This month’s Vital Viewpoints podcast features a special conversation with Jay Rosen, founder, president, and chairman of Health Management Associates (HMA), as he reflects on the evolution of Medicaid and the 40th anniversary of HMA’s founding. From his early days shaping Michigan’s Medicaid program in Michigan’s Office of Health and Medical Affairs, to building a national firm dedicated to public sector healthcare, Jay’s story is one of purpose, persistence, and visionary leadership. Over four decades, Jay has guided HMA’s strategic vision, growth, client service, and innovation in publicly funded healthcare.
Jay began his career at a time when Medicaid was still finding its footing. In the 1970s and early 1980s, states were grappling with how to operationalize a new federal promise—healthcare for low-income and aging Americans. Jay saw firsthand the complexity and urgency of that challenge. But he also saw opportunity: to build something better, smarter, and more accountable. That vision led to a fateful meeting at a Big Boy diner in East Lansing, Michigan, where Jay, Paul Allen (Michigan’s then Medicaid director), Elliot Wicks, and Jay Endsley laid the groundwork for what would become HMA on June 13, 1985, the date HMA was founded.
The 1980s saw extreme economic distress in the U.S., with healthcare costs rising by 1,520% annually. Pressure on the federal government to reduce financial support for public sector health programs meant state governments had to lead the way. Managed care emerged as a novel idea, using risk-bearing intermediaries between the state as a payer and providers/consumers. Michigan was an early adopter of managed care.
Over the next four decades, managed care programs evolved to bring more accountability in Medicaid, transforming the state’s role from administrator to regulator. The state agency could focus on using its levers to improve performance of public programs. Reporting requirements, data-driven decision making, quality measurement and other innovative tools were introduced.
“One-third of the country is on Medicaid, covering 90 million people, including the most expensive, vulnerable populations. Medicaid operates well despite financial challenges, addressing significant societal obligations,” says Rosen.
Now, as we celebrate the 60th anniversary of Medicaid in July, the program faces new operational and financial pressures, but also new tools — like AI and digital health technologies to meet the moment. Innovation in Medicaid isn’t optional, it’s essential. HMA experts work with states and other organizations to harness these tools and stay current with these new initiatives.
Hear more from Jay in this month’s podcast episode, “Medicaid At (Another) Crossroads: The Future of Public Healthcare Coverage”. And as you look ahead to the future of Medicaid, trust HMA to be your partner for the next 40 years to come. #HMAknowsMedicaid