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New Oregon Medicaid Director Emma Sandoe readies for challenges

Bearing a national health policy reputation, the new manager of the Oregon Health Plan will have to adapt to a very different program after working in North Carolina
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Emma Sandoe, Oregon's new director of Medicaid, will oversee care for 1.4 million low-income people in the Oregon Health Plan. She's shown speaking last week at the annual conference of CCO Oregon, a trade group focused on the regional care entities that manage Medicaid in the state. | COURTESY CCO OREGON
October 8, 2024

Even at an early age, Emma Sandoe’s parents told her, she was a “well actually” kind of kid who often corrected or supplemented what she heard others saying.

These days, getting things right could come in handy in her new position overseeing care for 1.4 million low-income Oregonians covered under the Oregon Health Plan.

Sandoe is now in her second month overseeing Oregon’s version of Medicaid. She joins the agency at a crucial stage as the state prepares to revise the five-year contracts governing the entities that manage OHP for the state, known as coordinated care organizations.

“Our role within the state really is to make sure that regardless of where you live, no one is getting suboptimal care,” she said from a lectern last week at the 2024 conference of CCO Oregon, a trade association composed of providers, care organizations and others. Rather, she said, the goal will be that “everyone is getting a really, really high level of care as we're moving from that coverage to access.”

Meanwhile, Sandoe and her colleagues at the Oregon Health Authority are also bracing for dozens of new legislative bills that could rewrite the rules for how the state oversees physical and behavioral health spending in the program. 

One bit of good news for Sandoe? After five years in North Carolina, she’ll be at a state that’s looked to as a national leader in Medicaid, she said at the conference.

“Quite frankly, that's why I'm here today, is because Oregon is the best,” she said to applause, shortly after divulging her parents’ description of her as a stickler at an early age.  

In North Carolina, watching her previous Medicaid program often be outperformed by Oregon, if only narrowly, was “really frustrating,” Sandoe added. She sparked chuckles with her next observation: “I may have also been a very competitive child.”

Now she’ll compete with high expectations. Can someone with a national reputation as a health policy wonk and expert now take the reins of the complicated, imperfect operational realities of Oregon’s program, and make it all work better?

She said she’s hopeful that her experience using policy mastery to respond to emergencies such as COVID-19 can help the state in times of wildfire or other stress, much as North Carolina has responded to its own natural disasters.

“Medicaid, at its strength and at its best, is that stabilizing force when there is tragedy,” she said.

Democracy focus turned to health care reform

Sandoe attended a public high school in Fremont, California, turning a senior-year history museum internship into a display on democracy and voting, hinting at her developing interest in society and public service. At the University of California, San Diego she double-majored in biology and political science.

She’d wanted to become a physician, but when she worked in a cancer ward she was struck by how many people could not pay for treatment, causing her to shift to a policy focus instead.

She earned her master’s degree in public health at George Washington University and worked at the federal Department of Health and Human Services during the rollout of the Patient Protection and Affordable Care Act. 

There, not only did she craft communication strategy and provide research for a Time Magazine article on hospitals and health care cost that became a prominent book, she also gained national attention for her leading role in crafting humorous health policy-themed Valentine’s Day messages, sparking a nerdy tradition that continued long after she left Washington, D.C. 

She then attended Harvard University to get her doctorate in health policy analysis. Her focus was Medicaid, with its ability to address health care inequities by providing free care to people who otherwise could not afford it.

In North Carolina, she served as the state’s deputy director for Medicaid policy, helping the agency chart its long-delayed expansion of Medicaid as well as its decision to contract with five private insurance companies, such as United Healthcare, to oversee regional care entities. The change led to criticisms of excessive administrative burden but also included new pilot programs with flexible spending to address health inequities. 

Sandoe also worked on efforts there to boost pay for home care workers, a move that sparked opposition and attacks by Congressional Republicans. 

Despite all this change, the state registered the nation’s largest percentage of Medicaid members to retain coverage even after the pandemic, when income eligibility checks resumed. Not only that, but it’s pursued an effort to leverage the state’s hospitals into erasing medical debt

In Oregon, Sandoe will work with health authority Director Sejal Hathi, who also spent time in North Carolina, to oversee Medicaid. Here, state leadership has sought to avoid consolidation of managed care under large private insurers, as done in North Carolina, and to prioritize community-based decision making and partnership.

Notwithstanding its good national reputation, the health authority has struggled both with its vision and with turnover, with some saying it has unfinished business on needed reforms. The agency lost Director Sejal Hathi’s predecessor, former Medicaid managed care executive James Schroeder, as well as the agency’s well-regarded previous Medicaid Director, Dana Hittle, during a time of change and high stress under new Governor Tina Kotek.

Sandoe, for her part, told The Lund Report that even though her job title in North Carolina was focused on policy, she ended up doing a lot on the operational side as well —  which should serve her well in Oregon. So should her mastery of federal policy and programs.

North Carolina had a lot of lessons learned during her time there, she said, not the least of which is how to build trust and a well-designed system. 

“I think that direct feedback with the community is just so vital to designing a program that works,” she said.

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