By Verlon Johnson, Executive Vice President & Chief, Government and Corporate Affairs, Acentra Health
LinkedIn: Verlon Johnson
LinkedIn: Acentra Health
Medicaid is more than statutes and systems. It is a living promise to children, families, older adults, and people with disabilities – people whose health and stability depend on whether we translate our best ideas into daily practice. I have sat with caseworkers stretched thin and with program leaders balancing spreadsheets against human stakes. And I have met parents who bring a folder of notes to every appointment because the system forgets what they cannot afford to. Our charge is not abstract. It is profoundly practical: to make this promise work reliably and respectfully every single day.
Without a doubt, Medicaid has always been about progress; sometimes incremental, sometimes bold. States have pushed forward modernization, workforce supports, and oversight with persistence and grit. What we are seeing now is momentum building across the board. This is not the start of Medicaid’s transformation, but the point where years of investment and ideas are gaining real traction. We are moving, together, from talk to traction.
I witnessed the shift from aspiration to action firsthand this year at MESC 2025 and HCBS 2025 – two gatherings that brought together the people and partners who make Medicaid work, not in theory, but in reality. These conferences weren’t about introducing new ideas for the sake of novelty. They were about showing where progress is finally sticking, where policy meets practice, and where states are beginning to see results from years of groundwork.
This is what traction looks like, and it’s worth examining more closely.
What Traction Looks Like
Traction is not just about new rules or tools. It is about leaders pairing ambition with guardrails, and urgency with dignity. It is about systems and services pulling in the same direction. And it is about a workforce with the tools and time to do hard things well and the breathing room to do them right.
I have learned that when Medicaid changes, it changes at three levels at once: the system, the service, and the standard we set for ourselves. From what I’ve seen this year, three imperatives define the work ahead.
1) Implement at Scale – with Guardrails
States are scaling what works faster. That momentum is good, but it must be matched with the discipline to make sure “faster” does not become “looser.”
Across the country, we are seeing the power of reuse and modular design. For states, this means learning from one another rather than rebuilding the same wheel fifty times over from scratch. Washington’s focus on reuse reflects this spirit: smarter architecture that strengthens integrity while reducing burden. Arizona’s real-time fraud analytics show how data, handled responsibly, protects scarce resources so they reach the people who need them.
As we apply AI and advanced analytics, we must move just as carefully. The Safe AI in Medicaid Alliance (SAMA), launched this year with support from Acentra Health state partners and other industry leaders, is one example of how to do this well. By aligning with recognized risk management frameworks, the alliance builds guardrails at the same time as it advances real-world use cases. This is how we keep pace with innovation while ensuring trust with the public.
2) Lead with Accountability – and Dignity
Accountability in Medicaid cannot be confined to dashboards. It has to be felt by the people we serve. Nowhere is this clearer than in home- and community-based services (HCBS), where oversight is not a bureaucratic exercise but a safeguard of dignity. West Virginia’s modernization of incident tracking shows how good oversight prevents harm and builds trust for vulnerable populations.
Accountability also means telling the truth about capacity. We ask case managers, assessors, and program staff to work miracles with limited tools. The result is moral injury on the front lines and delays for families. Implementation with dignity means investing in the workforce as intentionally as we invest in systems: agile, more usable tools, fewer redundant steps, clear escalation paths when the system falters. If the measure is whether people can get consistent, respectful help when they need it, then user experience is accountability, and we should treat it that way.
Accountability also extends to how we coordinate care across transitions. Whether from hospital to community, community to nursing facility, or reentry for juveniles and adults, Medicaid’s responsibility is to make sure people do not fall through the cracks. Strong assessments, evidence-based services, and selective use of prior authorization keep people connected to the right supports at the right time. Here, responsible use of AI can be transformative, helping states and their partners become more predictive, more efficient, and ultimately more humane.
3) Build the Future Through Partnerships That Last
Medicaid has never been a solo act. States, federal partners, vendors, community organizations, managed care plans, and advocates all carry pieces of the solution. The thread running through the most promising work today is a partnership that connects technology with care, compliance with compassion, and efficiency with equity.
The most effective partnerships are those that bridge transitions between clinical and community settings, between correctional facilities and neighborhoods, and between short-term treatment and long-term supports. This spirit powers national collaborations like SAMA and local efforts to stabilize the direct care workforce, expand behavioral health access, and strengthen transitions across care settings. When we align incentives and share what works, we build a foundation others can stand on.
In my role at Acentra Health, I see this every day. Durable progress comes when systems and services are integrated, when analytics and modernization are linked with oversight and care quality. That is how we make sure innovation never loses sight of accountability.
A Practical Near-Term Agenda
If you lead a Medicaid program today, you are balancing transformation on one hand and a thousand daily operational pressures on the other. You do not have time for rhetoric. So here is a practical near-term agenda, drawn from what I see working:
- Name your guardrails. Publish your AI and advanced analytics principles. Align with a recognized risk management framework. Make governance visible so staff and stakeholders know how decisions are made.
- Double down on reuse. Ask which modules, integrations, or oversight tools you can adapt rather than rebuild. The goal is not just speed—it is steadiness and integrity.
- Make oversight human-centered. Treat incident reporting, waiver monitoring, and managed care oversight as design problems, not just compliance tasks. If the tools are usable, accountability will follow.
- Invest in the workforce’s time. Every minute you give back by simplifying a workflow is a minute returned to a member. Track it as a performance metric.
- Choose one cross-sector problem to solve together. Whether it is behavioral health access, carceral-to-community transition, or social determinants of health linkages, pick a problem where shared data and shared accountability can move the needle within a year. Then publish what you learn so others can use it.
Seize the Moment
I have spent my career moving between policy rooms and program floors. The distance between them is shorter than we think when we insist on results we can see, measure, and explain. The promise of Medicaid is made real not by what we say at conferences but by what we build and sustain, safely, fairly, and at scale.
This is our moment for traction. Let’s seize it with the discipline to do hard things well, and the humility to do them together.