Medicaid chiefs may discuss something off the agenda

2014 has been a transformative year for Medicaid, featuring a coverage expansion to millions more Americans and a greater shift to managed care. So attendees at the National Association of Medicaid Directors' fall conference in Arlington, Va., this week have a lot on their plates.

HHS Secretary Sylvia Mathews Burwell will kick off the conference, which will run Nov. 3-5, with a plenary talk. Session topics will include better care coordination, integrating behavioral health with acute care, blending Medicaid and Medicare for dual-eligibles, and addressing the challenge of high-cost specialty drugs.

Conference speakers also will talk about how they are retraining current staff and hiring for different skills sets; developing new data infrastructure and analytic capacities; reforming business practices and purchasing strategies; and bringing Medicaid agencies together with other state agencies to address social determinants of health such as housing.

What's not on the agenda—but surely will be discussed privately—is the maneuvering that's going on in the 23 mostly Republican-led states that have not yet expanded Medicaid under Obamacare. Last week, North Carolina Gov. Pat McCrory became the latest Republican governor in a holdout state to say he's considering extending the program. According to a news report, he said he's “trying to figure out what to do with Medicaid … because the feds are offering all this money and yet I've got to be concerned with the bureaucracy that could be grown because of that. I'm doing that assessment right now.”

Follow Virgil Dickson on Twitter: @MHVDickson