Putting people first in Medicaid modernization

As Executive Managing Director of our Medicaid Enterprise Services business, Donna Migoni is committed to transforming service delivery to ensure seamless and empathetic experiences across all touchpoints, supporting states in their mission to improve the health and wellbeing of the people they serve.

With over three decades of leadership in government health and human services, Donna brings invaluable insights into the complexities of government-operated health services. She led the development and implementation of the previous generation of Medicaid Management Information Systems (MMIS) and has been a key figure in the shift toward Medicaid Enterprise modularity. Donna has also overseen fiscal agent operations and government health business units, positioning her at the forefront of Medicaid modernization efforts. 

At Maximus, she focuses on solutions and services that improve both provider and member experiences. She envisions a future where Medicaid solutions are not only effective, accurate, and flexible, but also enable state Medicaid and public health programs to fulfill their missions and support the needs of the most vulnerable populations.

We spoke with Donna to delve deeper into her extensive career journey and her strategic outlook for the future of Medicaid services.

For those entering the Medicaid industry, it's important to approach this field with a combination of operational focus, technical skill, and a deep sense of mission. Understand that every call we answer, provider we enroll, piece of code we write, every project implementation, and process improvement has the potential to significantly affect people's lives. My advice is to strive to maintain a focus on the ultimate goal of Medicaid: to improve health outcomes and provide necessary support to the most vulnerable populations. Stay informed about changes in program and healthcare policies, be adaptable to new technologies, and cultivate empathy for the users (both direct and indirect) of our solutions.

Government and its partners need to shift the focus from merely upgrading or replacing technology to truly enhancing the user experience for both Medicaid providers and members. It is crucial to prioritize the operational aspects that directly affect service delivery. This includes simplifying provider enrollment processes, improving the responsiveness of call centers, and ensuring that claims are processed efficiently and accurately. Ultimately, the goal is to make the healthcare experience as seamless and supportive as possible for those who rely on Medicaid services.

Self-service portals offer providers a single point of entry for streamlined enrollment, eligibility verification, claims submission and status, and in some cases, centralized credentialing. This allows for direct interaction with a state's Medicaid agency or fiscal agent, connecting to the MMIS or claims processing module, financial module, provider enrollment, reporting, and other MES entities.

But ensuring that technology continues to align with providers’ needs involves continuous engagement with stakeholders, including state agencies, healthcare providers, and other module vendors. It requires a commitment to understanding each group’s specific perspectives, challenges, and requirements and integrating this feedback into system design and functionality. Additionally, leveraging data analytics and user feedback can help identify gaps in service delivery and areas for improvement.

My guiding principle has always been to remember the human impact behind every decision and every project. Whether it's streamlining a process or introducing a new technology, the focus should always be on how these actions affect the individuals who depend on Medicaid. This human-centric approach ensures that even as we navigate technological and administrative complexities, we never lose sight of our ultimate responsibility: to serve and support our communities effectively and compassionately.

For the rest of my career, I see my job as changing the industry for the better, however small that may be. My Maximus MES team is the best in the industry, and I don’t say that lightly. They have program, operations, and technical experience and expertise, but more importantly, they have a deep commitment to program delivery and a passion for the mission of helping those we serve. Together, as industry and state partners, we can tackle the most difficult of challenges and deliver solutions and services that make a difference.