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Medicaid Directors Survey Reveals Top Priorities, Rapid Innovation, Key Challenges in $544 Billion Program
Medicaid Directors Survey Reveals Top Priorities, Rapid Innovation, Key Challenges in $544 Billion Program
The National Association of Medicaid Directors’ Fourth Annual Operations Survey reveals a large, complex Medicaid…
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted thisCall me biased but this is the best opportunity around for a proven HHS people leader with a knack for driving innovation in health care delivery and payment through strategic partnerships, data-driven decisions, and stakeholder engagement: https://lnkd.in/gFfVEU5y (posting closes 7/27, open to fed employees across the US Department of Health & Human Services)
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted this#NEW: ADVI Health is proud to announce expanded access to the monthly data feed across 100% of Medicare Parts A, B, and, D – unlocking a new level of speed, precision, and insight for our partners. With more timely data, our experts can identify emerging trends sooner, accelerate evidence generation, and provide clients with a clearer view of how utilization, treatment patterns, and policy-driven shifts are evolving. We’re turning complex healthcare data into actionable insights that help organizations stay ahead of change, demonstrate value faster, and make more informed decisions. Learn more about partnering with #ADVIHealth to turn data into impact: https://lnkd.in/euSidqaH
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted thisADVI Health is boutique by design, not by limitation. We often hear, "You're a boutique firm, right?" Yes, by choice. Our focus isn't on building the biggest teams or producing endless presentations. Instead, we prioritize clarity under pressure, candor with senior leaders, and teams that know how to lead a room. We're building the kind of firm we'd want advising us when the stakes are real. Ready to make an impact? Explore career opportunities at #ADVIHealth: https://lnkd.in/eQcR5ZwC
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted thisThe Medicaid unwinding did not return expansion enrollment to pre-pandemic levels. By June 2025: • Expansion enrollment: +21% • Traditional Medicaid enrollment: +7% The gap reflects the incentives built into Medicaid financing. https://t2m.io/dnSHyam
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted thisAs implementation of the #InflationReductionAct (IRA) continues to reshape drug pricing, a recent Health Affairs article references research from ADVI Health's strategic analytics, value and economics (SAVEs) solution team on the overlap between Medicare Maximum Fair Price (MFP) and 340B claims. The article explores the operational challenges created by overlapping pricing programs and what they mean for manufacturers, providers, and the evolving #Medicare landscape. Read the full article, "The Collision Of 340B Pricing And Medicare Drug Price Negotiation": https://lnkd.in/emdGm4AG
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted thisAlice L. Walton School of Medicine M2 student Emily Bunch was recently featured in the Journal of the Arkansas Medical Society as a student trustee. In this profile, she shares why she joined AMS and what drew her to pursue medicine. Read the profile on page 25 of the Journal’s Summer 2026 issue: https://lnkd.in/eHkitYYx Sharmila Makhija MD MBA #AWSOM #MedicalStudent #AMS #ArkansasMedicalSociety #Arkansas
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted thisI am incredibly excited to share an opportunity to join our Medicaid leadership team here in Delaware. Being a Deputy Medicaid Director is an enormously rewarding experience, touching so many lives (nearly a quarter of the state!) and providing access to life-changing and -saving services. Please share and consider applying! https://lnkd.in/gMGvxjpFDeputy Principal Assistant (Deputy Medicaid Director)Deputy Principal Assistant (Deputy Medicaid Director)
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Kip Piper, MA, FACHE reposted thisKip Piper, MA, FACHE reposted this🚨 NEW PAPER OUT NOW 🚨 We estimate that 9.2 million Medicaid expansion enrollees—nearly half (46%)—were likely ineligible for the program in 2024. That is an 88% increase from the 4.9 million improper enrollees estimated for 2019. The fiscal consequences are severe. We estimate that improper expansion enrollment cost the federal government approximately $32.9 billion in 2024—about 6 percent of all federal Medicaid spending. California alone accounts for $10.4 billion in federal costs. https://lnkd.in/eFCPVZSYMedicaid Expansion’s Growing Improper Enrollment Crisis: Nearly Half of Expansion Enrollees Likely Do Not Meet Eligibility RequirementsMedicaid Expansion’s Growing Improper Enrollment Crisis: Nearly Half of Expansion Enrollees Likely Do Not Meet Eligibility Requirements
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Kip Piper, MA, FACHE reposted thisWho’s interested?Kip Piper, MA, FACHE reposted thisND Health and Human Services is hiring a Medicaid Director! Come work with us! 🤩 This is one of the most consequential roles in state government. Medicaid touches more than 105,000 North Dakotans, from kids getting well-child visits to seniors receiving long term care to rural families who count on it as their only coverage. The person in this seat helps decide how that works. We are looking for someone who can hold two things at once: the technical depth to navigate federal authority, waivers, and rate setting, and the judgment to keep sight of who is on the other end of every policy decision. Prior Medicaid experience matters. So does curiosity, steadiness, and a willingness to say what you actually think. You would join a team that is doing real work right now on rural health transformation, behavioral health access, and long term care sustainability. There is no shortage of hard problems and no shortage of people who want to solve them. If that sounds like you, or like someone you know, take a look below! Please share!
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on this340B covered entities are seeing their 340B net profits shrink as list prices fall. But it's not just 340B monetizing the GTN bubble. --- 340B Report just quantified how the IRA and other new federal policies are squeezing 340B margins nationally. The ten IRA-negotiated Part D drugs already account for about 30% of the entire Part D market, and more join the list every year, including Medicare Part B drugs starting in 2028. Multiple providers in the article mention higher 340B purchasing prices and therefore lower margins on these drugs. Health centers are feeling it more than hospitals right now, since Part D drugs make up a bigger share of their drug dispensing. --- The mechanism is straightforward once you follow the math. (More math can be found here: https://drugch.nl/45zrjZa ) A drug's 340B ceiling price only hits a penny when Medicaid's inflation penalty pushes it low enough, and slower list-price growth (or list price reductions) means smaller penalties. The 2021 American Rescue Plan Act removed the cap on that inflation penalty starting in January 2024, which changed the math for manufacturers further. On top of that, IRA Medicare price negotiation, MFN deals, and PBM reform are all separately pushing manufacturers toward cutting WAC directly instead of just discounting off it. A lower WAC narrows the gap between market price and the 340B ceiling price=lower 340B margin. --- This is the Net Pricing Drug Channel #NPDC: the entire gross-to-net bubble deflating, not just the chunk that funds 340B. Background 👉🏻 https://drugch.nl/3RH2uaC 340B might be the most visible casualty because it's the second largest drug program, but it's not the only model built on monetizing GTN. ↳ PBMs negotiate rebates as a percentage of list price ↳ Net plan liability is lower with high GTN as patients pay cost sharing based on list prices ↳ Wholesalers and retail pharmacies earn margin off WAC-based reimbursement spreads Every one of those margins thins out as list prices fall toward net. What are you doing to prepare for the NPDC? 🔗 Source: 340B Report https://lnkd.in/eagDZbjp ♻ Repost to share why falling list prices squeeze 340B margins 🔔 Follow me for more on the Net Pricing Drug Channel (Bryce Platt, PharmD)
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on thisI’m excited to share that today I begin a new chapter at Iowa HHS as System Strategy Owner in the Medicaid Bureau of Data Governance & Systems Coordination. In this role, I’ll help shape and lead Iowa Medicaid’s data and technology strategy, guiding modernization planning, aligning systems with broader HHS and state enterprise goals, and ensuring our technology work supports strong outcomes for the Iowans we serve. I’m deeply grateful for the opportunity to continue contributing to work that makes a real difference in people’s lives. I’m energized to keep building on the foundation I've made over the last two years and to continue this adventure alongside the many wonderful colleagues I’ve had the privilege to work with at Iowa HHS. Looking forward to what’s ahead! #IowaHHS #Medicaid #PublicService #Iowa
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on thisThe New York Times gets Obamacare wrong. Taxpayers now cover more than 80% of ACA exchange premiums, improper enrollment remains widespread, and Medicaid spending is still rising. Read Paragon’s new Prognosis: https://lnkd.in/ejc8EqssWhat The New York Times Gets Wrong About ObamacareWhat The New York Times Gets Wrong About Obamacare
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on thisLast week marked the fourth anniversary of the #InflationReductionAct (IRA) becoming law — and its impact on #Medicare and cross-payer market access continues to evolve. As ADVI Health wraps the third cycle of Medicare drug price negotiations and prepares for the fourth, our experts are preparing for what's on the horizon and helping clients stay ahead. Connect with our #ADVIExperts to understand what's next for #IRA and now to prepare: https://lnkd.in/ei_W6_2X
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on thisI’m very excited to announce that I started a new role as Principal Analyst with MACPAC - Medicaid and CHIP Payment and Access Commission this week! I’m grateful for this opportunity to lead behavioral health policy development in areas that are critical to the Medicaid and CHIP populations and continue to advance access to care for individuals and families across the country.
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on thisCalifornia alone accounts for roughly one-third of all improper Medicaid expansion enrollment nationwide: an estimated 3.1 million ineligible enrollees, a 62% ineligibility rate, and $10.4 billion in improper federal spending in 2024. 📊 http://ow.ly/LfMb30sY6no
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on thisContinental Strategy was delighted to host Jarrod Agen, Executive Director of the White House National Energy Dominance Council, in mid-August for a wide-ranging, high-level conversation on the Administration’s global energy priorities including regeneration of the energy sector in Venezuela. The meeting was another outstanding opportunity to visit with senior government officials as part of Continental Strategy’s ongoing series of by-invitation engagements with political, policy, and business leaders. For additional information about these events and to identify how we can most effectively support your interests in Washington and around the world, please contact us at continentalstrategy@continentalstrategy.com. And don’t forget to give us a follow to stay up-to-date on our full suite of activities!
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Kip Piper, MA, FACHE reacted on thisKip Piper, MA, FACHE reacted on thisHealth Care Spending, Government Control, and Medicare for All’s Return This week’s Paragon Health Institute newsletter covers Medicare for All’s return to the national political conversation, health care spending outpacing economic growth, and the IRA’s Medicare Part D redesign proving far more expensive than Congress anticipated. 🔵 Medicare for All Returns Abdul El-Sayed’s win in Michigan’s Democratic Senate primary has put Medicare for All back into the national political discussion. An analysis by former Paragon research fellow Theo Merkel and Paragon public advisor Steve Parente estimated that then-Senator Kamala Harris’s Medicare for All proposal would increase federal spending by roughly $44 trillion over its first decade. Medicare for All would ultimately lead to lower-quality health care because government would increasingly determine how health care resources are allocated. For example, Medicare’s near-monopoly over dialysis financing has created a delivery system that relies far more heavily on dialysis and far less on kidney transplantation and home-based therapies than many peer nations. 🔵 Health Care Spending Continues to Outpace the Economy CMS’s latest National Health Expenditures projections show national health spending growing at more than 7 percent annually—about two percentage points faster than GDP—and exceeding one-fifth of the U.S. economy early in the next decade. Much of this growth reflects expanding federal involvement. Medicaid enrollment surged during the Biden administration because of pandemic-era continuous eligibility requirements, ACA subsidy expansions, and widespread improper enrollment, while states increasingly exploited financing arrangements such as Medicaid state-directed payments to draw down more federal matching funds. 🔵 Medicare Part D’s Costs Continue to Escalate New analysis from the Committee for a Responsible Federal Budget projects the IRA’s Part D redesign will cost taxpayers roughly 10 times CBO’s original estimate. The redesign significantly increased total premiums and spending—with the greater burden borne by future taxpayers through more federal debt. The Biden administration compounded these costs through its temporary Part D Premium Stabilization Demonstration, a blatantly political bailout program that transferred billions of additional taxpayer dollars to insurers in advance of the 2024 election to suppress visible premium increases. The Trump administration was right to end it rather than extending yet another costly federal bailout. Read the full newsletter here: https://lnkd.in/eX5MpvJPHealth Care Spending, Government Control, and Medicare for All’s ReturnHealth Care Spending, Government Control, and Medicare for All’s Return
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Kip Piper, MA, FACHE liked thisKip Piper, MA, FACHE liked thisExcited to share that we are currently recruiting for a Director of Government Affairs to join my team at ASTHO!
Experience & Education
Licenses & Certifications
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Fellow of American College of Healthcare Executives
American College of Healthcare Executives
Issued Expires
Volunteer Experience
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Member
Virginia Health Benefit Exchange Advisory Committee
- Present 2 years 3 months
Health
Appointed by Governor Glenn Youngkin in July 2024. The committee advises the State Corporation Commission (SCC) and the exchange director on the Commonwealth’s state-run health insurance marketplace. The marketplace is the Commonwealth’s own state-based health insurance marketplace where consumers can shop for, compare, and purchase high-quality and affordable health insurance plans. Learn more at http://marketplace.virginia.gov/
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Editorial Board Member
American Health and Drug Benefits Journal
- Present 20 years 10 months
Health
American Health & Drug Benefits (AHDB) is an independent, peer-reviewed professional journal providing original contributions in the areas of health economics, health services research, health policy, medical coverage decision making, and health insurance benefit design. To advance value-based health care, the journal translates research findings into actionable information decision makers need to devise benefit designs and determine coverage of drugs, biologics, other therapies, and…
American Health & Drug Benefits (AHDB) is an independent, peer-reviewed professional journal providing original contributions in the areas of health economics, health services research, health policy, medical coverage decision making, and health insurance benefit design. To advance value-based health care, the journal translates research findings into actionable information decision makers need to devise benefit designs and determine coverage of drugs, biologics, other therapies, and diagnostics. Because benefit designs and coverage decisions are greatly affected by clinical, business, and policy conditions, the journal offers a forum for multi-stakeholder, multi-disciplinary collaboration. Kip Piper is a frequent contributor and a member of the editorial board of American Health & Drug Benefits. Learn more, read online, or subscribe at www.AHDBonline.com.
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Advisory Board Member
National Institute of Collaborative Healthcare
Health
The National Institute of Collaborative Healthcare (NICH) is at the leading edge of intelligence-driven, proactive implementations of employer-sponsored and self-funded commercial health risk management solutions for population health outcome success. Learn more at www.nich-online.com.
Publications
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The Affordable Care Act and Cancer Patients: Winners and Losers in an Unsteady Paradigm Shift
Personalized Medicine in Oncology
See publicationHow implementation of the Affordable Care Act (ACA) brings new rules of engagement for cancer patients and their oncologists. First of a 2-part article by Kip Piper.
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The Affordable Care Act Conundrum: Facing Reality in America’s Giant Social Experiment
American Health & Drug Benefits
See publicationImplications of Affordable Care Act (Obamacare) for consumers, health insurers, and pharmaceutical and biotechnology firms. Meltdown of current individual health insurance market. Implications for Medicaid. Lessons from failed implementation of ACA health insurance exchanges and new regulatory framework. Commentary by Kip Piper.
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Implications of the Employer Mandate Delay on the Healthcare Marketplace
American Health & Drug Benefits
Commentary on the employer mandate under the Affordable Care Act, the Obama Administration’s decision to delay the enforcement of the ACA employer coverage and reporting requirements until CY 2015, and implications of the delay for Health Insurance Exchanges, state Medicaid programs, employers, and health plans.
Other authorsSee publication -
The Opportunity for Health Plans to Improve Quality and Reduce Costs by Embracing Primary Care Medical Homes
American Health & Drug Benefits
Examines health plan use of patient-centered, primary care medical homes. Recommend six steps health plans may use to take advantage of the opportunity to embrace medical homes as a means to improve healthcare quality and to reduce costs. For more information, visit KipPiper.com and PiperReport.com blog.
Other authorsSee publication -
Medicare Part D: Considerations for Urology Practices
Urology Practice Management
See publicationHow urology practices can help their Medicare patients by familiarizing themselves with Part D plans, benefit designs, and formularies in their respective service areas. Article by Kip Piper.
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Accountable Care Organizations and Medicare Shared Savings Program
American Health & Drug Benefits
See publicationPrimer on the Medicare Shared Savings Program and Accountable Care Organization option created under the Affordable Care Act. For more, visit www.KipPiper.com
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Accountable Care Organizations: Interview with Mark B. McClellan, MD, PhD.
American Health & Drug Benefits
See publicationKip Piper interviews Mark B. McClellan, MD, PhD, former administrator of the Centers for Medicare and Medicaid Services (CMS), about Medicare Accountable Care Organizations (ACOs). For more, visit www.KipPiper.com
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The Health Reform Law: Key Changes to Be Implemented in 2010
American Health & Drug Benefits
See publicationAn overview of the key changes in Medicare, Medicaid, and health insurance regulation in 2010 under the federal health reform law (Affordable Care Act). For more, visit www.KipPiper.com
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MediStrategy
Podcast on Medicaid, Medicare, and Health Reform
See publicationMediStrategy podcast covers hot business and policy issues in Medicaid, Medicare, and Affordable Care Act. Interviews with leaders and experts. Insights on health policy, finance, and business strategy. Hosted by Kip Piper. Available free on iTunes, most smartphone "podcatcher" apps, and on web at www.kippiper.com.
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Piper Report
Blog on Health Reform, Medicare, and Medicaid
See publicationKip Piper's blog on Medicare, Medicaid, and health reform. Covers range of hot topics in health policy, finance, and business. On the web at www.PiperReport.com.
Organizations
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American College of Healthcare Executives
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Professional society of healthcare executives, including health system, hospital, and health plan executives. www.ache.org
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Association of Certified Fraud Examiners
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Professional society of experts in fraud detection and investigation. www.acfe.org
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Association of State and Territorial Health Officials
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Professional association of state public health agency executives and former state health officers. www.astho.org
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Healthcare Financial Management Association
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Healthcare Financial Management Association (HFMA) is the professional society for healthcare financial management executives. www.hfma.org
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National Association of Medicaid Directors
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Association of State Medicaid directors and former Medicaid directors. www.medicaiddirectors.org
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