By Marnie Keogh, Senior Vice President, Marketing Reflections from the National Association of Medicaid Directors 2025 Conference: Challenges, Changes, and Opportunities Acentra Health returned from NAMD 2025 energized by the dedication of our nation’s Medicaid Directors and their teams. The conference, held November 18-21 at the Gaylord National Resort & Convention Center in Oxon Hill, Maryland, was the largest to date, giving us the opportunity to speak with many Directors. In a nutshell, here’s what we heard: the challenges brought on by market constraints will force them to change how they operate, giving them opportunities to do new things. Challenges At the highest levels, most states are dealing with significant challenges, and all agencies are feeling the pressure. Specifically, Medicaid agencies are struggling with: Funding Gaps: States are grappling with decreasing funding across many programs, at a time when inflation, tariffs, and medical costs are increasing. Medicaid agencies are looking at rate reductions, service limits, or elimination of optional benefits. Staff Shortages: Decreased funding has led to Medicaid agency staff reductions, leaving fewer people to do the same, if not more, work. New Requirements: Implementing H.R. 1 requirements and new rules from the Centers for Medicare and Medicaid Services (CMS) will tax already resource-strapped Medicaid agencies. Outdated Technology: Many Medicaid eligibility, claims, and other programs run on old hardware with software that is expensive and time-consuming to modify to meet new requirements. Systems are fragmented, making inter- and intra-agency data sharing difficult at a time when it’s needed the most. Heightened Expectations: States are expected to boost Medicaid program integrity with improved eligibility and auditing processes. Payment Error Rate Measurement (PERM) program scores were discussed at length. CMS also stressed the need for better health outcomes and long-term stability for bene