Supporting State Efforts to Address Healthcare Challenges

Reflections on the Governors’ Health and Human Services Policy Advisors Institute 2022

In the Fall of 2022 the National Governors Association Center for Best Practices (NGA Center) hosted Governors’ Health and Human Services Policy Advisors in Greensboro, North Carolina. Joined by state officials and subject matter experts, advisors discussed emerging topics relevant to both health and human service policy portfolios. Sessions at this meeting included topical discussions on the healthcare workforce, trauma-informed care and adverse childhood experiences (ACEs), and the implications for healthcare coverage of the unwinding of the public health emergency. The session topics were selected to provide support and resources for Governors and their staff in serving their constituents on these topics. The Healthcare Delivery team at NGA spent much of 2022 focused on these three important topics as a result.

Healthcare Workforce: Current National Challenges and Highlights from NGA’s Next Generation of the Healthcare Workforce Project

The NGA Center provided a preview of the innovative work states are doing related to the NGA Center’s Next Generation of the Healthcare Workforce project. Dr. Shelby Hockenberry, Program Director for Healthcare Delivery at the Center, gave an overview of the project and structure. Four Learning Collaborative states participated in an intensive technical assistance period with NGA that included strategic planning and goal setting, as well as monthly check-ins with NGA staff. Due to the level of interest in the project, NGA also convened a Knowledge Exchange Network of 16 states that were able to attend a webinar series, access NGA’s Healthcare Workforce Toolkit, and receive technical assistance to support their independent action planning. All states participating in the project had access to the webinar series and limited access toolkit.

Jen Davis, Health and Human Services Policy Advisor in the Wyoming Governor’s Office, highlighted efforts in the state to support the healthcare workforce as a part of NGA’s Learning Collaborative. Davis spoke about challenges faced by the healthcare workforce in Wyoming and how the COVID-19 pandemic exacerbated issues, including workforce shortages, burnout experienced among healthcare workers, workforce pipeline challenges and planning, and specific challenges related to healthcare delivery in rural and specialized care settings. Davis then highlighted her state’s action plan, developed as part of the Learning Collaborative. The state project teams subsequently met in October 2022 in Santa Barbara, California,to share outcomes from the first year of programming, engage in peer discussions, participate in learning sessions, and plan for year two of the project.

Adverse Childhood Experiences, Trauma, and Resilience: Best Practices from the State Trauma and Resilience Network

Another session hosted speakers spanning both state and national perspectives. Dr. Christopher Jones, Acting Director of the Injury Prevention and Control Center at the Centers for Disease Control and Prevention (CDC) highlighted the agency’s efforts in both preventing and responding to Adverse Childhood Experiences (ACEs), as well as their unique approach to youth violence prevention. After setting the stage from a national perspective, two states from the NGA State Trauma and Resilience Network (STRN) highlighted their work on this issue. Laurie Crawford, Director of the Virginia Office of Trauma and Resilience Policy, talked about standing up the office and their goals and activities moving forward to address trauma, resilience, and ACEs in Virginia. North Carolina highlighted their innovative state model of including individuals with lived experience in statewide decision-making. Lisa Cauley, Senior Director for Child, Family and Adult Services, and Adrian Daye, Deputy Director of Child Welfare Practice, talked about the North Carolina Division of Social Services’ Stakeholder groups: the Child Welfare Family Advisory Council, Strong Able Youth Speaking Out, and Foster Family Alliance of North Carolina. Barbara Young, Family Partner on the Child Welfare Family Advisory Council, also highlighted her role providing support as a member of the council from a parent’s perspective. The State Trauma and Resilience Network will release a publication in early 2023 on state efforts related to trauma-informed care and resilience that will update a 2021 report titled State Strategies to Prevent and Mitigate Adverse Childhood Experiences, which highlighted best practices in the NGA ACEs Learning Collaborative.

Unwinding the Public Health Emergency: Implications for Marketplace Coverage

To support state efforts to ensure individuals have continued access to health care coverage, NGA hosted a session focused on the unwinding of the public health emergency (PHE) and implications for insurance coverage.  Moderator Clay McClure, Executive Director of State Affairs at Blue Cross Blue Shield Association, provided the perspective from health plans and shared the work that plans are doing to be ready, including supporting states through data collections and aligned communications. Lindsay Lang, the Director of HealthSource RI, Rhode Island’s State Based Marketplace, highlighted strategies that help reduce the number of uninsured Rhode Islanders as well as best practices to mitigate coverage loss during the unwinding of the emergency. Lang spoke about Healthsource RI’s “Auto-Enrollment” program, which auto-enrolls those under 200% of the Federal Poverty Line (FPL) in a health insurance plan. As millions nationally could be determined ineligible for Medicaid when the PHE ends, Rhode Island’s innovative initiative is one-way states are working to mitigate the potential loss of coverage by connecting citizens to marketplace plans.

Looking Ahead to 2023

Participants left the Institute having heard from Governors’ advisors, subject matter experts, and NGA partners on a wide variety of topics that impact Governors’ health and human services priorities. The NGA Healthcare Delivery team remains focused on these critical topics through the next year, while adding additional programming focused on areas that Governors and their staff identify as important priorities. Through learning collaboratives, webinars, convenings, commentaries, and technical assistance, NGA will remain focused on supporting the healthcare delivery needs of Governors and their staff. For more information on program material centered around healthcare delivery, click here. To read about the Public Health focused sessions, click here.

This article was developed by Elijah McCabe, NGA Center for Best Practices. For more information on Governors’ HHS efforts please contact