Latest / Becker’s Payer Issues Podcast / Balancing Medicaid Costs, Access, and Member Experience with Nora Leibowitz

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Balancing Medicaid Costs, Access, and Member Experience with Nora Leibowitz · Becker’s Payer Issues Podcast

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  Hi, everyone. This is Elizabeth Casselow with the
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  Becker's Payer Issues podcast here at the April
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  2026 Payer Roundtable in Chicago.
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  I'm thrilled today to be joined by Nora
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  Leibowitz, chief Medicaid programs officer at CareOregon. Nora,
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  thank you so much for joining us today.
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  My pleasure.
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  So before we get into the questions, I
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  would love to hear a little bit more
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  about you and how you wound up at
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  CareOregon, what your background in health care is,
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  all of that fun stuff.
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  So,
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  I sometimes like to say that I ended
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  up in health care,
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  by standing on a bridge in Chicago.
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  This is a long time ago, but during,
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  the
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  Clinton administration,
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  you know, there were discussions about universal health
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  coverage. And I was
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  with a group
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  of other young folks, and we put banners
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  over the expressway
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  that said things like, are your breasts covered?
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  Better check. And then you would drive, and
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  I would say, call Senator Mosley Braun.
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  But that really got me interested in why
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  do some people have coverage and and what
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  impacts access and kind of all the the
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  whole world of,
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  of health care.
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  And so I went to grad school and
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  worked for the federal government for a while,
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  worked,
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  with the state of Rhode Island,
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  moved back to Oregon,
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  worked for the state
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  in the Medicaid program setting rates,
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  and then worked on the exchange side during
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  the ACA development days
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  before
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  acting as a consultant
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  and then moving into the payer space.
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  So I'd love to hear from your perspective,
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  especially on the Medicaid side of things, what
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  is the most pressing operational challenge that Medicaid
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  payers are facing right now and how is
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  CareOregon? Well,
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  I would say the biggest thing that's going
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  on for us and has been going on
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  for at least a year is related to
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  the state budget
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  and what that means for our ability
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  to pay for
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  appropriate care for our members
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  and also
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  not have,
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  member benefit ratios that are, you know, so
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  high that we can't function.
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  And I would really say that
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  we,
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  like many,
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  payers, saw a lull during the pandemic. People
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  weren't leaving their houses, weren't seeking care.
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  But then,
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  particularly
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  around
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  services like behavioral health care, we found
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  a significant
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  need. And this both the state agency and
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  CareOregon
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  put significant money into increased capacity.
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  We put in a $100,000,000
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  of,
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  of of new capacity
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  and increased rates for providers, etcetera.
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  Not surprisingly, you've increased access.
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  You know, you you make that more available
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  and you pay providers more, you're gonna see
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  more utilization.
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  So we have a
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  pretty intense
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  utilization
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  spike
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  that is not
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  matched by the state rates.
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  And that has been
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  that has been really a challenge for us.
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  I think the states
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  often see the managed care plans as having
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  very deep pockets and have the expectation that
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  we can just fund endlessly
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  without
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  being appropriately
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  paid.
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  So I would just say that's a multi
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  front response.
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  It's both
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  providing the data to
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  the state agencies so that they can appropriately
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  set rates.
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  It's also,
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  making our own internal changes and that's really
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  the operational piece of it, is getting our
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  ducks in a row. And then
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  we, in Oregon, are having a statewide conversation
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  about what does Medicaid look like,
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  whether that's do we make changes to benefits,
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  do we change administrative structures, etcetera.
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  Yeah. So building off of concerns around costs,
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  as you said, it's pressing in Oregon. It's
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  also pressing everywhere right now considering HR one
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  and other state budget concerns.
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  So, you know, there's this
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  tension between
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  keeping costs down and having a good member
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  experience.
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  And that's something you might see with care
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  coordination, for example. So how is CareOregon balancing
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  that cost containment while also still ensuring strong
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  member experience and quality?
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  We have historically
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  tried to be valedictorian
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  of everything.
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  And what that's meant is that when we
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  get,
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  advice from
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  our state regulators about what should be done,
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  We try to push that out, you know,
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  member experience to the to the nth degree.
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  And I think that has brought as a
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  culture for us has been really great, but
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  also is maybe not sustainable,
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  which is not to say that we're not
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  continuing to have the member at the center.
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  But the way that we talk about it
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  is
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  if,
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  a small community benefit organization is a one
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  and,
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  a for profit health plan that
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  in some theoretical world doesn't care about their
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  members and just wants to make money. Right?
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  Like, is a 10.
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  So both of those are kind of imaginary,
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  but we feel like we've been
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  a two and a half maybe. And we
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  don't wanna be a 10, but we do
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  wanna be a five.
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  So that has really meant
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  we continue to have a member focus. We're
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  thinking about the changes that we're making,
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  as ways to streamline
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  and both for members and for providers.
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  How do we make ourselves
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  frictionless?
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  So a lot of our changes have been
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  about
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  our internal operational changes, whether that's PA work
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  or whether that's credentialing, etcetera,
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  where we're saying we wanna
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  reduce the bumps in the road that both
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  are costly for our operations and are annoying
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  to providers.
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  I would love to chat a little bit
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  about digital engagement and transformation,
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  especially for the Medicaid population and certain barriers
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  they may face with that. So
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  how like, what sorts of technologies,
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  and types of AI are you prioritizing right
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  now when it comes to the Medicaid population?
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  How are you seeing ROI? And, also, how
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  are you seeing engagement with members if the
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  engagement is strong, if it still has room
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  for improvement?
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  What are you seeing there?
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  I think from my perspective, it's really
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  in some ways less about the technology for
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  its own sake. You know, every email that
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  everyone gets says AI will fix X, Y,
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  and Z. And what I really wanna know
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  is what does this do for us
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  and our ability to manage? And I think
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  about that in terms of
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  data accuracy
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  is a really good example where
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  if we are better able to have a
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  handle on our information
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  and we are sure that we are getting
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  the right information, that we're providing the right
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  information,
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  that that really
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  allows us to, as I said before, to
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  be frictionless with with providers and also to
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  make that member experience better. So
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  I think for
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  us, it's meant things like
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  eliminating
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  issues that we've had with our provider directory.
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  And this is, you know, none of these
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  are are
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  mind bending. These are things that
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  payers have an issue with all over. So
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  in addition, eliminating,
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  claims processing issues or simplifying our operations.
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  And all of those things come down to
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  the benefit of good data.
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  So that's been our that's been at core
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  of the kind of work that we're doing.
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  That makes a lot of sense. So where
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  do you,
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  I would love to hear, like, a little
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  bit more on that frictionless point. So
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  what great or is the greatest opportunity for
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  AI with reducing friction when it comes to
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  communicating with members and different administrative workflows
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  while still being personal?
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  Mhmm. One of the areas that we have
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  made a change is in customer service.
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  So
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  we have
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  a tool that is listening to all the
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  calls,
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  and that has multiple benefits. One is that
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  it's identifying
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  what are the topics that people are coming
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  up with, what are people struggling with.
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  Are our customer service agents able to answer
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  those questions in a meaningful way?
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  And then using those analytics,
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  we're doing things like training our customer service
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  agents, but we're also able to push out
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  information that where we're seeing a spike
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  in questions about a topic. So that has
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  direct member impact
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  that then also reduces the number of calls,
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  which means that people can get to an
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  agent quicker and they have a better experience.
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  Yeah. That's a really interesting case study, and
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  it'll be cool to see how the data
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  continues to play out that you gather over
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  time. Do you have anything else that you
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  wanna share, Nora, while I have you here?
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  I think advice? Yeah.
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  Oh, advice. That's that's a hard one. I
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  guess I would say
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  the experience as
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  a Medicaid focused
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  person, both working on the state side, working
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  for the feds, and as a health plan
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  person is
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  that
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  I think we undervalue
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  direct and clear communication
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  across
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  the sectors
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  so that there's a lot of health plans
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  wondering what it is that the state agency
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  means or the state is waiting on federal
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  advice. And I think the more that we
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  are in collaborative communication
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  to solve some of these thorny problems, the
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  better. And,
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  that just means basically that I'm gonna always
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  be asking the pushy questions.
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  Well, thank you so much, Nora, for joining
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  us today. Yeah, my pleasure. And to our
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  listeners, if you'd like to listen to more
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  podcasts from Becker's Healthcare, you can go to
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  beckershospitalreview.com.
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  Thank you.