Building a Successful Medicaid-Public Health Partnership: Lessons from New Hampshire
August 17, 2026 | Orobosa Idehen, Cory Caldwell
Improving population health depends on intentional partnership, aligned priorities, and sustained collaboration between Medicaid and public health leaders. Strong Medicaid and public health partnerships can also help states make more efficient use of taxpayer dollars by aligning investments in prevention, health care delivery, and population health strategies to reduce duplication, improve coordination, and better target re
New Hampshire demonstrates this dynamic through its Department of Health and Human Services (DHHS), where both divisions work closely across financing policy and program efforts. Leaders emphasize that the partnership’s strength is rooted not only in structure but also in shared commitments to maternal health, rural health access, and population health goals. This is reflected in initiatives such as maternal health data summits and Rural Health Transformation Program planning that leveraged complementary expertise in financing, prevention, and population health.
To explore New Hampshire’s Medicaid-public health partnership and its impact on the state’s population, ASTHO and NAMD interviewed two members of the National Committee for Sustainable Medicaid and Public Health Partnerships (supported by HRSA’s National Organizations of State and Local Officials program): DHHS Associate Commissioner Patricia Tilley and Medicaid Director Henry Lipman. It offered insights into the structures that cultivated this partnership, its success and maturity, exchanges of assets between Medicaid and public health, and lessons for states considering how to mature their own partnerships.
Building an Integrated Structure for Close Collaboration
DHHS operates as a “super agency,” housing both the Division of Medicaid Services (under Lipman) and the Division of Public Health Services (under Tilley):
- The Division of Medicaid Services: New Hampshire administers Medicaid primarily through a managed care delivery system, with most services provided through managed care organizations and limited fee-for-service populations. The state elected to expand Medicaid coverage to the adult expansion population under the Affordable Care Act in August 2014 following the passage of the New Hampshire Health Protection Program. The Division of Medicaid Services oversees Medicaid and the Children’s Health Insurance Program (CHIP), providing coverage for children, pregnant women, parents and caretakers, older adults, and individuals with disabilities. It also oversees Medicaid waivers and plays a significant role in financing long-term services and support, as well as broader behavioral health initiatives.
- The Division of Public Health Services: This division leads the state’s public health efforts, including infectious disease control, chronic disease prevention, maternal and child health, immunizations, environmental health, and emergency preparedness. New Hampshire operates a decentralized public health system in which services are delivered through regional public health networks, municipal health officers, and community partners rather than county health departments.
This integrated structure has helped cultivate close collaboration between Medicaid and public health by enabling regular communication, shared problem-solving, and alignment around statewide health priorities. Tilley described Medicaid as having significant influence on policy and financing discussions throughout the department and across state government. She emphasized that Medicaid’s financing authority and broad impact on the state budget make it a central driver of access to care and policy decision-making. At the same time, she described public health as bringing a broader population-level perspective focused on prevention, community health, infectious disease response, regulatory oversight, and long-term health outcomes.
The close organizational proximity between Medicaid and public health has strengthened opportunities for routine collaboration. Tilley noted that the two divisions are often nearby, making communication and coordination more seamless. This structure has enabled the state to combine Medicaid’s financing expertise with public health’s policy and prevention expertise to better align efforts toward shared health outcomes for New Hampshire residents
Rooting in Sustained Relationships
While New Hampshire’s integrated structure creates opportunities for collaboration, both leaders emphasized that the strength of their partnership is also rooted in longstanding relationships and a shared commitment to improving health outcomes. For Lipman, health access and maternal health have remained central priorities throughout his career. These interests helped establish early connections with public health leadership, including Patricia Tilley. Similarly, a critical component of Tilley’s work — since joining New Hampshire DHHS nearly 26 years ago — has been identifying ways to leverage Medicaid financing to advance public health priorities and improve long-term health outcomes while reducing costs.
Both leaders identified maternal and child health as a foundational area of collaboration. Tilley highlighted ongoing efforts to address maternity care deserts and strengthen maternal health services across the state, while Lipman noted that Medicaid’s role in financing coverage and supporting access to care naturally aligned with public health’s prevention and population health goals
Celebrating Early Successes in Data Sharing
One of the partnership’s earliest major collaborative efforts was the development of a maternal health data summit. Tilley described the initiative as being guided by the principle, “I’ll bring my data if you bring yours.” Through this effort, Medicaid and public health staff worked together to compare data systems, definitions, and measurement frameworks that were often used differently across agencies. Tilley and Lipman explained that differences between Medicaid quality measures (e.g., HEDIS metrics) and public health indicators (e.g., CDC hypertension measures) sometimes created challenges in interpreting outcomes and aligning priorities. By jointly reviewing datasets and methodologies, Medicaid and public health teams were able to identify new opportunities for alignment and better understand how each agency approached shared goals.
The partnership has continued to evolve through shared policy work, regular communication, and a mutual commitment to improving health care access across New Hampshire communities. Tilley emphasized that the ability to convene shared partners — including health care providers, managed care organizations, and community organizations — has strengthened the state’s ability to advance coordinated policy priorities more effectively
Strengthening Statewide Initiatives Together
Tilly and Lipman described the state’s Rural Health Transformation Program planning efforts as a clear example of how years of collaboration positioned the agencies to work together effectively on a high-priority initiative
While Medicaid and public health teams had collaborated previously on smaller initiatives, the Rural Health Transformation Program application process required a far more coordinated and department-wide approach. Its urgency and complexity reinforced the importance of longstanding trust, communication, and shared leadership between divisions. Both leaders noted that their ability to align priorities, share expertise, and coordinate across teams allowed New Hampshire to develop a stronger and more cohesive strategy for rural health transformation. Reflecting on the partnership, they described the collaboration as combining complementary strengths from both agencies.
“We took the peanut butter from Medicaid and the chocolate from public health and built a Reese’s peanut butter cup for the Rural Health Transformation Program.”
Together, New Hampshire’s Medicaid and public health leaders demonstrate how integrated agency structures, strong interpersonal relationships, shared data efforts, and aligned policy goals can create durable partnerships that improve coordination and strengthen statewide health initiatives
Key Takeaways
These leaders leveraged integrated shared policy priorities, integrated agency structures, and strong interpersonal relationships to support sustainable Medicaid and public health partnerships in New Hampshire
Shared Policy Priorities
Throughout their partnership, leaders emphasized that meaningful collaboration depended on sustained communication, trust, and a shared commitment to improving health outcomes across the state. Identifying shared priorities early and building collaboration around common goals (e.g., maternal health, rural health access, and population health improvement) was critical. Leaders described how assessing existing relationships across agencies helped strengthen coordination and create clearer pathways for collaboration. In addition, efforts such as the maternal health data summit illustrated the value of aligning language, metrics, and data systems across agencies to better support shared policy and quality improvement efforts.
Integrated Agency Structures
The partnership also reflected the complementary roles Medicaid and public health play within state government: Public health brought expertise in prevention, population health, provider and consumer education, data analysis, and programs (e.g., Title V, immunizations, and the Ryan White HIV/AIDS Program). Meanwhile, Medicaid contributed expertise in health care financing, managed care oversight, provider regulation, policy tools (e.g., waivers and state plan amendments), and long-term funding sustainability. Together, these complementary strengths helped the agencies align financing, policy, and prevention efforts to support broader statewide health initiatives.
Strong Communication for Strong Interpersonal Relationships
Finally, leaders emphasized the importance of maintaining both formal and informal communication structures — including regular meetings, shared workgroups, and ongoing interagency coordination — to sustain collaboration and strengthen long-term partnership efforts
Opportunities to Improve Medicaid-Public Health Partnerships
Learning from New Hampshire’s experience, other states can work to improve Medicaid-public health partnerships by…
- Establishing a baseline understanding of aligned Medicaid and public health priorities.
- Assessing existing cross-agency relationships and opportunities for collaboration.
- Aligning language, metrics, and health outcome goals across agencies.
- Leveraging public health strengths in prevention, education, data, and subject matter expertise.
- Leveraging Medicaid strengths in financing, managed care, provider oversight, and policy mechanisms.
- Creating ongoing communication structures to support sustained partnership and coordination.
Reviewed by Susan Kansagra, MD, MBA, Chief Medical Officer and Alexandra Kearly, MPH, Senior Director, Population Health
