After Transforming And Expanding The Program, Nc Medicaid Director Steps Down

By Jaymie Baxley

After 3 years astatine nan helm, Jay Ludlam is stepping down arsenic head of North Carolina’s Medicaid program.

Ludlam’s tenure included North Carolina’s description of Medicaid, a decade-in-the-making endeavor that has fixed much than 710,000 low-income residents entree to sum since December 2023. As of February, group who joined nan rolls done description relationship for astir a 4th of nan state’s 3.09 cardinal beneficiaries.

His departure comes amid national changes that frighten nan program’s future. Ludlam has many times warned authorities lawmakers they must return action to sphere description earlier Medicaid activity requirements and different provisions of President Donald Trump’s One Big Beautiful Bill rule go into effect adjacent year.

Though Ludlam said he’s concerned astir each of nan challenges facing Medicaid successful nan adjacent term, he’s not worried astir nan capacity of nan group who will prime up wherever he’s leaving off.

“This is 1 of nan champion teams I’ve worked with. They are incredibly dedicated, incredibly smart, really cognize their work, lead pinch their bosom — and present for North Carolina,” he said. “I worked successful Silicon Valley successful nan ’90s, erstwhile it was each these entrepreneurs and consultants, and this squad really puts them each to shame.”

When Ludlam was tapped to win erstwhile lawman caput Dave Richard successful March 2023, he came to nan domiciled pinch a heavy bid of Medicaid argumentation and operations.

He had spent 5 years arsenic nan state’s adjunct caput for Medicaid transformation, shepherding North Carolina’s displacement from a accepted fee-for-service exemplary to managed attraction — a sweeping overhaul designed to power costs, amended coordination and necktie payments much intimately to diligent outcomes. After having led Missouri’s move to managed attraction arsenic nan acting head of that state’s Department of Social Services, Ludlam had nan acquisition and knowledge to shepherd North Carolina’s programme done nan shift, Richard said.

“We were conscionable incredibly fortunate to get Jay astatine nan clip we did because nan modulation [to managed care] was massive, and we had ne'er done thing to that size,” Richard said. “When Jay came in, he had awesome operational skills and created a building wrong nan statement that allowed for what I deliberation was a beautiful dang soft transition.”

The activity that went into Medicaid translator was mostly invisible to beneficiaries. They conscionable saw their sum continuing without disruption. 

“I deliberation 1 of nan things that I had learned successful Missouri that we were capable to do present was to thief modernize nan soul activity that we do astatine North Carolina Medicaid,” Ludlam said. “We brought business principles to our work. We focused connected information and transparency. We focused connected improving our expertise to forecast budget, to beryllium capable to measurement outcomes.”

Those changes, Ludlam added, person created a stronger business operating exemplary and an organizational civilization that allows nan section to “provide much consistent, little risky rollouts for nan state.”

For North Carolinians who dangle connected Medicaid, nan value of programme activity seldom registers — unless thing goes wrong. Smooth enrollment, seamless scheme transitions and reliable entree to attraction don’t hap by accident. They are nan merchandise of administrators who understand some nan argumentation mechanics and nan quality stakes, and who build organizations tin of executing connected a ample scale. 

An ‘incredible legacy’

Kody Kinsley, nan erstwhile caput of nan N.C. Department of Health and Human Services who picked Ludlam to tally nan programme aft Richard’s exit, said Ludlam grew into 1 of nan astir tin Medicaid administrators successful nan country.

“Jay’s method prowess and capabilities arsenic an operational leader are 2nd to none,” Kinsley said. “He really delivered successful an immense measurement and, frankly, successful a batch of ways that galore group will ne'er know.”

Jay Ludlam successful May 2025. Credit: N.C. DHHS

That behind-the-scenes operational prowess was cardinal to nan state’s successful rollout of description , Kinsley said. Nearly 273,000 recently eligible beneficiaries were automatically enrolled erstwhile nan measure, which raised nan state’s strict income period for Medicaid, went unrecorded connected Dec. 1, 2023.

“Once it was enacted, we were capable to make judge that group who qualified for nan programme connected Day One had a paper successful hand,” Ludlam said. “We knew that they were qualified. They didn’t person to capable retired a form. They didn’t person to telephone a telephone number. They didn’t person to show up to a DSS office. They sewage nan paper and were capable to entree attraction immediately.”

National leaders took note. The National Association of Medicaid Directors recognized Ludlam and his squad successful 2024 pinch its Spotlight grant for “exceptional activity and innovation.” 

The relation cited North Carolina’s implementation of description and its handling of nan “unwinding” — nan yearlong process of reviewing enrollees’ continued eligibility aft nan national authorities ended sum protections that were enacted during nan COVID-19 pandemic — arsenic examples of nan program’s operational excellence.

In summation to those milestones, Ludlam oversaw nan state’s long-awaited rollout of “tailored” Medicaid plans for beneficiaries pinch analyzable needs. These specialized plans, designed to coordinate beingness health, behavioral wellness and semipermanent attraction services for group pinch superior intelligence illness, constituent usage disorders and intelligence aliases developmental disabilities, marked a important measurement toward integrating attraction for immoderate of nan program’s astir susceptible enrollees.

Working crossed nan aisle

Kinsley said Ludlam “leaves an unthinkable bequest of delivering connected nan legislature’s imagination of really Medicaid should operate” — a position echoed by lawmakers.

“Over nan clip I worked pinch Jay, I recovered him to person a wealthiness of knowledge,” said Rep. Larry Potts (R-Lexington), who presides complete nan state’s Joint Legislative Oversight Committee connected Medicaid. “He was ever disposable and, pinch his varied background, he was a go-to personification erstwhile situations arose requiring speedy responses.”

Rep. Donny Lambeth (R-Winston-Salem), a co-chair of nan committee, said nan outgoing head “left his mark” connected North Carolina’s Medicaid program.

“He was cardinal to expanding Medicaid to thousands of our citizens who could not spend wellness insurance,” Lambeth said, adding that Ludlam “had a passion for helping beforehand nan programme to 1 of nan premier government-sponsored programs successful nan country.”

Jay Ludlam successful March 2024. Credit: N.C. DHHS

Ludlam’s expertise to support productive relationships pinch Republican authorities lawmakers — moreover arsenic their legislature counterparts were advancing sweeping Medicaid cuts successful Washington — reflected a deliberate attack to keeping argumentation conversations grounded successful North Carolina’s reality and circumstances alternatively than nationalist politics.

“During nan One Big Beautiful Bill debate, location was a batch of misconceptions connected nan portion of legislature legislative staff, North Carolinians that were moving successful offices up successful D.C. aliases legislators themselves about” who Medicaid serves, he said. He added that galore successful Washington persisted successful holding a “1980s position that it’s a societal use program.”

The reality, he said, is that moving adults successful agrarian communities thin to trust connected Medicaid much than immoderate different group.

“After Obamacare, it became a wellness security programme chiefly for moving individuals,” Ludlam said, utilizing nan communal nickname for erstwhile President Barack Obama’s Affordable Care Act. “Those individuals who aren’t moving mightiness beryllium excessively sick to activity aliases excessively disabled. They mightiness beryllium caregiving aliases successful school.”

Medicaid activity requirements, a arguable proviso of nan OBBBA law, will return effect successful January 2027, forcing “able-bodied” enrollees to beryllium they are working, volunteering aliases attending schoolhouse for astatine slightest 80 hours a period to support their benefits.

Ludlam called nan looming instruction 1 of nan “most analyzable programme changes” for Medicaid. He noted that erstwhile attempts to necktie eligibility to employment, specified arsenic Georgia’s Pathways to Coverage initiative, person been costly misfires.

“Most Medicaid programs person grounded astatine this successful nan past, and they had a batch much clip and a small spot much clarity than we presently do now,” he said. “I deliberation that location is simply a batch of consequence crossed nan state successful whether aliases not activity requirements are going to beryllium implemented successful a measurement that really supports moving people.”

But nan much devastating consequence of nan national law, Ludlam said, will beryllium North Carolina’s nonaccomplishment of much than $50 cardinal successful national backing for Medicaid complete nan adjacent 10 years. 

“That’s going to beryllium a situation for nan authorities to fig out,” he said, adding that nan mislaid gross threatens to undo strides nan authorities has made successful improving entree to attraction for agrarian residents. “We person built strategies, bipartisan strategies, to support our agrarian communities, and we put 12 years of sweat equity into supporting agrarian communities and agrarian hospitals. Now, we’re going to person to look for caller strategies and caller techniques.”

Taking lessons nationwide

Ludlam is leaving NC Medicaid to return connected a activity position astatine Molina Healthcare, a managed attraction institution that has many times made nan Fortune 500 list. 

“My attraction will beryllium connected trying to bring a batch of nan lessons that we learned present successful North Carolina to different states,” he said of his domiciled astatine Molina, pointing to nan state’s now-defunct Healthy Opportunities Pilot arsenic a exemplary worthy replicating. 

Launched successful 2022, nan first-in-the-nation inaugural utilized Medicaid dollars to provide nutrient deliveries, transportation to appointments and other nonmedical services to agrarian residents facing important barriers to health. An independent evaluation recovered that nan aviator programme lowered participants’ health attraction costs by up to $1,020 a year, but it was shuttered aft lawmakers decided to discontinue its backing successful 2025. 

Jay Ludlam addresses lawmakers successful April 2024. Credit: Jaymie Baxley/NC Health News

Ludlam besides hopes to dispersed what he sees arsenic North Carolina’s unique civic culture. 

“We tin count connected our neighbors. We tin count connected each other. Not each authorities is for illustration that,” he said. “I deliberation that’s missing and should beryllium broadly shared.” 

Melanie Bush, nan state’s adjunct caput of Medicaid, has been named interim lawman secretary. Ludlam expressed assurance successful his successor, calling Bush — who is celebrating her 15th twelvemonth pinch nan agency — an easy choice.

“Melanie is exceptional,” he said. “She’s been described to maine arsenic a stone star, and I person ever been impressed pinch her work.”

Bush brings cross-state acquisition that Ludlam said mirrors his ain path: She worked successful Texas Medicaid earlier coming to North Carolina, and nan 2 person collaborated connected Medicaid translator for 8 years. He credited her arsenic nan superior designer of nan state’s attack to nan unwinding.

“She really focused connected really do we make judge that group who are eligible and are willing successful staying connected Medicaid are successful nan programme — but arsenic importantly, those group who don’t suffice for Medicaid are not successful nan program,” Ludlam said.

Her inheritance besides includes a stint astatine nan legislature’s fiscal investigation division, giving her a fluency successful nan fund process that Ludlam said will service her good arsenic nan programme confronts its national backing challenges. 

“I deliberation she’s awesome and will beryllium awesome for North Carolina,” he said. “I’m really excited for her.”

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