Three Strategic Priorities for New Governors Leading State Health Policy
Incoming governors must prioritize operational expertise, proactive crisis management, and focused legislative agendas.
1Prioritizing Operational Leadership
New governors must prioritize hiring experienced operators for key health roles, including health secretaries and Medicaid directors. These appointees need proven track records in managing large government teams and navigating complex legislative processes. Success depends on leaders who can build trust across partisan lines, hospitals, and community stakeholders during critical periods.
2Managing Medicaid Eligibility Shifts
Starting January 1, 2027, expansion states face new federal mandates requiring adults aged 19 to 64 to document 80 hours of work or service monthly. Governors must prepare for significant coverage losses driven by administrative paperwork rather than eligibility changes. Proactive management of these redetermination processes is essential to mitigate local impacts.
3Addressing Public Health Crises
With measles cases reaching record highs since 1991, governors must immediately review kindergarten vaccination rates by county. Establishing robust outbreak response plans, ensuring surge staffing capacity, and preparing crisis communication strategies are vital day-one tasks. Protecting public health status requires rigorous oversight and clear, actionable plans for when outbreaks inevitably occur.
4Ensuring Medicaid Program Integrity
Governors should anticipate increased scrutiny from the Centers for Medicare and Medicaid Services regarding program integrity. States must submit provider revalidation plans and ensure fraud units are fully resourced to prevent federal payment withholding. Treating program integrity as a top priority protects state budgets and maintains essential federal funding partnerships.
5Driving Meaningful Health Affordability
To provide immediate relief, governors should focus on capping out-of-pocket costs for high-use medications and reforming pharmacy benefit managers. Implementing medical debt protections and limiting facility fees can shield patients from excessive billing. Long-term affordability requires setting cost growth targets and utilizing state purchasing power to drive value-based payment models.
6Optimizing Rural Health Funding
States have received significant Rural Health Transformation Program awards, averaging 200 million dollars annually through 2030. Governors must avoid spreading these funds too thinly across too many initiatives. Instead, they should set measurable goals like maintaining emergency services and building regional referral networks to ensure long-term sustainability after federal funding ends.
7Regulating Artificial Intelligence Use
Governors should implement clear rules for AI investment, emphasizing disclosure, consent, and mandatory clinician review. By using Medicaid contracts to require reporting of outcomes, states can steer vendors toward tools that improve access. Initial pilots should focus on internal government functions like call centers to support the existing state workforce.
8Leveraging States as Laboratories
With a divided federal government, states must act as primary laboratories for health innovation. By aligning priorities across funding silos and focusing on actionable levers, governors can unlock untapped potential in insurance and social services. Delivering measurable results within two years is critical for sustaining public trust and improving family well-being.
Original article: STAT — Three Strategic Priorities for New Governors Leading State Health Policy