Medicaid Transformation: Expanding Access for Complex Populations

Seizing a Historic Opportunity for Medicaid

Shifts in Medicaid program structure – such as new delegation agreements and the consolidation of multiple plans – present both challenges and opportunities for health systems. For this organization, experience in managed care was only the starting point. Expanding into long-term services and supports (LTSS) required entirely new clinical, technical, and operational capabilities.

With aggressive deadlines, heightened compliance expectations, and a mandate to improve access and outcomes, the stakes were high. Success demanded disciplined cross-functional collaboration, clear decision-making structures, and targeted external expertise. This was never just about meeting contract requirements, it was about building a durable foundation to serve vulnerable populations in new and more effective ways.

Orchestrating Alignment for Rapid Execution

Execution began with governance and establishing an enterprise-wide structure rooted in seven dedicated workstreams, staffed by senior leaders, subject matter experts, and external advisors. These teams locked in roles, decision authority, and escalation paths, ensuring accountability across the enterprise.

Each workstream focused on a critical area of success: network contracting, member experience, compliance, IT, and clinical operations. Regular cross-team huddles, weekly progress reviews, and embedded real-time issue tracking kept the effort agile and responsive. Leadership sponsorship was hands-on, removing barriers and driving alignment across internal stakeholders, state agencies, and plan partners.  Key phases included:

• Planning & Analysis – Defined requirements, closed compliance and staffing gaps, and engaged stakeholders in program design.
• Governance & Alignment – Built governance frameworks, coordinated partners, and synchronized delivery across functions.
• Product Launch & Readiness – Prepared teams, regulators, and partners for go-live; expanded services for diverse populations; and ensured immediate access to advanced care.
• Closure & Transition – Created a phased roadmap and ensured smooth handoffs for long-term stability.

This disciplined structure provided both speed and consistency, enabling the organization to move from strategy to execution under tight deadlines.  Freed worked in close partnership with the health system to translate strategy into execution. By aligning leadership, coordinating across workstreams, and maintaining strong oversight, Freed helped minimize risk and keep the launch on track.

Delivering Measurable Impact

The effort culminated in the successful launch of Medicaid long-term services and supports. The results were astounding, delivering measurable compliance achievements, operational readiness, and member benefits.  Key outcomes included:

• Met 250+ contract requirements.
• Executed 20+ provider and vendor contracts.
• Built 20+ secure file transfers.
• Operationalized 100+ policies, procedures, and reports.
• Added and retained 700+ members annually.

Beyond operational achievements, the true measure of success is the impact to members’ daily lives.

Putting Members at the Center

For many, the launch meant immediate access to care coordinators who could help navigate their care needs. Members with complex medical needs could now be connected to providers prepared to deliver high-touch, integrated care. Families caring for loved ones gained relief and greater confidence that services would arrive on time and consistently. These human outcomes highlight the deeper purpose of the transformation: not only meeting regulatory requirements, but enhancing dignity, stability, and health for people who rely on Medicaid as their lifeline.

Building Scalable Foundations for Growth

The program launch created capabilities that extend well beyond compliance. More than 30 functional areas were engaged to expand services, strengthen care models, and reinforce clinical and operational infrastructure. Processes, job descriptions, and compliance workflows were deliberately designed for reuse, while contracting strategies and provider networks developed for Medicaid expansion can now support additional product lines. Technology platforms were also structured for adaptability, accelerating implementation of dual-eligible programs and value-based care models.

By designing with scalability in mind, the organization ensured each investment created compounding value shortening timelines, lowering risk, and positioning the plan to respond quickly as new opportunities and regulatory changes emerge. These strengths became even more critical as Medicaid policy entered a period of accelerated change.

Navigating a Shifting Medicaid Landscape

States are consolidating plans, tightening oversight, and moving steadily toward value-based payment models. For health systems, the ability to adapt quickly to new requirements has become a competitive necessity. Expanding into long-term services and supports underscored the need for scalable infrastructure capable of absorbing new populations and meeting evolving standards of care. By investing early in governance, scalable systems, and member-centered processes, the organization positioned itself not only to comply with today’s mandates but also to thrive in tomorrow’s Medicaid landscape.

Setting the Stage for Repeatable Innovation

This engagement demonstrated that large-scale Medicaid transformation can succeed when governance, execution discipline, and member impact remain at the center. The organization now has a framework for market expansion that is not only scalable but also repeatable enabling it to deliver advanced care, integrate new populations, and sustain growth across an evolving healthcare landscape.