: Upcoming Medicaid reporting rules and twice-yearly eligibility reviews present major administrative risks for widespread enrollee coverage losses.
Governors must establish focused health agendas early to incorporate key policy initiativ…: Governors must establish focused health agendas early to incorporate key policy initiatives into their opening executive budgets.
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As former state health leaders, we know the challenges and opportunities facing the 21 new governors stepping into their roles on Jan. 1. Health is what lets people go to work, raise their kids, and enjoy the years they’ve earned. Health is also the largest line item in most state budgets and a primary driver of the affordability crisis for American families.
To succeed in harnessing the power of state government to improve health and well-being and tackle affordability, new governors need to do three things: hire operators, see the trouble that’s already here, and set a focused agenda.
Hire operators
A governor’s three most consequential health appointments are the state’s health and human services secretary, Medicaid director, and public health officer. The attributes that matter most in these leaders include, foremost, a track record in getting things done in and with government. Look for leaders who have managed large government teams, legislative processes, and stakeholder associations.
Expertise matters, especially in this moment. The Medicaid director should understand evolving federal financing rules, eligibility systems and operations, and the state’s Medicaid…
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