Healthcare Leaders Call for Cooperation as Medicaid Laws Shift

Ricci told the conference, “We really needed to step back and look internally at what was strong, what was weak, and where we needed to focus on creating our foundations. And then we needed also, externally, to understand how has the healthcare system changed, how have our patients’ needs changed, how has Alaska’s needs changed? And what does the path look like going forward? Because it looks really different than it did in 2019 or 2018.” 

On top of the changes, she noted, the department is grappling with old operational systems, some of which date back to 1983. Most rely on people to “push the button to do the thing to move something forward,” Ricci said. “And we’re in the space right now where we don’t have people in the same way that we did fourteen years ago, and we’re probably not going to have that in the future.

Ricci said the department is considering how it can leverage AI-driven tools as it updates its systems. “This is both a challenge and an opportunity,” she said.

Lighting a Fire

Alongside Ricci at the conference in Anchorage on September 11 was Jared Kosin, president and CEO of the Alaska Hospital & Healthcare Association. The two were asked to address the future of Alaska Medicaid, particularly in the light of the recent federal legislation outlining how Medicaid will work beginning in 2026. 

Although Ricci saw the legislation—which she and Kosin called OB3, referring to its alliterative title, “One Big, Beautiful Bill”—as an opportunity to reshape how Alaska provides Medicaid coverage, Kosin voiced significant concerns. 

“Any time anyone loses coverage—especially a vulnerable population—I just don’t think it’s a good outcome. And I think we’re going to see a lot of that. I think we’re going to see providers struggle with the implementation of the OB3 requirements, and I think it’s going to be really challenging—and I just need to air that, on behalf of providers, because it’s frustrating,” Kosin said. “The ethos right now against the healthcare system is, ‘Burn it down,’ and I just don’t think that is the most constructive way to go about affecting change. But with that said, the fire has been lit, the circumstances are what they are, and it really is about looking ahead, and that’s where I really appreciate your optimism.”

Kosin noted that state Department of Health employees have a “thankless job,” tasked with keeping systems working even as coverage options change. The healthcare industry—and particularly public sentiment about it—has changed drastically following the COVID-19 pandemic, he said. But through the pandemic and afterward, state health officials and private operators “united and gave each other space and grace,” Kosin said, and came back together despite differing opinions. “We all have, I think, the right intentions. Sometimes we disagree on what they should be or where they should be, but I think as we give each other space to express ourselves, but then come back together and kind of get back to work… that’s where you have success.”

Ricci said she believes building on that long term relationship will help Alaska’s healthcare industry when it comes to implementing the changes that lie ahead with the new federal Medicaid rules. 

“Systems are made up of people, and they really reflect how well people either work together towards a common goal or how much they fracture apart. And so, I think that if we decided that we had a common goal, and that now is the time and we want to leverage the opportunities that we have in front of us to meet the challenges that are there and are not going to go away, I think we can do that,” Ricci said. “I’m really hoping that this is that time, and that we can leverage these funds to kind of walk in across the shaky bridge, to the healthcare system that we want to see.”

Shelley Ebenal, CEO of Foundation Health Partners, the nonprofit operator of Fairbanks Memorial Hospital, put a finer point on it: “You said, ‘If not now, when?’ After Bartlett [Regional Hospital in Juneau] goes broke? After Fairbanks [Memorial Hospital] goes broke? After Kenai [Central Peninsula Hospital] goes broke?” 

Ebenal added, “We have an opportunity to do something right for our state, but if we don’t come together as a state, we will waste this money. So I guess it’s my call to everyone in this room: We need to change healthcare, and we need to change it now. Now, maybe Providence and Alaska Regional will not go broke, but the rest of us will. So we need your help—and what’s the plan? Let’s get on board.”