Big Moves, Bold Partnerships: How Public Sector Leaders Are Scaling Family Success Through Equity-Centered Innovation

Discover revolutionary approaches to Medicaid reform, early childhood development, and two-generation strategies that prioritize family voice, cultural responsiveness, and equity in public sector transformation.

Key Takeaways

• Public sector leaders must function as decision facilitators rather than decision makers, showing up in communities to build authentic relationships and understanding
• Qualitative data infrastructure is essential alongside quantitative systems, creating feedback loops between communities and policymakers for responsive governance
• Community co-creation should guide every step of policy development, with communities experiencing the most inequity leading design and evaluation processes
• Cultural responsiveness in public programs requires investing in community health workers, doulas, traditional healers, and trusted messengers rather than one-size-fits-all approaches
• Two-generation strategies succeed when states center families asking what they want rather than just what they need, avoiding scarcity mindset in program design
• Federal funding threats demand immediate relationship-building between early childhood advocates and legislators at all levels for sustainable advocacy
• Bearing witness to equity impacts during resource cuts enables strategic reinvestment when opportunities arise, maintaining focus on most-affected communities
• Civic engagement must become continuous rather than episodic, with public servants providing information for community decision-making beyond election cycles
• Success breeds success through positive reinforcement, building engagement through concrete wins that demonstrate the power of collective action
• Opening Acknowledgment — Recognition of recent political violence in Minnesota affecting leaders Melissa Hortman and John Huffman, establishing safety and equity context
• Leader Introductions — Dr. Nathan Chomalo (Minnesota Medicaid Medical Director) and Terresa Ramos (Illinois Early Childhood Director) sharing state-specific approaches
• Community-Centered Governance — Discussion of listening infrastructure, decision facilitation, and moving beyond policy expertise to family-centered design
• Medicaid Innovation Examples — Minnesota's doula benefit improvements, continuous coverage policies, and community engagement strategies for better health outcomes
• Early Childhood System Building — Illinois's new department creation through extensive community feedback, data integration, and asset-based community partnerships
• Federal Funding Threats — Analysis of potential Medicaid cuts ($500M-$1.6B in Minnesota, $3B early childhood budget in Illinois) and preparation strategies
• Partnership Success Stories — Examples from Southern Minnesota Initiative Foundation, Chicago data integration, and healthcare system community engagement
• Civic Engagement Vision — Emphasis on relationship infrastructure, voter engagement, and community governance models for sustained advocacy
• Bold Move Commitments — Leaders share next steps including budget development, maternal health transformation, and personal community-building strategies

Decision Facilitation: Transforming Public Sector Leadership

Both Minnesota and Illinois demonstrate a fundamental shift from traditional top-down governance to community-facilitated decision-making that prioritizes authentic relationships and local expertise.

• Decision facilitators rather than decision makers represent the new paradigm, with leaders like Terresa Ramos spending extensive time in communities - "showing up" across regions to build relationships and understand local needs.
• Listening infrastructure requires systematic investment beyond traditional policy-making capabilities, creating formal systems for ongoing community feedback rather than episodic engagement during crisis moments.
• Team-wide community engagement ensures entire agencies understand ground-level realities, with finance officers and operations staff participating in provider conversations to build institutional understanding.
• Regional variation recognition moves away from one-size-fits-all approaches, acknowledging that while system issues may be consistent, community needs and assets vary significantly across geographic areas.
• Relationship building precedes policy development with leaders emphasizing authentic connections and trust-building as prerequisites for effective governance rather than afterthoughts to implementation.
• Grace and persistence become essential leadership qualities, recognizing that both community members and government staff are at different stages of critical consciousness and change readiness.

"I really think about this role as not just as a decision maker but a decision facilitator" - highlighting the fundamental shift toward collaborative governance.

Qualitative Data Infrastructure: Beyond Numbers to Community Voice

Minnesota and Illinois are pioneering comprehensive data systems that value community expertise alongside traditional metrics, creating feedback loops for responsive policy development.

• Quantitative data infrastructure exists but lacks qualitative counterpart in most states, limiting understanding of how policies actually impact families and communities on the ground.
• Community engagement must be systematized rather than ad hoc, with formal mechanisms for ongoing input, feedback, and co-creation throughout policy development and implementation cycles.
• Integrated data systems reveal service gaps as Illinois builds statewide early childhood data integration based on successful Chicago pilots, enabling comprehensive understanding of where children receive services.
• Asset-based community assessment replaces deficit-focused analysis, highlighting existing strengths and resources that can be supported rather than creating entirely new programs.
• Continuous feedback mechanisms include diverse engagement options from intensive weekly participation to quick surveys, recognizing different community capacity and preference levels.
• Trusted community messengers serve as essential partners for information dissemination and feedback collection, leveraging existing cultural networks and communication preferences.

"We need a qualitative data infrastructure that also is giving information with our communities we serve, getting information back and really helping inform the policies and decisions."

Community Co-Creation: Centering Most-Affected Voices

Both states demonstrate how centering communities experiencing the greatest inequities leads to universal improvements while addressing specific cultural and structural barriers.

• Lead with communities experiencing most inequity because addressing their needs creates solutions that benefit everyone, while the reverse approach often leaves gaps for most vulnerable populations.
• Community-defined success metrics challenge traditional evaluation frameworks, requiring state agencies to share power over what constitutes effective outcomes and measurement strategies.
• Cultural specificity in service delivery includes supporting doulas, community health workers, traditional healers, and other culturally responsive providers rather than forcing communities into mainstream service models.
• Structural racism acknowledgment moves beyond individual bias training to systemic change, recognizing how policies and procedures exclude communities by design rather than accident.
• Asset mapping before problem-solving ensures community strengths and existing resources are identified and supported rather than overlooked in favor of external solutions.
• Policy co-creation from inception involves communities in design rather than just implementation, ensuring lived experience informs fundamental program structure and approach.

The approach recognizes that "things weren't always this way they were designed and so they can be designed a different way as well."

Medicaid Innovation: Health Equity Through System Transformation

Minnesota's Medicaid reforms demonstrate how state flexibility can address health disparities through community-responsive policy changes and cultural competency integration.

• Doula benefit transformation increased reimbursement rates from among the lowest to highest nationally, removing administrative barriers and practice requirements that excluded community-based providers.
• Continuous coverage for children eliminates re-enrollment requirements during first six years of life, addressing community feedback about bureaucratic barriers that interrupted care access.
• Community health worker integration expands beyond traditional medical models to include cultural healing practices and community-defined wellness approaches.
• Enrollment process simplification removes unnecessary administrative requirements that disproportionately affect communities experiencing structural barriers to healthcare access.
• Community engagement in benefit design ensures residents understand available services through trusted messengers rather than relying solely on state communication channels.
• Equity forums for system improvement bring together managed care partners, counties, community organizations, and religious groups for ongoing feedback and system refinement.

"We can improve it for our communities that have experienced the most gaps. It's going to improve it for everyone."

Early Childhood System Building: Family-Centered Agency Development

Illinois's new Department of Early Childhood exemplifies how to build public agencies based on community input rather than bureaucratic convenience or existing organizational structures.

• Family wants versus needs assessment moves beyond scarcity mindset to ask what families want for their children rather than just addressing deficits or problems.
• Provider partnership in system design includes childcare providers, early intervention specialists, and community organizations as co-designers rather than just service implementers.
• Data integration across programs enables comprehensive understanding of child and family service utilization while identifying gaps in coverage or coordination.
• Anti-racist human-centered design partnerships with specialized firms ensure equity principles guide program development rather than being added as afterthoughts.
• Neighborhood-level program customization recognizes that effective early intervention may look different in various communities rather than imposing uniform approaches.
• State operations alignment with community needs requires internal bureaucratic changes to support responsive service delivery rather than maintaining convenient administrative structures.

"We are starting with centering families we're asking them what they want and need not just what they need we don't want that scarcity of mindset."

Federal Funding Threat Response: Strategic Advocacy and Preparation

Both states face potential federal funding cuts requiring immediate advocacy while preparing for possible service reduction scenarios through community engagement and data analysis.

• Medicaid cuts threaten $500 million to $1.6 billion in Minnesota with Illinois facing $3 billion early childhood budget impacts including Head Start, requiring unprecedented state-federal coordination.
• Community education about program benefits helps residents understand what they could lose while building advocacy capacity through personal story sharing and testimonials.
• Equity impact analysis prepares decision-makers with data about which communities would be most affected by various cut scenarios, ensuring equity considerations in difficult choices.
• Relationship infrastructure with legislators must be continuous rather than crisis-driven, with early childhood advocates maintaining ongoing communication with state and federal representatives.
• Creative funding alignment explores how communities can leverage multiple funding streams and partnerships to maintain services during federal reductions.
• Bearing witness documentation ensures equity impacts are tracked during cuts to inform strategic reinvestment when resources become available again.

"Equity work doesn't stop or isn't just when there's plenty. It's also when there's cuts."

Partnership Innovation: Scaling Community-Driven Solutions

Both states demonstrate successful models for scaling local innovations through strategic partnerships that maintain community ownership while leveraging state resources.

• Regional foundation partnerships like Southern Minnesota Initiative Foundation enable local testing of programs before state-wide expansion, providing proof of concept and community buy-in.
• Healthcare system community engagement through initiatives like "Little Moments Count" brings private sector resources to early childhood development while building employer awareness.
• Data system scaling from Chicago's early childhood integration to statewide Illinois implementation shows how local innovation can inform broader policy.
• Anti-racist design partnerships with specialized firms ensure equity principles guide system development rather than being retrofitted onto existing approaches.
• Cross-sector collaboration includes community organizations, healthcare systems, employers, and educational institutions in comprehensive family support strategies.
• Community health worker integration demonstrates how traditional healing practices and cultural approaches can be incorporated into formal healthcare delivery systems.

These partnerships maintain community leadership while leveraging state capacity for broader impact.

Civic Engagement Infrastructure: Building Democratic Participation

Both leaders emphasize the need for continuous civic engagement that goes beyond electoral cycles to create sustained community power and advocacy capacity.

• Relationship infrastructure becomes the foundation for advocacy, with leaders encouraging community members to know their legislators and maintain ongoing communication.
• Information sharing for community decision-making positions public servants as resources for informed civic participation rather than sole decision-makers.
• Community governance models like community health center boards with 50% community representation inspire new approaches to public sector accountability.
• Positive reinforcement through concrete wins builds engagement by demonstrating that collective action produces tangible results for families and communities.
• Voter registration and civic education should be integrated into service delivery, helping families understand how political participation connects to their daily experiences.
• Leadership pipeline development includes supporting community members to run for office while building advocacy skills across the constituency.

"Our job is to really continue to move and I think one part two is like how are we governed? What are the incentives?"

Leadership Sustainability: Supporting Public Sector Champions

The conversation acknowledges the personal toll of transformative public sector work while highlighting strategies for sustaining leaders committed to equity and justice.

• Community support for leaders includes recognizing the challenges of working within systems while trying to transform them, requiring grace and persistence from all stakeholders.
• Personal relationship building through book clubs, community gatherings, and informal networks helps leaders maintain connection to their values and purpose.
• Collective problem-solving among peer leaders across states enables sharing strategies and providing mutual support during difficult periods.
• Bold move accountability includes public commitments to specific changes and innovations that maintain momentum for transformation.
• Grace for institutional change recognizes that both community members and government staff are at different stages of critical consciousness development.
• Celebration as core value ensures that wins are acknowledged and shared to build morale and demonstrate progress toward larger goals.

"Distraction is a strategy of folks who want to see progress derailed" - emphasizing the need for sustained focus on equity goals.

Common Questions

Q: How do states build authentic community engagement beyond consultation?
A: Through systematic listening infrastructure, decision facilitation rather than top-down control, and continuous relationship building across regions.

Q: What makes Medicaid reform successful for health equity?
A: Community co-creation of policies, cultural responsiveness in service delivery, and centering communities experiencing greatest health disparities.

Q: How can early childhood systems better serve diverse families?
A: By asking families what they want rather than just addressing deficits, building data integration, and customizing programs to neighborhood assets.

Q: What strategies help during federal funding threats?
A: Continuous legislative relationships, community education about benefits, equity impact analysis, and bearing witness to document cuts' effects.

Q: How do successful partnerships maintain community leadership?
A: By scaling local innovations while preserving community ownership, using trusted messengers, and ensuring shared power in design and evaluation.

The transformation of public sector leadership toward equity requires fundamental shifts in governance, relationship-building, and community engagement that prioritize family voice and cultural responsiveness over bureaucratic convenience.