Partnerships Are Key to Improving Population Health

Overview

Public health and Medicaid agencies have a shared goal of improving the health of their populations. Strong partnerships between these agencies can drive meaningful improvements in both healthcare delivery and evidence-based prevention strategies. While these agencies differ in operational structures and purpose—Medicaid provides access to health care for enrollees on an individual basis, and public health focuses on population health and upstream interventions that target the root causes of health problems—their complementary expertise serves overlapping populations. This creates opportunities for strategic collaboration that maximizes personnel and financial resources to advance mutual state priorities. By sharing data, resources, and expertise, these collaborations enable more proactive responses to population health challenges, such as chronic disease management and maternal health. Together, Medicaid and public health agencies create a more efficient, coordinated healthcare system that can improve policies and population health.¹

With support from The Pew Charitable Trusts, the Center for Health Care Strategies (CHCS) conducted research to better understand how partnerships between state Medicaid and public health agencies work to improve population health. From April through December 2025, CHCS facilitated 20 individual and group interviews with state Medicaid and public health leaders across the country to gather their perspectives. This report presents key insights from that research to help states develop and sustain long-term, effective public health-Medicaid agency partnerships. The report also examines how these partnerships influence policies and programs, highlights the limited but emerging evidence on population health outcomes, and distills lessons that states can use to build and strengthen their own partnerships. In addition, 14 state case studies illustrate how public health-Medicaid agency partners are successfully working to address shared priorities.

This research yielded key takeaways:

• States are already building partnerships between Medicaid and public health agencies, usually in small or ad hoc ways.
• Data sharing is often at the center of these partnership efforts, providing a better picture of the health needs of a population and helping agencies target efforts and resources.
• While current partnerships have successfully supported the work of both Medicaid and public health agencies on a range of health issues, barriers—such as differing agency priorities, operational barriers to data sharing, and staff turnover that affects the sustainability of partnership efforts—remain.
• States interested in bolstering their partnership efforts can draw on the case studies in this report and identify opportunities to apply these approaches within their own state.

Why collaboration is key

Partnerships between state Medicaid and public health agencies can help improve policies, programs, and initiatives related to chronic and infectious disease, maternal and child health, behavioral health, and other population health concerns.¹⁷ Such collaboration can also strengthen data and monitoring efforts aimed at reducing health disparities and improving population health outcomes.¹⁸ Sharing public health data—such as information in vital records and immunization databases—along with Medicaid claims and enrollment data provides states with greater insight into the populations they serve and the ability to more effectively implement initiatives to address health needs and gaps.¹⁹

Over the past several years, organizations including the National Association of Medicaid Directors and the Association of State and Territorial Health Officials have developed resources to support collaboration between Medicaid and public health agencies.²⁰ In fall 2024, Pew launched its state health solutions project to further support state Medicaid and public health officials and policymakers in establishing long-term, data-driven partnerships.

To inform this work, CHCS conducted interviews with 44 representatives from Medicaid and public health agencies in 14 states from April to December 2025, focusing on current and past partnerships between the two agencies.²¹ States were identified through responses to a nationwide questionnaire (see Appendix A for project methodology). Interviewees included department leadership and staff working in program, policy, data, and communications roles. A map of participating states is in Figure 1. Interviewees were selected to reflect diversity in geography, agency structure (e.g., Medicaid and public health agencies housed within the same or different agencies), and political context.

Advance Health & Well-Being How Public Health-Medicaid Partnerships Can Improve Outcomes

Article

While Medicaid and public health agency partnerships can support health improvement efforts across multiple healthcare issues, interviews primarily focused on maternal and child health; chronic disease; behavioral health; and workforce planning and support. Other topics discussed included immunizations, environmental health, cancer screening and referrals, and reproductive health.

This report outlines key findings from the interviews and shows how Medicaid and public health agencies develop productive partnerships and data-sharing strategies. It explores several aspects of partnerships, such as characteristics that shape the operations of public health and Medicaid agencies across states; infrastructure that supports cross-agency collaboration; common data-sharing practices; facilitators and barriers to partnership; and the impact of partnerships on state policies, programs, and population health. Case studies for each state highlight partnership and data-sharing details as well as key takeaways. The perspectives shared can support states looking to establish and strengthen partnerships between their own Medicaid and public health agencies.

Key interview themes

Medicaid and public health officials highlighted the variety of ways that cross-agency partnerships have contributed to changes in policies, programs, and population health outcomes. They also shared lessons on building and sustaining partnerships, including approaches to collaboration, facilitators and barriers, and factors that supported partnership success. Key themes from these discussions are detailed below and include the impact of public health-Medicaid partnerships and the approaches and conditions that supported them.

The impact of partnership

Partnerships between Medicaid and public health agencies can shape policies and programs by expanding access to high-value services, supporting the implementation of new programs, and strengthening evaluation efforts. Interviewees described a range of benefits associated with these partnerships. The examples below illustrate key outcomes of public health-Medicaid agency partnerships—including state-specific examples—and their influence on policies, programs, and population health.

• Increasing access to high-value services. Direct benefits from Medicaid and public health partnerships include adding new high-value services proven to improve health significantly at a reasonable cost, which can be reimbursed by Medicaid. For example, states can use legislation or Medicaid policies and programs to expand the number and types of providers able to offer reimbursable services. Massachusetts’ Medicaid (MassHealth), for example, enrolls doulas and reimburses them for services provided to Medicaid members, and the public health agency (Department of Public Health) funds workforce development and certification of doulas. Partnerships can also improve use of high-value services and increase enrollment in programs. For example, Tennessee Medicaid (Division of TennCare) and public health (Department of Health) agencies partnered to invest in supporting rural providers and organizations in the form of grants to help increase access to healthcare services.²²
• Strengthening community and provider engagement. Medicaid and public health agencies have leveraged their partnerships to jointly coordinate public communication campaigns and messaging, provider education, and stakeholder engagement. New Jersey’s public health agency (Department of Health) worked with Medicaid (Division of Medical Assistance and Health Services) to create a public information campaign that created greater awareness of the types of Medicaid-covered tobacco cessation services. Similarly, Arkansas’ public health and Medicaid agencies (Department of Health and Department of Human Services, respectively) partnered to analyze data on timing for first maternity care visits and attendance at perinatal appointments. This led the agencies to create a targeted statewide messaging campaign to inform members about when, where, and how to access maternity care. Massachusetts agencies collaborated on a public messaging strategy to help people stay enrolled in Medicaid at the end of the COVID-19 public health emergency. Through this effort, the state’s Medicaid and public health agencies worked together to connect with Medicaid beneficiaries, presented together to local organizations, coordinated with other state agencies, and extended the reach of their public messages to help Medicaid enrollees at risk of losing coverage understand how to maintain their enrollment.
• Advancing quality improvement efforts. Another benefit of public health-Medicaid agency partnerships is the joint implementation of new areas of focus or evaluation within Medicaid, such as new quality measures using a value-based payment (VBP) model—which pays for high-quality healthcare outcomes rather than individual services—or adoption of new state or department-wide goals. Idaho public health (Division of Public Health), Medicaid (Division of Medicaid), and behavioral health agencies partnered to inform a statewide suicide prevention initiative. As part of this effort, Idaho Medicaid increased the number of depression screenings by adding the measure to its VBP program.
• Implementing evidence-based strategies to improve health outcomes, including social drivers of health such as access to food and transportation. While many impacts on population health are difficult to attribute solely to partnerships, Medicaid and public health agency collaborations can contribute to improvements in maternal and child health, substance use disorder (SUD), mental health, chronic disease, tobacco cessation, and other outcomes, such as cost. For example, North Carolina’s Healthy Opportunities Pilots used Medicaid funding under a 1115 waiver (a policy tool that allows Medicaid agencies to seek federal government approval to innovate and improve Medicaid services) to address nonmedical drivers of health, such as interpersonal violence, food insecurity, and transportation. Staff from across agencies participated in the design and implementation of the program, identifying evidence-based strategies and screening mechanisms to use in the pilots. Interim evaluation of the pilots showed cost savings in part because of fewer emergency department visits and meeting enrollees’ health-related social needs.²³

Partnership approaches

Interviewees identified several ongoing partnerships between their Medicaid and public health agencies to improve health services and outcomes. These were often focused on an individual health issue or program, and officials identified a number of different approaches their agencies took to support these efforts, including using existing state opportunities, building partnership infrastructure, and expanding data-sharing practices. The sections below explore aspects of these approaches that other states can leverage to support initial partnership efforts or expand to new areas of collaboration.

Capitalizing on existing opportunities for collaboration

When state public health and Medicaid agencies are part of a single division or department, they have the advantage of shared leadership and strategic goals. However, interviewees across Medicaid and public health agencies reported that there were already opportunities within their states that they are able to build on to support partnership efforts. For example, states can:

• Use shared mandates and priorities as a foundation for partnership. Common catalysts for developing partnerships include shared priorities from state administrators or legislators, legislative mandates, and grants or funding requiring collaboration. For example, interviewees from Maryland highlighted a requirement under the Title V Maternal Child Health Services Block Grant to complete an assessment of healthcare needs every five years.²⁴ The process provided these agencies an opportunity to identify mutual population health priorities and strengthen their partnership through a memorandum of agreement that outlined shared goals and collaborative activities over the five-year cycle. Such shared mandates can help facilitate initial conversations and build a foundation for partnerships that can be expanded over time to other health priorities.
• Participate jointly in learning opportunities. National learning collaboratives or technical assistance opportunities can also be a driver for partnerships. Rhode Island public health (Department of Health) and Medicaid (Executive Office of Health and Human Services) staff have participated in multiple learning collaboratives and joint forums hosted by national organizations. Recently, the agencies participated in the American Academy of Pediatrics’ learning collaborative of experts exploring how to apply the “Blueprint for Children” findings to children and youth with special healthcare needs.²⁵ Through their participation, Rhode Island Medicaid was able to implement reimbursement for healthcare transitions, an important time when a patient moves from one healthcare setting to another, such as from pediatric to adult care. Interviewees said participating in joint learning allows them to network across state agencies and better understand each other’s roles. An interviewee from North Carolina said learning collaboratives provided structured and external facilitation for the partnership and helped participants integrate Medicaid and public health terminology and perspectives into their day-to-day work.
• Coordinate managed care and quality initiatives with population health initiatives. Medicaid agencies that contract with managed care organizations (MCOs), which administer health plans for individuals enrolled in Medicaid, can coordinate to align these programs and contracts with population health goals. For example, interviewees from North Carolina described robust coordination during the state Medicaid program’s transition to a managed care program in 2021. Medicaid (Division of Health Benefits) and public health (Division of Public Health) staff worked closely with local health departments to continue existing care management programs that helped patients manage care for complex health needs. Interviewees from Idaho also described engaging in regular meetings that include staff from Medicaid MCOs, Medicaid, and public health agencies. These meetings enhance collaboration among the agencies as they work toward shared population health goals.

Building partnership infrastructure

Public health and Medicaid agencies can build strong partnerships using infrastructure that already exists in their states. Examples include written agreements, funding support for joint initiatives, and designated staff who work as liaisons across agencies. Specifically, states can consider:

• Formalizing partnerships with joint strategic planning and written agreements. Joint strategic plans, interagency agreements, memorandums of understanding (MOUs), and other written and negotiated arrangements commonly serve as the foundation for partnerships. New Hampshire, for example, created a state roadmap, a document that outlines shared priorities, goals, and related activities for population health improvement.²⁶ An interviewee from the state’s public health department (Department of Health and Human Services) said, “Oftentimes, people work in silos if you let them, because they have a ton of work to do. The roadmap is a department-wide initiative that we can always point back to and use to collectively get people engaged in pursuing a goal or completing an initiative. It has a forced collaborative effect in some cases, which has been helpful.” Cooperative processes for updating these arrangements enable partners to regularly discuss their priorities and needs, and to identify opportunities to amplify their organizational strengths. Contractual agreements can also support delivery of care and services for Medicaid enrollees. In Tennessee, local health departments deliver integrated care coordination for pregnant and postpartum women as well as children under contracts between the public health agency and Medicaid.²⁷ Integrated care coordination is a form of support that helps patients and families navigate the healthcare system and receive needed medical and social supports such as access to postpartum care and housing.²⁸ The descriptions, terms and conditions, and exchange of information and funds of such contracts are publicly available online.²⁹ Similarly, in North Carolina, an interagency memorandum of agreement (MOA) outlines the funding and staffing dedicated to public health-Medicaid agency partnership activities.
• Creating structured, routine check-ins. Regularly scheduled meetings between agency leadership, which—depending on the topics being discussed—can include staff from across public health and Medicaid agencies, are common practices for ongoing collaboration. An interviewee from Idaho Medicaid highlighted the usefulness of monthly meetings that included a mix of standing agenda items, program updates, and topic-specific discussions. Agendas for these meetings are designed to spur collaboration on specific needs, such as response to legislative requests, as well as to streamline coordination across divisions. A Maryland public health interviewee noted stronger coordination with colleagues from Medicaid by reducing siloed topic-oriented meetings in favor of regular interagency meetings to discuss challenges across programs and think through how to collaborate. Regular meetings are also helpful for building relationships between staff across Medicaid and public health agencies, which helps spread knowledge and sustain ongoing initiatives despite staff turnover.
• Using work groups to support shared goals. Public health-Medicaid agency collaboration can take many forms, including short-term taskforces, committees, work groups, advisory boards, and quality improvement projects, to identify an area for improvement and dedicate work toward that goal. For example, interviewees from Alaska Medicaid (Division of Health Care Services) and public health (Division of Public Health) described joint participation in a Medicaid-led work group to update clinical guidelines based on healthcare utilization and cost data, including for people with complex healthcare needs. Interviewees from Idaho described a joint data project comparing diabetes prevalence and screening. In this project, Medicaid data on hemoglobin A1C screening—a blood test used in screening and monitoring diabetes—was combined with public health estimates of diabetes prevalence, according to where people live. This data-sharing project allowed Medicaid and public health agencies to identify high-risk areas defined by increased prevalence of diabetes and low screening rates.
• Aligning funding mechanisms. States can take several approaches to identify financial support to achieve partnership goals, such as leveraging Medicaid reimbursement to provide direct service or public health funding for programs and services, including support for staff who conduct outreach and education activities. For example, in Maryland, access to doula services covered by Medicaid reimbursement was supplemented by funds from the Public Health Improvement Fund under the Statewide Integrated Health Improvement Strategy.³⁰ This alignment allows more pregnant women in the state to access care from doulas. Via an MOU that is renewed every two years, Indiana public health (Department of Health) shares costs with Medicaid for the statewide tobacco quitline, a publicly available telephone service that provides support to tobacco users who would like to quit.³¹
• Investing in staffing and cross-agency supported positions. Staffing practices—such as jointly funding positions, supporting liaison roles, and documenting roles and workflows for succession planning—provide important infrastructure to support public health-Medicaid agency partnerships. For example, North Carolina’s public health agency employs a dedicated Medicaid liaison to streamline conversations, connect public health staff with the right Medicaid contacts, and help track ongoing joint efforts. In addition, proactive planning for staff turnover can help with partnership sustainability. New Jersey’s public health agency engages new staff in multilevel interagency meetings that discuss current state health priorities, aligned goals across agencies, and long-term vision. The agency also holds meetings to address upcoming staff departures and facilitate the transfer of critical relationships and knowledge when long-term staff leave.

Expanding data-sharing practices

Effective data sharing is a critical component of public health-Medicaid partnerships. Agencies share data to inform program evaluation, monitor health trends, support workforce planning, and better target health interventions where they are most needed. This section highlights how states can incorporate data into partnership efforts.

• Sharing a wide range of data types. Medicaid shares different types of data, including numbers and demographics of enrollees, health provider information, and medical and pharmacy claims data. Examples of data that public health agencies can share include disease prevalence, population health measures, vital records such as births and deaths, and immunization records. Medicaid and public health agencies can also share data from other sources, such as controlled substance databases, which track prescriptions and might help identify overdose risk; survey data from the telephonic Behavioral Risk Factor Surveillance System, which provides information on individuals’ health risk behaviors; and data from state health information exchange systems, which allow health professionals and patients to access patient medical data.³²
• Establishing structured processes for data exchange. Data-sharing processes may involve secure drives, accessing shared databases, or engaging data analysts or data management offices. For example, the North Carolina Medicaid data warehouse—the secure location where Medicaid files and claims are saved—is accessible to select staff members from other divisions, including the Division of Public Health under MOAs, which outline specific data use cases. Massachusetts provides data access through its All-Payer Claims Database, which contains data from public and commercial health insurers.³³ Louisiana Medicaid (Bureau of Health Services Financing) pulls aggregate and member-level data from the Louisiana Electronic Event Registration System housed within and managed by the Office of Public Health, such as the number of live births for maternal health initiatives. Likewise, the Office of Public Health has access to Medicaid’s Management and Administrative Reporting Subsystem and can retrieve Medicaid claims and patient encounter data. Data-sharing requests may be one-time or recurring and can involve third-party vendors, including academic institutions or consultant groups. Regardless of the process for sharing data, state agencies’ data-sharing agreements can outline appropriate uses and restrict permissions for access to the least data necessary to complete assigned tasks to safeguard privacy.
• Using data to achieve and promote priority goals. Once Medicaid and public health agencies have identified a shared focus area, they can seek additional data sources to paint a more holistic picture. For example, Nevada’s public health (Division of Public and Behavioral Health) staff participate in a supporting role in a maternal mortality review committee, which identifies opportunities to improve perinatal healthcare.³⁴ The committee uses different types of shared information during case reviews, including insurance data; enrollment data for Medicaid, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Supplemental Nutrition Assistance Program (SNAP); and prior interactions with Child Protective Services. This combined data allows for additional insight into potential factors associated with maternal mortality in the state.
• Using data sharing to support evaluation and reporting. Medicaid and public health agencies share data for several purposes, including supporting grant applications and reporting, understanding the prevalence of health conditions, assessing trends and gaps in the use of healthcare or prevention services, and bolstering enrollment in programs offered. Additionally, initiative-specific metrics are important for monitoring partnership outcomes. Interviewees from Colorado, for example, said they consider cross-agency data sharing during program and service evaluation design to avoid duplicative data collection efforts. After Nevada Medicaid (Nevada Health Authority) expanded coverage of school-based services, it used claims data to evaluate the services schools provided.
• Promoting data transparency to inform community efforts. Data sharing can also be used to create public-facing dashboards and reports, and to inform community or healthcare provider outreach and education. For example, Alaska’s state health information exchange uses both Medicaid and public health data, which are then shared externally with healthcare providers to inform treatment decisions and quality-of-care improvement efforts.
• Supporting workforce planning. Cross-agency data sharing can also support workforce planning. In Massachusetts the Medicaid agency collects information on the number of doulas enrolled as Medicaid providers, while the public health agency manages workforce development and doula certification. Aggregate administrative data sharing has helped identify the number of doulas enrolled, as well as the race/ethnicity and languages spoken by enrolled doulas who provide that information, and the number of Medicaid members who have used Medicaid-covered doula services. Sharing this data helps Medicaid and public health agencies engage in statewide planning for the doula workforce and enhance Medicaid enrollee access to doula services.

Facilitators and barriers to partnership and data sharing

Strong partnerships and effective data sharing between Medicaid and public health agencies are supported by a combination of leadership, expertise and relationships, and shared priorities. Conversely, partnerships can be constrained by unaddressed operational barriers, including technical challenges and incompatibilities. This section outlines key facilitators and barriers that affect collaboration, efficiency of data exchange, and sustainability of cross-agency initiatives.

Securing leadership buy-in

Interviewees from several states said leadership buy-in and open communication were central to their ability to pursue joint goals. Partnerships that lack leadership support can leave individual staff members responsible for initiating cross-agency outreach and relationship-building without broader institutional support to drive participation and collaboration. One New Hampshire interviewee said, “Leadership in our department has built structures for us to have routine communication to work through issues and toward goals that we have for our roadmap and for other improvement initiatives.” Cross-agency partnerships can also be affected by changes within agency leadership, state administration, or legislative direction that can shift Medicaid or public health agency priorities and established strategies. Partnerships can begin with staff at any level, and those connections can help secure leadership support and stronger initiatives.

Capitalizing on staff expertise and relationships

Interviewees highlighted staff knowledge and experience as a key facilitator of strong partnership, particularly when combining subject matter expertise across Medicaid and public health agencies for cross-agency partnerships. Having both agencies housed in the same department can create practical and strategic advantages. For example, interviewees from Maryland said that Medicaid staff with prior experience in public health programs, including Maternal and Child Health and Title V initiatives, bring valuable context and institutional knowledge that strengthens understanding of shared priorities and enhances cross-agency collaboration. Interviewees also said there is value in having staff in one agency with experience working in the other, especially because they have inside knowledge of how the agencies operate as well as credibility, relationships, and trust with their counterparts across agencies.

Common barriers to partnership and data sharing include lack of staff capacity and funding. Staff attrition and the resulting loss of institutional knowledge, limited personnel with expertise in data analytics, budgetary pressures, and inadequate funds to support data system updates, interoperability projects (efforts to support improved data sharing and use across different platforms), or sustained collaboration all contribute to these challenges.

Building cross-agency language and shared understanding

Differing priorities and limited understanding of each other’s operations can become barriers to partnerships between Medicaid and public health agencies. Interviewees said Medicaid’s annual budgeting cycles, combined with pressures to demonstrate cost-savings or budget neutrality, can result in a short timetable to demonstrate returns on investment. They also said shared priorities and goals and mutual understanding of each other’s roles and scope were central to effective collaboration. An interviewee from Louisiana described the usefulness of a shared policy agenda in documenting shared goals, while another from New Hampshire highlighted the value of shared language and working together on long-term projects as facilitators to relationship-building and achieving shared goals.

State officials highlighted how anticipating differences in organizational culture (e.g., language or operating procedures) and taking the time to build shared definitions and goals can enhance the agencies’ ability to partner and also help avoid misunderstandings. One New Jersey Medicaid interviewee said, “As a public health agency, they have a certain lens, and they have certain practices. Just as we have our own as a payer [an organization that covers the cost of medical care]. It’s not impossible to bridge that divide, but you should always assume there’s going to be some work required.”

Establishing data-sharing processes

Methods for facilitating data sharing include shared data systems, offices, or projects; appropriate staffing and expertise; data use agreements (DUAs); established processes for data requests; and use of third-party vendors that expand data sharing capabilities. For example, the Rhode Island Ecosystem is a shared information system populated with Medicaid, public health, and other data sources that can be used to look at population trends.³⁵ Nevada has an integrated data analytics unit with positions that are funded by different divisions and cross-trained in analytics methodologies, including public health and Medicaid. This team of analysts can process data requests efficiently and provide a range of expertise. A Nevada interviewee said, “Data requests come in via email and the process is customer-service-oriented. A benefit [of the integrated unit] is access to different types of expertise other than what you fund.”

Additionally, interviewees from several states highlighted the value of DUAs as providing opportunities to consider data requests comprehensively rather than as single cases. Once a DUA is in place, staff in either agency know how to interact and can work together more efficiently. A DUA with third-party vendors, such as academic institutions, also has these advantages and may expand the capacity of Medicaid and public health staff to analyze data. For example, New Jersey Medicaid has an Office of Business Intelligence, which manages data requests and receives analysis support via contract with the Rutgers Center for State Health Policy.³⁶

A barrier to data sharing is incompatible, siloed, or fragmented information technology systems, which make it difficult to share or match data. At times, processes for data requests are unclear, making it difficult to access shared data. Additionally, a lack of specific, approved uses and permissions for shared data can create extra steps for using combined data. Interviewees also reported difficulty coordinating resources needed to develop data-sharing agreements, which include not only program experts and program leadership who know which data is meaningful for evaluation, but also legal experts and data analysts.

Even when data can be shared, interviewees noted multiple barriers to using the data effectively, such as inaccurate or incomplete demographic data, rules or privacy concerns about the use of individual-level data, long time lags from data collection to availability, and difficulty disentangling data from different data source models. One example raised by several interviewees from Tennessee noted that strict interpretation of state legislation for data privacy has limited the scope of data that can be shared for public health-Medicaid agency partnerships.

Strategies for success

Interviewees shared strategies that have made their partnerships successful for population health improvement. The following outlines key lessons for developing and sustaining public health-Medicaid agency partnerships.

• Lead partnership development with respect and intention. Partnerships are most effective when agencies understand and respect each other’s unique expertise and resources. Sharing responsibility and treating each other as equals facilitates understanding and fosters the goodwill necessary to jointly drive positive health outcomes. An Arkansas public health interviewee said, “We’re equals in everything. There are certain things we can’t do without the other, and we realize we have to work together. We’re sharing the responsibility, we’re sharing our goals, and it’s working.”
• Build relationships across multiple levels of each agency. There is value in connecting over long periods of time and across multiple initiatives with leadership and program staff from both agencies. Strong relationships between program staff and leadership help drive partnership activities. Regular communication and discussion about objectives and challenges at all staff levels are beneficial strategies to keep partners informed and coordinated. Staff at all levels can initiate relationships and gain leadership support to strengthen partnerships. A Colorado public health staff member said, “If your agency leadership is in the know and on board, there is constant internal education for your work and what the priorities are, which helps make your efforts more successful.”
• Cultivate cross-agency awareness of organizational strengths. A Nevada public health interviewee said, “Knowing where you can leverage each other’s strengths is important. Public health can promote initiatives, and Medicaid might not have the budget to do that. Learning what each other can do and leveraging each other’s strengths help the people of Nevada.” In Louisiana the Medicaid interviewee discussed combining public health expertise in maternal health with Medicaid expertise in developing managed care contracts to build a new case management model for MCOs. Together, the agencies were able to improve care coordination for Medicaid members, including high-risk pregnant women and children with special healthcare needs.
• Create consistent messaging across agencies to improve public understanding of population health initiatives and increase awareness of healthcare services and programs. According to Medicaid and public health officials interviewed, community members often see Medicaid and public health as the same entity. Aligning messaging can minimize confusion and help ensure that people are aware of available services that match their needs. A New Jersey Medicaid interviewee described this collaboration on messaging as “having one voice on topics of mutual concern.”
• Partner with outside agencies to strengthen population health initiatives. Several states discussed collaboration with additional partners, such as MCOs and community-based organizations, which may have stronger connections to members. Non-Medicaid and public health agencies, as well as academic institutions, can support data sharing.

State case studies

Alaska: Strengthening outreach and messaging for available services

Background: Alaska’s Medicaid and public health agencies are partnering to increase awareness of chronic disease programs available to residents. Collaboration regularly includes representatives from the Office of the Commissioner, who support work across all divisions of Alaska’s Department of Health and contribute expertise in health policy and analytics. Regular meetings between agency leadership and program staff generate ideas for developing public-facing materials and outreach strategies to inform Alaskans, including Medicaid members, about available services.

• Agency structure: Medicaid and public health are housed within several divisions of the Alaska Department of Health. Public health initiatives fit within the Division of Public Health, while Medicaid functions are spread across the Division of Health Care Services, Division of Public Assistance, Division of Behavioral Health, and Division of Senior and Disabilities Services.
• Key data-sharing structures: Department staff across agencies engage with data in many ways, including through the statewide health information exchange and the master client index, a database that houses information on individuals receiving state services. These sources centralize records of services provided and clients served across the department’s portfolio of health programs. In addition to having a chief data officer who supports the entire department, several divisions have staff with extensive data analysis knowledge.

Partnership highlight: Fresh Start, a statewide effort launched in December 2022, connects Alaskans to local, evidence-based programs to meet health goals, such as lowering blood sugar and increasing physical activity.³⁷ The program has enrolled over 4,000 Alaskans as of December 2023, who collectively reported over 10,600 total pounds lost and on average an 11-point reduction in systolic blood pressure.³⁸ A bulletin published in November 2024 showed overall program awareness improved as a result of its campaign targeting select public health regions.³⁹ Flyers, handouts, and videos help raise awareness, and collaboration has been important to ensure that Fresh Start is accessible to and known among Medicaid members. The program is funded by the Division of Public Health’s Section of Chronic Disease Prevention and Health Promotion, with outcomes monitored to support the development of a Medicaid Section 1115 waiver to cover public health services addressing health-related social needs.

Key lesson: Technical assistance can serve as a template for partnership. Alaska received technical assistance as part of the CDC’s 6|18 Initiative, a multiyear project that explored preventable health conditions and interventions to improve healthcare outcomes and costs. Engagement focused on connecting Medicaid members to tobacco cessation services and improving insulin access for diabetics in Alaska’s rural communities. The state’s efforts through the 6|18 Initiative helped create a replicable structure for effective partnership between these state agencies. Processes established and sustained through this engagement, such as regular meetings, have spurred new ideas for communications materials, including flyers on other Medicaid-covered services, as well as services that are available to all Alaskans regardless of eligibility and enrollment in certain benefit programs.

Arkansas: Increasing access to prenatal care

Background: Arkansas’ public health and Medicaid agencies partner to improve maternal health and reduce rates of infectious disease.⁴⁰ Employees across the agencies—from senior leadership to program staff—meet regularly to discuss their priorities, programs, and initiatives. The agencies have open lines of communication, involve other stakeholders as needed to discuss the state’s health concerns, and design and implement appropriate policy changes and interventions.

• Agency structure: Medicaid and public health are housed in separate agencies. The Arkansas Department of Human Services (DHS) administers Medicaid, and the Department of Health (ADH) coordinates public health activities.
• Key data-sharing structures: The agencies have an MOU, which is reviewed annually and updated as needed, to streamline the process of data sharing. Both share Medicaid and public health data to support partnership initiatives, including the Presumptive Eligibility for Pregnant Women (PE-PW) program, through the MOU as well as the State Health Alliance for Records Exchange (SHARE). SHARE is a key mechanism for integrating medical information from different healthcare providers, including Medicaid providers and the health department’s local health units (LHUs) which are community-based public health centers, and it allows ADH to access medical records for Medicaid members to direct patient services.⁴¹

Partnership highlight: In 2024 the governor established the state’s Strategic Committee for Maternal Health, with ADH and DHS as primary partners and leaders. This collaboration aimed to improve the quality of Medicaid maternal health services and resulted in the reinstatement of the PE-PW program on July 1, 2025.⁴² With the return of PE-PW, the LHUs can provide prenatal care more quickly to women who test positive for pregnancy and coordinate a transfer to another Medicaid prenatal care provider.⁴³ The program aims to mitigate the effects of maternity deserts (geographic regions where access to obstetric care is severely limited or completely absent due to a Medicaid provider shortage) by allowing LHUs, many of which are located in these maternity deserts, to provide initial prenatal care.⁴⁴

Key lesson: State leadership mandates and cross-agency collaboration can reduce gaps in access to healthcare. While the governor’s executive order was a catalyst for improving access to maternal healthcare, DHS and ADH’s day-to-day communication and coordination have also improved access. The agencies recognized that collaboration and common population health goals enhanced their ability to improve the lives of Arkansans.

Colorado: Expanding community-based workforce reimbursement

Background: Colorado Medicaid and public health agencies partnered on several shared priorities, including diabetes prevention and management and Medicaid reimbursement for community health worker (CHW) services.⁴⁵ CHWs work in communities to help connect people with health and social care services. Interviewees described a long relationship of almost a decade, with a partnership approach centered around shared goals, mutual respect, and proactive collaboration. Other important elements supporting collaboration include the Governor’s Wildly Important Goals, which establish shared aims at the state administration level, and standing monthly meetings to discuss departmental goals and identify collaboration opportunities.⁴⁶

• Agency structure: Public health and Medicaid are housed in separate agencies, the Colorado Department of Public Health and Environment (CDPHE) and the Department of Health Care Policy and Financing (HCPF) respectively.
• Key data-sharing structures: An interagency agreement between CDPHE and HCPF describes which data can be shared and the conditions, privacy protections, and processes for sharing data, ensuring compliance with privacy requirements, and providing access based on necessary functions. One outcome of data sharing is the availability of public-facing dashboards on health outcomes.⁴⁷

Partnership highlight: In 2023 Colorado passed legislation authorizing Medicaid reimbursement for CHW services beginning January 1, 2028.⁴⁸ In preparation for implementation, CDPHE and HCPF took a collaborative approach to stakeholder engagement. This included meetings with tribal communities across Colorado with the goal of reimbursing community health representatives (CHRs) from Tribal communities. CHRs are frontline public health workers and trusted community members who bridge the gap between Indigenous populations and the formal healthcare system. These discussions led to exploration of Tribal communities’ concerns with submitting CHRs’ personal information to state agencies and led to an agreement to allow CHRs to enter the CDPHE-maintained CHW registry without submitting personal data.

Key lesson: Data sharing supports evaluation. The community health work project spurred additional cross-agency conversations about data sharing to inform evaluation. CDPHE’s evaluation will focus on the demographics and language abilities of the workers who pass assessments and overall community health worker program implementation. HCPF’s evaluation will assess Medicaid members’ use of CHW services for specific conditions, including the education provided and resulting health outcomes and costs. Both agencies are also interested in patient experience data.

Idaho: Enhancing access to prevention and maternal health services

Background: Idaho Medicaid and public health agencies partner across several priority areas, including the Drug Overdose Prevention Program (DOPP) and the implementation of the National Diabetes Prevention Program (DPP). These collaborative efforts have resulted in approved Medicaid reimbursement for DPP services and expanded coverage for diabetes self-management programs.⁴⁹ The partnership is supported by regular monthly meetings with leadership and staff from the divisions of Medicaid and public health as well as workgroup meetings with additional partners, including the Idaho Board of Pharmacy and Division of Behavioral Health.

• Agency structure: Medicaid and public health are housed within the Idaho Department of Health and Welfare in the Division of Medicaid and the Division of Public Health.
• Key data-sharing structures: Data-sharing agreements support program needs across different health issues, such as the early screening, diagnostic, and treatment programs for breast and cervical cancer, and evaluation activities (e.g., services provided to individuals with HIV via the Ryan White program or those for children with special health needs). Both the Division of Public Health and Medicaid also contribute data to the publicly available Get Healthy Idaho site, which gathers population health indicators from multiple sources, including an Idaho health report card and state health assessment.⁵⁰

Partnership highlight: The divisions have leveraged formal relationships to address maternal mortality, including participation in the Maternal and Child Health Policy Innovation Program supported by the National Academy for State Health Policy (NASHP). The Divisions of Public Health, Medicaid, Behavioral Health, and DOPP worked together to conduct stakeholder engagement with prenatal care clinicians, behavioral health clinicians, and women with SUD who had been or were currently pregnant. As a result, they pursued implementation of case management for Medicaid-eligible pregnant women with SUD and expanded enrollment of perinatal, Medicaid-enrolled women in SUD treatment.

Key lesson: Building relationships through collaboration takes time. Medicaid and public health have strengthened relationships across divisions over time and continue to formalize and build on these relationships to ensure that Idahoans have access to health-promoting services. As a result of their collaboration on Medicaid case management to address perinatal SUD, public health subject matter experts are now included on the Maternal Mortality Review Committee, and the state is in the process of establishing the Idaho Perinatal Quality Collaborative.⁵¹

Indiana: Connecting Medicaid members to tobacco cessation services

Background: Indiana Medicaid and public health have a longstanding partnership to connect Medicaid members to the Indiana Tobacco quitline, a statewide telephone-based cessation service for tobacco users.⁵² The public health team aims to reduce tobacco use statewide and tailors outreach to Medicaid members, who have higher smoking rates than the general population.⁵³ Public health staff also have relationships with the state’s managed care entities (MCEs), which are private health insurers that contract with the state Medicaid agency to coordinate care for most individuals with Medicaid coverage, to help connect patients to tobacco cessation services. Joint participation in technical assistance provided by the Centers for Disease Control and Prevention (CDC) 6|18 Initiative provided a foundation to carry this partnership through staff and leadership transitions.

• Agency structure: Medicaid and public health operate as separate agencies. Medicaid is housed in the Indiana Family and Social Services Administration’s Office of Medicaid Policy and Planning, while the Indiana Department of Health (DOH) leads the state’s public health initiatives, including tobacco-related activities under the Division of Tobacco Prevention and Cessation (TPC).
• Key data-sharing structures: An MOU outlines the data-sharing process for matching Indiana Tobacco quitline data with Medicaid data on enrollment, quitline service use, and tobacco treatment medication prescriptions, which helps identify Medicaid members using the quitline. Most data sharing is managed by TPC staff; however, DOH has an Office of Data and Analytics that employs a dedicated data analyst who supports data projects for TPC and other DOH divisions.

Partnership highlight: Medicaid and public health jointly fund the Indiana Tobacco quitline, where 46% of enrolled individuals are Medicaid members.⁵⁴ Staff from both agencies participate in quarterly meetings, where TPC staff share best practices for treatment, approved medications, and cost-sharing to help ensure that Medicaid coverage for tobacco cessation is evidence-based. TPC staff also meet regularly with MCE staff to discuss opportunities for promoting tobacco cessation services to Medicaid members.

Key lesson: Robust reporting demonstrates value and impact. The TPC team provides detailed reports to Medicaid showing member-level connections to services and reductions in smoking among Medicaid members who use the quitline. In the past year, approximately 3,800 Medicaid members used the quitline to stop smoking.⁵⁵

Louisiana: Engaging managed care to improve member outcomes

Background: Louisiana Medicaid and public health agencies have partnered on a range of priorities, including sickle cell disease, maternal and child health, and Medicaid expansion. Prompted by the state’s Title V interagency agreement, the agencies have worked together to identify opportunities to improve maternal and child healthcare access and develop a shared policy agenda to address related health outcomes. Interviewees described a shared commitment to partnership and long-standing working relationships that have supported productive collaboration to address multiple state health issues.

• Agency structure: The Bureau of Health Services Financing (Medicaid) and the Office of Public Health (OPH) are both housed within the Louisiana Department of Health.
• Key data-sharing structures: To support implementation of changes to the care coordination program that offers dedicated care managers to help members manage chronic conditions, navigate the healthcare system, and connect with local support resources, Medicaid shared its “External Quality Review Technical Report: Aggregate Report for the Healthy Louisiana Managed Care Organizations” with its public health counterparts. The report’s care coordination findings are being used to help inform improvement strategies.⁵⁶ The report, which is an assessment of the performance of the state’s Medicaid and Children’s Health Insurance Plan (CHIP) MCOs, is publicly available on the website. Additionally, Medicaid and OPH share immunization data, vital statistics, and other data from multiple data systems, some specific to Medicaid and others managed by OPH, using a secured shared drive and designated points of contact.

Partnership highlight: The agencies partnered to enhance the state’s managed care system to improve maternal and child health in Louisiana. The team’s maternal and child health needs assessment and recommendations from legislative reports guided the two divisions to combine expertise to revamp the support coordination program (formerly known as case management). Medicaid staff brought expertise in working with MCOs to administer care coordination, and OPH contributed knowledge of the healthcare needs of prenatal/postpartum women and children with special healthcare needs. With OPH’s support, Medicaid implemented a default-enrollment model, broadened eligibility criteria, and expanded services to increase enrollment among eligible members and improve access for individuals with health-related social needs^.57 Medicaid and OPH partner to assist the state’s MCOs implement performance improvement projects (PIPs)—mandated, structured initiatives designed to achieve significant, sustained improvement in healthcare for enrollees.⁵⁸ The agencies have partnered on several PIPs, including ones to improve screening for congenital syphilis and cervical cancer; preliminary data for the congenital syphilis PIP show an increase in screening rates.

Key lesson: Choosing a priority focus helps build the foundation for partnership. Louisiana interviewees highlighted the importance of identifying a shared priority as a starting point for strengthening public health-Medicaid agency partnerships. They encouraged other states to select a topic with existing momentum or interest, which can help motivate both agencies to engage and learn how to work together effectively.

Maryland: Improving maternal and child health services

Background: In Maryland interagency and data-use agreements play a central role in supporting partnerships between Medicaid and public health agencies. Beyond establishing a formal framework for collaboration, staff said they have gotten to know one another and use shared communications platforms, like Google Chat, to efficiently exchange information and requests, describing their relationships as less transactional and more collaborative. At the department level, transition planning helps minimize the loss of institutional knowledge and maintain continuity amid staff turnover.

• Agency structure: Medicaid and Public Health Services are housed within two of the five administrations in the Maryland Department of Health (MDH); the Office of Health Care Financing and Medicaid and Public Health Services.
• Key data-sharing structures: MDH has an updated data-use agreement to streamline and centralize requests by creating approved use cases (i.e., examples of how someone will use data to support a specific purpose or outcome) to allow for more efficient processing. The department also contracts with the Hilltop Institute at the University of Maryland, Baltimore County, to administer the Medicaid data warehouse, the central storage system that hosts the state’s Medicaid data, and support data and analytics requests.

Partnership highlights: The agencies partner to support referrals to services for pregnant women and for children with Medicaid coverage. CenteringPregnancy is a program that connects pregnant women to care, support, and learning opportunities through group visits with other pregnant women.⁵⁹ The public health agency provides start-up funds to onboard providers to the program, and Medicaid reimburses for the services provided. Title V and Integrated Maternal Health Services funding from the Health Resources and Services Administration also support digitizing state prenatal and postpartum assessments and referral forms, which will be shared with the state’s health information exchange to enhance timely referrals and follow-up services for pregnant and postpartum Medicaid members. For children, Medicaid supports programs from the CHIP Health Service Initiative to reduce lead exposure and asthma triggers through home visits.⁶⁰ The programs are managed by environmental health and maternal and child health staff within the public health agency, as well as Medicaid staff. A public portal hosts data from both agencies on program enrollment, as well as rates of elevated blood lead levels and asthma across the state.⁶¹

Key lesson: Using resources effectively supports shared population health goals. Medicaid and public health agencies both aim to improve health outcomes for Maryland residents. Investments in programs from existing funding sources have resulted in more referrals to state programs for pregnant women, children, and families. This alignment ensures that limited funds are used to serve populations with the greatest need.

Massachusetts: Partnering to advance maternal and child health initiatives

Background: Massachusetts Medicaid and public health staff partner on several maternal and child health initiatives as part of the Advancing Health Equity in Massachusetts (AHEM) initiative.⁶² The initiative calls for a public-private-community partnership that includes a focus on maternal health. Medicaid and public health staff from the Bureau of Family Health and Nutrition (BFHN) within the Department of Public Health (DPH) have regular meetings across staff levels to build relationships and develop interventions.

• Agency structure: MassHealth (Medicaid) and DPH are both housed within the Executive Office of Health and Human Services (EOHHS).
• Key data-sharing structures: Medicaid and BFHN’s Title V Interdepartmental Service Agreement involves ongoing sharing of aggregate maternal and child health data to inform Title V performance measures, joint planning, and quality improvement. Initiative-specific data-use agreements are also used. Medicaid and BFHN share data with other state agencies under EOHHS, such as the Bureau of Health Care Safety and Quality, and engage independent state agencies, such as the Betsy Lehman Center, to support data collection and review.⁶³ The state’s all-payer claim data system, which contains Medicaid data, is often used by public health epidemiologists to examine health outcomes.

Partnership highlight: Medicaid, DPH, and other agencies have partnered to develop several policies and programs to meet the medical, behavioral health, and social needs of children and families. Medicaid has extended provider-led screening for postpartum depression and perinatal SUD from 60 days to 12 months postpartum. Medicaid also provides perinatal mental health training to providers and reimburses doula services and donor breastmilk. The state agencies collaborate to provide support to parents and children through programs like MassHealth CARES for Kids and Moms Do Care, a broader state program, which provide support to pregnant women, parents and caregivers impacted by SUD, and children with complex medical needs, respectively.⁶⁴

Key lesson: Multi-stakeholder engagement supports public health-Medicaid partnership. Medicaid and public health have collaborated with other state agencies under EOHHS. Interviewees said their collaboration has enabled them to be liaisons across the state agency system and “show up at every table across agencies” that affects parents, children, and families, rather than limiting their partnership to Medicaid and public health agencies.

Nevada: Enhancing care for women and infants

Background: Nevada Medicaid and public health agencies have partnered in formal collaborations, such as those related to the Title V Maternal Child Health Services Block Grant program. They have also worked together on technical assistance opportunities, such as the Collaborative Improvement and Innovation Network.⁶⁵ These joint technical assistance opportunities allow agency staff to share knowledge and collaborate on topics such as preterm birth, co-occurring behavioral health and intellectual and developmental disorders, and diabetes program service coverage. Interviewees described a long-standing relationship spanning staff and agency changes, grounded in transparency, responsiveness, and a collaborative approach.

• Agency structure: Medicaid and public health are housed in separate agencies; the Nevada Health Authority (NVHA) administers Medicaid, and the Department of Human Services (DHS) houses the Division of Public and Behavioral Health (DPBH).
• Key data-sharing structures: NVHA has an integrated data and analytics unit staffed with biostatisticians and health analysts funded by divisions within NVHA and DHS.⁶⁶ Analytics staff prioritize data needs for DPBH providing their funding and are cross-trained to fulfill requests from other divisions. Staff from within DHS and NVHA, as well as members of the public, can submit data requests to a shared email inbox, and all requests are tracked. This centralized system of cross-trained analysts has expanded the capacity to quickly fulfill data requests.

Partnership highlight: One collaboration around maternal and infant health is Nevada’s work to improve treatment pathways for infants who screen positive for severe combined immunodeficiency (SCID), a group of disorders affecting a newborn’s immune system that is detected through a blood test and usually requires treatment within the first few days of life.⁶⁷ Medicaid, DPBH, and the Nevada Newborn Screening Program at the University of Nevada, Reno, convened before integrating SCID screening in the newborn blood test to create streamlined out-of-state referral for services not available in Nevada at the time.⁶⁸

Another collaboration has supported improving access to reproductive health services, particularly around the underutilization of long-acting reversible contraceptives (LARC), such as intrauterine devices and subdermal implants, in the postpartum population. Medicaid and DPBH hosted community-based meetings to gather feedback about providers’ willingness to prescribe and patients’ ability to access LARC. They learned that Medicaid reimbursement for LARC was part of bundled maternity care rates for acute care hospitals, meaning that patients would need to consent to LARC immediately postpartum to have Medicaid cover it. For some, noncoverage by Medicaid at a time other than immediately postpartum was a barrier to accessing LARC. In response, Nevada Medicaid pursued a state plan amendment that allowed hospitals to be reimbursed separately for LARC devices, insertion, and removal, increasing flexibility for providers and patients.⁶⁹

Key lesson: Sharing expertise can remove barriers to care. Nevada interviewees said that years of working together via learning opportunities, community engagement, and policy implementation efforts have strengthened their collaboration. Their partnership centers on shared goals of removing barriers to care and improving population health.

New Hampshire: Identifying state health needs and priorities

Background: Medicaid and public health agencies collaborate on maternal, oral, and behavioral health, as well as primary care. Strong relationships and data-sharing practices have allowed the agencies to jointly identify areas of need and develop interventions that address state health priorities.⁷⁰ Medicaid and public health staff credit their relationship-building for the success of their partnerships, including routinely sharing Medicaid and public health terminology to build a common language and understanding between agencies.

• Agency structure: The Medicaid and public health agencies are housed within the New Hampshire Department of Health and Human Services (DHHS).
• Key data-sharing structures: The agencies share Medicaid enrollment and healthcare utilization data, and public health data, such as birth records. No formal data-sharing agreement is needed since the agencies are housed under the same department. Public health held two data summits in 2025—one-day events for Medicaid, public health, and other key stakeholders to jointly analyze Medicaid and public health data and identify areas for improvement.

Partnership highlight: Medicaid, public health, and other divisions within DHHS came together to create the DHHS Roadmap 2024–2025, their strategic plan which outlines goals and initiatives to guide DHSS in addressing key priorities. The State Health Assessment, which contains population health and health disparities data, and the State Health Improvement Plan, which contains key health outcomes and ways the state can achieve them, were referenced to align goals in the roadmap.⁷¹ To develop the plan, DHHS convened a 40-member council including Medicaid and public health officials as well as representatives from several housing agencies, including DHHS’s Bureau of Housing Supports, the Attorney General’s Office, and critical access hospitals—a Centers for Medicare & Medicaid Services designation given to certain rural hospitals.⁷² The roadmap’s primary focus is maternal health, supported by a legislative priority to decrease maternal mortality in the state. Medicaid and public health partnered to improve use of first-trimester prenatal and postpartum care, implement Medicaid coverage for doula services and donor breastmilk, and increase WIC enrollment. Medicaid and public health also partnered to improve maternity care access in the state’s critical access hospitals.

Key lesson: Sharing data helps drive improved health outcomes. Data sharing has been integral to the success of the Medicaid and public health partnership in New Hampshire. The data summits allow Medicaid and public health to share data and align metrics to help meet roadmap goals. These summits support meaningful exchange between the two agencies and help foster maternal health collaborations. Given the success of these summits, the state may begin to host the data summits on an annual basis.

New Jersey: Improving diabetes prevention and care

Background: In partnership with public health, New Jersey’s Medicaid agency has implemented policies aimed at tobacco cessation, improving diabetes outcomes, and access to services rendered by community health workers, such as preventive health education and healthcare navigation. Medicaid and public health interviewees attributed their partnerships to strong relationships developed through respect, trust, and a willingness to collaborate. Staff meet regularly to discuss goals and monitor progress for partnership initiatives. They also implement onboarding and succession planning practices to help sustain partnership efforts.

• Agency structure: Medicaid and public health are housed in separate agencies within the New Jersey Department of Human Services: The Division of Medical Assistance and Health Services (DMAHS) administers Medicaid, and the Department of Health (DOH) coordinates public health activities.
• Key data-sharing structures: The agencies share data to support both joint and independent work. Sharing aggregate, nonidentifiable data has been especially valuable to avoid challenges and delays in creating data-sharing agreements for member-level data not included in existing agreements. While Medicaid has an Office of Business Intelligence (OBI), which is responsible for data analytics and reporting, the aggregate data-sharing process is often driven by program staff who have access to relevant data, avoiding strain on OBI staff capacity.

Partnership highlight: State officials formed the Diabetes Action Plan Committee, including representatives from public health, Medicaid, and other stakeholders, in response to the state’s Diabetes Action Plan statute that was created to reduce the impact of diabetes.⁷³ The committee created a report on the action plan and advanced policies to support its goals. This work includes finding opportunities to better control diabetes, especially for Medicaid members, as the program serves a disproportionate number of people with diabetes.⁷⁴ The partnership resulted in the state achieving Medicaid coverage for services provided by two evidence-based CDC programs—the National Diabetes Prevention Program (DPP), a lifestyle change program to reduce the risk of type 2 diabetes, and Diabetes Self-Management Education and Support, an ongoing personalized program that equips individuals with the skills to manage diabetes—and the Medical Nutrition Therapy for members with diabetes. Medicaid also broadened the definition of diabetes care providers to include community-based organizations such as the YMCA, that are CDC-certified DPP providers.

Key lesson: Taking time to build trusting relationships is key. Medicaid and public health invest time to bridge the divide between agencies with different perspectives and operations. During regular meetings, they assess each agency’s priorities and align goals and messaging to speak with a singular voice on mutually important topics. They also orient new staff to partnerships and proactively plan for staff transitions, both within individual agency and partnership meetings, to sustain collaboration.

North Carolina: Improving access to services for pregnant women

Background: North Carolina Medicaid and public health staff collaborate across several maternal and child health initiatives to improve access to services for high-risk pregnant women and advance activities outlined in the state’s Perinatal Health Strategic Plan (PSHP).⁷⁵ The Perinatal Health Equity Collaborative (PHEC) is the overarching body driving the work of the PSHP. Maternal and child health has been a consistent priority for both current and previous department leadership. Representatives from Medicaid and public health agencies also participate alongside providers, professional associations, patient advocates, community members, and others in the PHEC’s Maternal Health Workgroup to further opportunities for coordination and partnership at the state level.⁷⁶

• Agency structure: Medicaid and public health are housed in North Carolina’s Department of Health and Human Services’ Division of Health Benefits (DHB) and Division of Public Health (DPH), respectively.
• Key data-sharing structures: The department hosts a centralized data office, led by the chief data officer, to support data governance activities across all divisions. Agreements for specific initiatives facilitate data sharing between DHB and DPH agency staff with special authorization to access internal data sources. Examples of data shared in these partnerships include public health birth registries and Medicaid enrollment and claims. Shared data is used to help identify pregnant women enrolled in Medicaid who could also qualify for the WIC program and monitor MCO performance measures, which are health and healthcare outcomes that can be improved by health plan programs and services.

Partnership highlights: Expanding and monitoring services for high-risk pregnant women in North Carolina has been a focus of the public health-Medicaid partnership in recent years. The agencies work together on the Care Management for High-Risk Pregnancies program, which builds on an initiative started in 1988 by local health departments. Pregnant Medicaid recipients identified through screening as being at risk for adverse birth outcomes are referred to their local health departments for services, with Medicaid covering this care.⁷⁷ Members may be referred to additional prenatal services provided by their managed care health plan, known as value-added services.⁷⁸ Additionally, representatives from Medicaid, public health, and other maternal health stakeholder groups are working together to establish maternal levels of care, which categorize healthcare facilities based on the complexity of care they can provide, from basic to more specialized, to ensure that pregnant women receive services tailored to their level of risk.

Key lesson: Remaining committed to partnership supports sustainability. Interviewees reflected on the importance of understanding each division’s operations, strengths, and policy strategies in successfully managing partnerships. Medicaid and public health are committed to strengthening their partnerships, reflected in their leadership roles in the National Committee for Sustainable Medicaid and Public Health Partnerships, a national group of state leaders working to integrate collaboration into agency operations and sustain partnerships beyond administration changes.⁷⁹

Rhode Island: Enhancing funding for home visits to improve early childhood health

Background: Rhode Island Medicaid and public health have a long history of partnership across multiple areas, including maternal and child health, workforce development, oral health, immunization, asthma, chronic diseases, and community health worker programs. Key facilitators include shared administrative and support staff, such as human resources and finance; understanding each other’s work; and the ability to engage in transparent, good-faith conversations as challenges arise. To sustain these relationships, the agencies hold monthly department director meetings and introduce new colleagues to everyone they may need to know and collaborate with in the future.

• Agency structure: Rhode Island’s Executive Office of Health and Human Services (EOHHS) serves as the state’s designated Medicaid agency and the umbrella agency overseeing the Rhode Island Department of Health (RIDOH) and other health and human services departments. This integrated governance structure enables close coordination between Medicaid and RIDOH on public health and healthcare initiatives. RIDOH representatives said Rhode Island’s centralized state public health system—without separate county or municipal health departments—further supports statewide alignment and joint administration of programs across agencies.
• Key data-sharing structures: In addition to interagency agreements for data sharing, an EOHHS Office of Data, Analytics and Evaluation (ODAE) supports data services, including sharing and analysis. The Rhode Island Ecosystem is an EOHHS information system that receives data from many divisions of EOHHS and allows staff to request de-identified or aggregate information about populations for specific purposes.⁸⁰ The types of information shared include birth and death records, demographic data, syndromic surveillance data, and Medicaid eligibility, enrollment, and claims data, among other datasets. Interviewees described the Ecosystem as an efficient way to access integrated data sets, and they use it to examine populations and trends.

Partnership highlight: Rhode Island’s evidence-based family home visiting programs, including models such as Healthy Families America and Parents as Teachers, provide services to pregnant individuals and families with young children.⁸¹ Through regular home visits, these programs support maternal and child health, child development, family self-sufficiency, and early identification of health and developmental needs while helping families navigate healthcare and community resources. As part of implementation efforts to strengthen and sustain these services, Medicaid and public health partners worked together to establish Medicaid reimbursement mechanisms for eligible home visiting services and disseminated billing guidance to participating providers.

Key lesson: Communication can support bridging the public health-Medicaid language divide. Interviewees acknowledged the challenge of sharing data and codeveloping programs due to their different missions for the state. However, transparent communication, understanding each other’s operations and language, and a commitment to finding ways to work together have served them well in their partnerships.

Tennessee: Establishing connections to providers for well-child and oral health visits

Background: Tennessee’s Medicaid and public health agencies coordinate on select initiatives related to child health, including primary care and oral health care. Partnerships are standardized using publicly available written interagency agreements.⁸² Leadership, including individuals who have served in both agencies, also meet regularly to discuss shared goals.

• Agency structure: The agencies operate separately. Tennessee Medicaid is housed in the Department of Finance and Administration’s Division of TennCare, while the Tennessee Department of Health (TDH) supports public health activities.
• Key data-sharing structures: Publicly available data-use agreements outline types of data shared, such as oral health service records, vital statistics, immunizations, and the frequency of file transmission.⁸³ Data management staff for both Medicaid and public health agencies also process aggregate data requests on a regular cadence outside of these agreements. As of fall 2025, Tennessee is in the process of defining more consistent data-sharing procedures and re-establishing a statewide health information exchange.

Partnership highlights: The TennCare Services and Coordination contract outlines the Community Health Access and Navigation in Tennessee program, which connects children with Medicaid coverage to their assigned TennCare primary care provider to complete well-child visits required under Medicaid’s Early Periodic Screening Diagnosis and Treatment benefit. The partnership to deliver services is supported by $28 million in state and federal Title V Maternal and Child Health Services Block Grants, which are administered by TDH, and Title XIX Medicaid funds and managed by TennCare.⁸⁴ TennCare and TDH also have an agreement to help administer school-based oral health services to TennCare members in kindergarten through eighth grade via the School-Based Dental Prevention Program, which includes preventive screenings and services such as fluoride treatments, sealants, and varnish.⁸⁵ These efforts increase the number of TennCare members seen by a primary care or oral health provider, with outcomes included in annual program reports.

Key lesson: A mutual willingness to collaborate has helped sustain strong relationships between the two agencies. Staff, who have experience in both Medicaid and public health, are using this foundation to advance data-sharing projects that align with current state administration priorities.

About this report

This report was developed by Rachel Zetts, Amanda Carrillo-Perez, and David Hyun of Pew’s state health solutions project. Maureen Bowers helped with the research. Demetra Aposporos, Taylor Fussman, Emily Langer, Josh Wenderoff, and OTHERSTK provided communications, design, and editorial support. Former colleagues Kyra Fryling and Heather Cable also contributed to the research and development of this report.

Acknowledgments

The project team recognizes the significant contributions of the Center for Health Care Strategies staff members—Shilpa Patel, Stephanie Paneca-Navarro, Vicki Quintana, Megan Terrell, and Rachel Yard—who led the research and drafting of this report.

This report benefited from the insights and expertise of external reviewers Orobosa Idehen at the Association of State and Territorial Health Officials and Susan Buell at the National Association of Chronic Disease Directors. Although they have reviewed the report, neither they nor their organizations necessarily endorse its findings or conclusions.

Appendix A. Methodology

Background research

The Center for Health Care Strategies (CHCS) project team compiled published case studies, articles, and tools focused on state Medicaid and public health agency partnerships that featured elements of data-sharing agreements, exchange, and reporting. CHCS also researched how Medicaid and public health agencies are structured within each state’s executive branch. These examples and takeaways informed the development of an online questionnaire and the guide used to interview state officials.

Questionnaire

CHCS administered an online questionnaire via Microsoft Forms between February and April 2025 to better understand current and past partnerships between state public health and Medicaid agencies. The questionnaire included a mix of multiple choice and open-ended responses on activities, facilitators, barriers, data sharing, and the impact partnerships had on health outcomes. With support from the National Association of Chronic Disease Directors (NACDD), CHCS drafted an outreach strategy to ensure robust participation, including distributing the questionnaire via primary and secondary channels.

Responses received from participating states and agencies were incorporated into a Microsoft Excel database. Analyses included descriptive statistics on quantitative data stratified by factors such as agency structure and political context, and thematic analysis of open-ended responses to identify and interpret themes at the state and aggregate level.⁸⁶ A summary of the findings was developed for the Pew state health solutions team.

State interviews

To gather in-depth information on public health-Medicaid partnerships, CHCS conducted 20 individual and/or group interviews with 44 individuals in 14 states from April to December 2025 via Zoom. States were selected based on their responses to the questionnaire and interest in participating in an interview. As part of assessing the states included for interviews, factors such as agency type, geography, and political affiliation were also considered. All states identified for interviews were reviewed and approved by Pew before beginning outreach. CHCS drafted the interview guide, which was reviewed by Pew and NACDD, piloted with two states, and revised before conducting the interviews in the remaining 12 states. The interview guide included oral consent to participate in and record the interview; consent was obtained before conducting each interview. Interview questions were tailored to each state based on the responses provided in the questionnaire. Interview transcripts were generated by Zoom.

State interview analysis and case study development

After each interview, CHCS anonymized all interview transcripts and reviewed them for accuracy. For each interview, CHCS and Pew developed an interview summary template to ensure that the type of information and level of detail shared was consistent across all interviews. Each memo included an overview of the public health-Medicaid partnership, including facilitators and barriers, the role of data sharing in the partnership, and the impact of partnership on policies, programs, and population health. Pew reviewed each memo, and suggested revisions were made. Before sharing interview memos with Pew, memos were anonymized and stored on a password-protected SharePoint site.

In parallel, from December 2025 to January 2026, CHCS conducted a thematic analysis of the transcripts to identify and describe recurring trends across all interviews. CHCS created a codebook of key themes across the interview guide topics, reviewed and reconciled a small group of transcripts among all reviewers to ensure consistency in coding, and analyzed the remaining transcripts. CHCS staff engaged in the analysis met regularly to discuss results, potential updates to the codebook, and contextual details and examples to highlight for inclusion in the final case study report. The report highlights the themes identified in the thematic analysis and includes case studies representing the 14 states that participated in interviews.

Limitations

The online questionnaire was designed to be completed within 20 minutes and focused on specific aspects of partnerships, such as activities, facilitators, barriers, data sharing, and impact on population health outcomes. Responses to the questions varied in depth and detail.

Interviews were limited to 60 minutes and did not include all instances of Medicaid and public health agency partnerships or staff who participated in the partnerships mentioned. In most states, interviews focused on partnerships related to maternal and child health and/or chronic disease topics. Medicaid agencies in two states, Arkansas and Indiana, were not interviewed because of unsuccessful outreach. Therefore, the case studies for these states only represent the public health agency perspective. Some interviewed staff transitioned out of their roles from the time of the interview to the publication of this report. In these cases, efforts were made to connect with other agency staff with knowledge of partnerships to confirm the accuracy of the case studies. Population health outcomes resulting from Medicaid and public health agency partnerships were limited, as initiatives were either new or lacked a formal evaluation process to measure changes or improvements. This report does not reflect the perspectives of local, territorial, or tribal institutions as CHCS only interviewed officials at the state level.

Endnotes

1. De Beaumont Foundation, “Medicaid and Public Health Partnership Learning Series: Promoting Value Through Medicaid-Public Health Partnership,” https://debeaumont.org/resources/promoting-value-through-medicaid-public-health-partnership/.
2. “About Chronic Diseases,” Centers for Disease Control and Prevention, May 14, 2026, https://www.cdc.gov/chronic-disease/about/index.html.
3. Kari Ferver, Bryan Burton, and Paul Jesilow, “The Use of Claims Data in Healthcare Research,” The Open Public Health Journal 2 (2009): 11-24, https://openpublichealthjournal.com/contents/volumes/V2/TOPHJ-2-11/TOPHJ-2-11.pdf.
4. “Collaborative Improvement and Innovation Network to Reduce Infant Mortality (Infant Mortality CoIIN),” National Institute for Children's Health Quality, https://nichq.org/projects/collaborative-improvement-and-innovation-network-to-reduce-infant-mortality-infant-mortality-coiin/.
5. “Community Health Workers,” American Public Health Association, https://www.apha.org/apha-communities/member-sections/community-health-workers.
6. “Doula,” Cleveland Clinic, https://my.clevelandclinic.org/health/articles/23075-doula.
7. “About Diabetes Self-Management Education and Support,” Centers for Disease Control and Prevention, https://www.cdc.gov/diabetes/education-support-programs/index.html.
8. The Pew Charitable Trusts, “State Public Health Data Reporting Policies and Practices Vary Widely,” 2024, https://www.pew.org/en/research-and-analysis/reports/2024/12/state-public-health-data-reporting-policies-and-practices-vary-widely.
9. “What Is the National DPP?,” Centers for Disease Control and Prevention, https://www.cdc.gov/diabetes-prevention/programs/what-is-the-national-dpp.html.
10. “Quality Measurement and Quality Improvement,” Centers for Medicare & Medicaid Services, https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/mms/quality-measure-and-quality-improvement-.
11. “Quality Measurement and Quality Improvement,” Centers for Medicare & Medicaid Services.
12. “Section 1115 Demonstrations,” Centers for Medicare & Medicaid Services, https://www.medicaid.gov/medicaid/section-1115-demonstrations.
13. “Medicaid State Plan Amendments,” Centers for Medicare & Medicaid Services, https://www.medicaid.gov/medicaid-state-plan-amendments/index.html.
14. The Pew Charitable Trusts, “State Public Health Data Reporting Policies and Practices Vary Widely.”
15. “Title V—Maternal and Child Health Services Block Grant,” Social Security Administration, https://www.ssa.gov/OP_Home/ssact/title05/0500.htm. Association of Maternal & Child Health Programs, “Collaborations Between State Title V Maternal and Child Health Programs and Medicaid,” 2019, https://amchp.org/resources/collaborations-between-state-title-v-maternal-and-child-health-programs-and-medicaid/.
16. “Title V—Maternal and Child Health Services Block Grant,” Social Security Administration. Association of Maternal & Child Health Programs, “Collaborations Between State Title V Maternal and Child Health Programs and Medicaid.”
17. Laura C. Seeff, Tricia McGinnis, and Hilary Heishman, “CDC's 6|18 Initiative: A Cross-Sector Approach to Translating Evidence Into Practice,” Journal of Public Health Management & Practice 24, no. 5 (2018): 424-31, https://pubmed.ncbi.nlm.nih.gov/29474211/.
18. Shilpa Patel et al., “Cross-Agency Partnerships for Health Equity: Understanding Opportunities Across Medicaid and Public Health Agencies,” Center for Health Care Strategies, 2021, https://www.chcs.org/resource/cross-agency-partnerships-for-health-equity-understanding-opportunities-across-medicaid-and-public-health-agencies/.
19. Liz Gipson et al., “Leveraging Partnerships Between Public Health and Medicaid to Strengthen the Healthcare Safety Net,” Center for Health Care Strategies, 2023, https://www.astho.org/globalassets/report/leveraging-partnerships-between-public-health-and-medicaid-to-strengthen-the-healthcare-safety-net.pdf.
20. Cory Caldwell, “Medicaid Meets Public Health: A Blueprint for Collaboration,” National Association of Medicaid Directors, 2025, https://medicaiddirectors.org/resource/medicaid-meets-public-health-a-blueprint-for-collaboration/. “Medicaid and Public Health Partnerships,” Association of State and Territorial Health Officials, https://www.astho.org/topic/population-health-prevention/healthcare-access/medicaid/.
21. Medicaid and public health agency names vary across states. For simplicity, throughout this report, “Medicaid” and “public health” are used as generic references to state Medicaid and public health agencies. The full agency name is provided on first reference.
22. “Healthcare Resiliency in Tennessee,” Tennessee Department of Health, https://www.tn.gov/health/hrp.html.
23. Cecil G. Sheps, “NC Healthy Opportunities Pilots,” North Carolina Department of Health and Human Services—Division of Health Benefits, 2024, https://www.ncdhhs.gov/healthy-opportunities-pilots-interim-evaluation-report/download?attachment.
24. Cecil G. Sheps, “NC Healthy Opportunities Pilots.”
25. “Blueprint for Children,” American Academy of Pediatrics, https://www.aap.org/en/advocacy/blueprint-for-children/.
26. “DHHS Roadmap 2025-2027,” New Hampshire Department of Health and Human Services, https://www.dhhs.nh.gov/reports-regulations-statistics/dhhs-roadmap-2025-2027.
27. “Community Health Access & Navigation,” Tennessee Department of Health, https://www.tn.gov/health/chant.html.
28. “Community Health Access & Navigation,” Tennessee Department of Health, https://www.tn.gov/health/chant.html.
29. “Tenncare Contracts,” Tennessee Division of TennCare, https://www.tn.gov/tenncare/information-statistics/tenncare-contracts.html.
30. “Statewide Integrated Health Improvement Strategy,” Maryland Health Services Cost Review Commission, https://hscrc.maryland.gov/Pages/Statewide-Integrated-Health-Improvement-Strategy-.aspx. Maryland Department of Health, “Maternal and Child Health Population Health Improvement Fund Program Year Four—FY 2025 Annual Report,” 2025, https://hscrc.maryland.gov/Documents/Modernization/Statewide%20Integrated%20Health%20Improvement%20Strategy/MCH%20PHIF%20-%20PY4%20Report_final.pdf.
31. “Quit Now Indiana,” Indiana Department of Health, https://www.in.gov/health/tpc/quit-now-indiana.
32. “About Health Information Exchange,” Office of the National Coordinator for Health Information Technology, https://healthit.gov/health-it-basics/hie/.
33. “Massachusetts All-Payer Claims Database,” Massachusetts Center for Health Information & Analysis, https://www.chiamass.gov/databases/ma-apcd/.
34. “Nevada Maternal Mortality Review Committee (MMRC),” Nevada Division of Public and Behavioral Health (DPBH), https://www.dpbh.nv.gov/programs/maternal-child-and-adolescent-health-mcah/nevada-maternal-mortality-review-committee/.
35. “Ecosystem,” Executive Office of Health and Human Services, State of Rhode Island General Assembly, https://eohhs.ri.gov/initiatives/data-analytics-and-evaluation/data-ecosystem.
36. Margaret Koller, “Support for Development of the New Jersey Medicaid Office of Business Intelligence,” 2026, https://cshp.rutgers.edu/projects/support-for-development-of-the-new-jersey-medicaid-office-of-business-intelligence.
37. “Fresh Start: Programs for Better Health,” State of Alaska Department of Health, https://health.alaska.gov/en/services/fresh-start/.
38. Yereth Rosen, “With New Year’s Resolutions on the Way, Alaska Health Officials Tout Fresh Start Program,” Alaska Beacon, 2023, https://alaskabeacon.com/2023/12/29/with-new-years-resolutions-on-the-way-alaska-health-officials-tout-fresh-start-program/.
39. Heidi Hedberg et al., “First-Year Evaluation of Alaska’s Fresh Start Campaign,” State of Alaska Epidemiology, 2024, 1, https://epi.alaska.gov/bulletins/docs/b2024_15.pdf.
40. This case study represents public health-Medicaid partnerships from only the public health perspective. The project team was unable to conduct an interview with Medicaid representatives.
41. “What Is SHARE?,” State Health Alliance for Records Exchange, https://sharearkansas.com/about/about-share/.
42. Office of Arkansas Governor Sarah Huckabee Sanders, “Sanders Signs Executive Order to Support Moms, Protect Babies, and Improve Maternal Health,” news release, March 6, 2024, https://governor.arkansas.gov/news_post/sanders-signs-executive-order-to-support-moms-protect-babies-and-improve-maternal-health/. “Presumptive Eligibility for Pregnant Women (PE-PW),” Arkansas Department of Human Services, https://humanservices.arkansas.gov/divisions-shared-services/medical-services/healthcare-programs/presumptive-eligibility-for-pregnant-women-pe-pw/.
43. Arkansas Department of Health, “Sanders, Arkansas Department of Health Launch Statewide Campaign to Connect Women to Pregnancy Care,” news release, May 6, 2026, https://healthy.arkansas.gov/article/sanders-arkansas-department-of-health-launch-statewide-campaign-to-connectwomen-to-pregnancy-care/.
44. Sarah Khatib, “Report Highlights Maternal Health Care Challenges in Rural Communities,” Arkansas Center for Health Improvement, May 14, 2025, https://achi.net/newsroom/report-highlights-maternal-health-care-challenges-in-rural-communities/.
45. Colorado Department of Health Care Policy and Financing, “Community Health Workers (CHW) & Community Health Representatives (CHR),” https://hcpf.colorado.gov/sites/hcpf/files/Community%20Health%20Workers%20Fact%20Sheet_2025%20Update.pdf.
46. “What Is the Governor’s Dashboard?,” Colorado Governor Jared Polis, https://dashboard.colorado.gov/learn-more.
47. “Health Equity Strategic Plan|Health Care Policy & Financing,” Colorado Department of Public Health and Environment, https://cdphe.colorado.gov/SB21-181/HCPF#strategy2 “Home Hospital Report Card,” Colorado Department of Public Health and Environment, https://cdphe.colorado.gov/health-facilities/looking-for-information-about-existing-licensed-health-facilities/hospital-report.
48. “Community Health Workers,” Colorado Department of Health Care Policy and Financing, https://hcpf.colorado.gov/communityhealthworkers.
49. Tracy Berreth, “Idaho’s Public Health Priorities: Diabetes, Obesity, Behavioral Health, and Unintentional Injury,” Idaho Department of Health & Welfare, Sept. 19, 2023, https://healthandwelfare.idaho.gov/dhw-voice/idahos-public-health-priorities-diabetes-obesity-behavioral-health-and-unintentional. Idaho Department of Health and Welfare, Division of Medicaid, “Medic Aide: An Informational Newsletter for Idaho Medicaid Providers,” 2023, https://www.idmedicaid.com/MedicAide%20Newsletters/July%202023%20MedicAide.pdf.
50. “Welcome to the Maternal Mortality Review Committee,” Idaho Division of Occupational and Professional Licenses, https://dopl.idaho.gov/mmr.
51. “Welcome to the Maternal Mortality Review Committee,” Idaho Division of Occupational and Professional Licenses. “About IDPQC,” Idaho Perinatal Quality Collaborative, https://idahopqc.org/about.
52. “Quit Now Indiana,” Indiana Department of Health.; This case study represents public health-Medicaid partnerships from only the public health perspective. The project team was unable to conduct an interview with Medicaid representatives.
53. “Quit Now Indiana,” Indiana Department of Health.
54. Indiana Department of Health, “Tobacco Prevention and Cessation’s State Fiscal Year 2025 Report,” September 2025, https://www.in.gov/health/tpc/files/SFY-2025-TPC-annual-report_final.pdf.
55. Indiana Department of Health, “Tobacco Prevention and Cessation’s State Fiscal Year 2025 Report.”
56. Louisiana Department of Health, “External Quality Review Technical Report: Aggregate Report for the Healthy Louisiana Managed Care Organizations,” 2025, https://ldh.la.gov/assets/medicaid/EQRO/2025/LA_SFY2024_MCO_Aggregate_ATR_F1.pdf.
57. “Support Coordination,” Louisiana Department of Health, https://ldh.la.gov/office-of-intellectual-and-developmental-disability-supports/support-coordination.
58. “Quality Requirements under Medicaid Managed Care,” Medicaid and CHIP Payment and Access Commission (MACPAC), June 4, 2021, https://www.macpac.gov/subtopic/quality-requirements-under-medicaid-managed-care/#:~:text=entity.
59. “Medicaid CenteringPregnancy Services,” Maryland Department of Health, https://health.maryland.gov/mmcp/medicaid-mch-initiatives/Pages/CenteringPregnancyServices.aspx.
60. “Services for Children With Lead Poisoning,” Maryland Department of Health, https://health.maryland.gov/phpa/OEHFP/EH/Pages/LeadHomeVisiting.aspx. “Home Visiting Services for Children With Asthma,” Maryland Department of Health, https://health.maryland.gov/phpa/OEHFP/EH/pages/chipenvcasemgmt.aspx.
61. “Services for Children With Lead Poisoning,” Maryland Department of Health. “Home Visiting Services for Children With Asthma,” Maryland Department of Health.
62. “Advancing Health Equity in MA,” Masschusetts Executive Office of Health and Human Services, https://www.mass.gov/advancing-health-equity-in-ma.
63. “Advancing Healthcare Safety in Massachusetts,” Betsy Lehman Center, https://betsylehmancenterma.gov/.
64. “Moms Do Care,” Bureau of Substance Addiction Services, https://www.momsdocare.org/. “CARES for Kids Program Services,” MassHealth for Individuals, Families, and People with Disabilities, https://www.mass.gov/cares-for-kids-program-services.
65. “Title V—Maternal and Child Health Services Block Grant,” Social Security Administration. “Collaborative Improvement and Innovation Network to Reduce Infant Mortality (Infant Mortality CoIIN),” National Institute for Children's Health Quality.
66. “Office of Analytics,” Nevada Health Authority, https://www.nvha.nv.gov/working-together/office-of-analytics/.
67. “Severe Combined Immunodeficiency,” Nevada State Public Health Laboratory, University of Nevada, Reno School of Public Health, https://www.unr.edu/nevada-state-public-health-laboratory/newborn-screening/disorders-screened/severe-combined-immunodeficiency.
68. “Newborn Screening,” Nevada State Public Health Laboratory, University of Nevada, Reno School of Public Health, https://www.unr.edu/nevada-state-public-health-laboratory/newborn-screening
69. Nevada Medicaid, “Nevada State Plan Amendment,” 2024, https://www.medicaid.gov/medicaid/spa/downloads/NV-24-0014.pdf.
70. Orobosa Idehen and Cory Caldwell, “Building a Successful Medicaid-Public Health Partnership: Lessons from New Hampshire,” Association of State and Territorial Health Officials, Aug. 17, 2026, https://www.astho.org/communications/blog/2026/building-a-successful-medicaid-public-health-partnership-lessons-from-new-hampshire/.
71. “State Health Assessment,” New Hampshire Department of Health & Human Services, https://www.dhhs.nh.gov/programs-services/population-health/nh-lives-well/state-health-assessment. New Hampshire Department of Health & Human Services, “2023-2028 New Hampshire Health Improvement Plan,” https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/nh-state-health-improvement-plan.pdf.
72. “State Health Assessment and State Health Improvement (SHA-SHIP) Advisory Council,” New Hampshire Department of Health & Human Services, https://www.dhhs.nh.gov/about-dhhs/advisory-organizations/state-health-assessment-and-state-health-improvement-sha-ship. “Critical Access Hospitals (CAHs),” Rural Health Information Hub, https://www.ruralhealthinfo.org/topics/critical-access-hospitals#:~:text=Critical%20Access%20Hospitals%20(CAHs)%20are%20designated%20by,patients%20*%20Provide%2024/7%20emergency%20care%20services.
73. Senate and General Assembly of the State of New Jersey, Diabetes Action Plan, 3432 (2013), https://pub.njleg.gov/bills/2012/AL13/104_.HTM.
74. New Jersey Department of Health, “New Jersey Diabetes Action Plan Report,” https://www.nj.gov/health/fhs/chronic/documents/17-Diabetes%20Action%20Plan_2.0.pdf.
75. North Carolina Department of Health and Human Services: Division of Public Health, “NC Perinatal Health Strategic Plan,” 2022, https://wicws.dph.ncdhhs.gov/phsp/docs/PerinatalHealthStrategicPlan-9-15-22_WEB.pdf.
76. “Task Force on Maternal Health,” North Carolina Institute of Medicine, https://nciom.org/task-force-on-maternal-health/.
77. “Care Management for High-Risk Pregnancies (CMHRP),” North Carolina Medicaid Division of Health Benefits, https://medicaid.ncdhhs.gov/providers/programs-and-services/care-management/care-management-high-risk-pregnancies-cmhrp.
78. “Compare Health Plans,” North Carolina Medicaid Division of Health Benefits, https://ncmedicaidplans.gov/en/compare-health-plans.
79. Dawn Cutler-Tran, “National Committee for Sustainable Medicaid and Public Health Partnerships,” Feb. 26, 2025, https://medicaiddirectors.org/resource/national-committee-for-sustainable-medicaid-and-public-health-partnerships/.
80. “Ecosystem,” Executive Office of Health and Human Services, State of Rhode Island General Assembly.
81. “Parents as Teachers,” State of Rhode Island Department of Health, https://health.ri.gov/family-visiting/services/parents-teachers. “Healthy Families America,” State of Rhode Island Department of Health, https://health.ri.gov/family-visiting/services/healthy-families-america.
82. “Tenncare Contracts,” Tennessee Division of TennCare.
83. “Tenncare Contracts,” Tennessee Division of TennCare.
84. Tennessee Department of Finance and Administration, “Interagency Agreement Between the State of Tennessee Department of Finance and Administration, Division of Tenncare and Department of Health,” 2025, https://www.tn.gov/content/dam/tn/tenncare/documents2/DeptHealth90454.pdf.
85. Tennessee Department of Finance and Administration, “Oral Disease Services for School Children in Grades Pre-K-8,” 2024, https://www.tn.gov/content/dam/tn/tenncare/documents2/Health78212.pdf.
86. National Conference of State Legislatures, “State & Legislative Partisan Composition,” 2025, https://documents.ncsl.org/wwwncsl/About-State-Legislatures/2025-State-and-Legislative-Partisan-Composition.pdf.