The North Highland HHS team recently returned from the 2025 Medicaid Enterprise Systems Conference (MESC), where state leaders, federal partners, and industry experts came together to exchange ideas and strategies for advancing Medicaid modernization. A clear theme emerged across sessions: real progress requires collaboration, foresight, and practical execution to ensure systems deliver value early and often for beneficiaries, states, and taxpayers.
MESC 2025 underscored that modernization is not only about technology. It is equally about leadership, vision, and shared responsibility. By aligning with federal direction, strengthening cross-agency collaboration, leveraging data, and working with trusted partners, states can continue to advance systems that improve health outcomes and deliver measurable value.
Federal Direction and Proactive Planning
New federal guidance is reshaping expectations for planning and oversight. States are being encouraged to focus on sustainability, moving beyond short-term compliance activities toward strategies that strengthen Medicaid systems for the future. Clearer frameworks and standardized processes help streamline reviews, but success requires a proactive approach. Building strong business cases, conducting cost-benefit analyses, and engaging early with federal partners are critical to keeping modernization moving forward in the most cost-effective way.
States are also eager to understand how AI could help expedite and simplify modernization efforts, representing a growing area of interest as agencies seek innovative approaches to complex implementation challenges.
Collaboration Across Agencies and Stakeholders
Successful modernization depends on stronger partnerships between Medicaid and IT agencies. Leaders reflected on the ongoing challenge of balancing day-to-day operations with long-term transformation. In times of fiscal uncertainty, collaboration becomes even more important. Aligning program priorities with IT capacity, sharing resources, and working transparently with federal and state stakeholders were highlighted as essential steps to reduce risk and maintain momentum.
A recurring theme throughout sessions was the challenge states face in managing multiple vendors and ensuring effective collaboration across MES projects. This complexity underscores the importance of strong governance frameworks and clear collaboration and communication protocols.
Data-Driven Transformation
States are rethinking how they manage and use data. Traditional data warehouses have often limited actionable insights, but new approaches are helping agencies move from data collection to real-time decision-making. Purpose-built data environments, cloud adoption, and stronger governance frameworks are enabling advanced analytics in areas such as eligibility, care coordination, and payment accuracy. This shift is creating more responsive systems that serve members more effectively.
Modernization in Practice
States shared real-world lessons from their modernization journeys. Massachusetts reflected on the complexities of updating legacy systems while balancing cost, risk, and stakeholder expectations. New Mexico showcased how their Health Care Authority is addressing data fragmentation by building modern data services designed to turn information into action. These examples reinforced that modernization is not a one-size-fits-all process. Each state must tailor solutions to its own priorities and constraints.
Across all regions, states face remarkably similar challenges, though their specific needs vary based on where they are in their modernization journey—whether in procurement, design development implementation, or production phases.
Partnering for Impact
Gregg Dunning, Managing Director at North Highland, joined Craig Golden, Enterprise Architect at the Georgia Department of Community Health, to highlight how strong public-private partnerships can accelerate modernization. They emphasized the importance of building trust between state leadership and implementation partners, structuring efforts to achieve incremental and lasting impact, and maintaining clear communication and governance to keep stakeholders aligned.
A key point of discussion was the value of structured testing in reducing risk. By embedding testing services into implementation plans, states can create accountability across organizational boundaries, validate and accelerate progress at each stage, build confidence among stakeholders, and move forward with clarity. Their session reinforced how both thoughtful collaboration and disciplined execution can help states modernize with confidence.
The conference's collaborative spirit was evident throughout, with meaningful connections made across the hundreds of attendees representing state agencies, federal partners, and industry experts.
