This past June, I was sitting at my computer, looking at a tiny Slack notification and screaming with joy. Hawaii’s Med-QUEST division, the Medicaid program that covers just under 400,000 people, had just approved a customer experience team modeled on the product operating model for government: an engineer, a product manager, a designer, and a chief customer experience officer, reporting directly to the Med-QUEST Administrator. Its success is measured by outcomes for residents: more successful renewals, fewer people dropping off mid-application, and fewer procedural terminations. As far as we can tell, no other state has one (yet!).
That team came about through hard work from the Medicaid folks in Hawaii and Tech Talent Project’s Medicaid Delivery Innovation Initiative (MDII) team, who began working together in October 2025. In seven weeks, they found quick wins that made Medicaid more accessible to eligible people. Then they turned to the harder job: building an in-house team to sustain that work.
Early, quick wins show change is possible and creating effective teams is what makes it stick. The MDII team worked alongside Hawaii for months, through the hard parts. Hiring cross-functional roles is harder than it should be inside government (see How to Peel a Banana), and creating these roles took sign-off from the governor and the legislature. The team helped the state build the conditions to make those hires and brought best practices for hiring qualified tech team members.
Let’s be clear: many people implementing government programs dread an outside team arriving with “We’re from tech and we’re here to help.” They’ve heard it from folks who were expensive and didn’t deliver. So we show up and work alongside Medicaid teams and leadership: a few weeks beginning to learn how things actually work, then a few weeks partnering with state Medicaid teams to fix something.
On the ground, we meet leaders who deeply understand and deeply care about serving the public, and dedicated teams who brute-force the work when tech systems break or underperform. When we’re invited in, we often ask questions no one has asked yet, find the highest-leverage opportunities to increase automated renewals, reduce procedural terminations, and reduce worker burden. And then we help implement improvements.
In my last post, I wrote that government is solid until it isn’t. It holds firm at rest and moves when enough force hits it – during crisis or transition. Two forces are about to hit at once in January 2027.
First, 36 states elect governors this fall, and at least 18 will get a new one. Even where incumbents win, new senior staff may arrive, creating new mandates for teams. Second, starting January 1, 2027, 44 states (including DC) must make Medicaid eligibility for millions of adults dependent on meeting work requirements, and those adults will have to show they qualify every six months when they renew. The Congressional Budget Office estimates the law’s Medicaid changes will leave 7.5 million more people uninsured in 2034.
Together, these forces hit several indicators of crisis (hat tip to the authors of Crisis Engineering) for many state Medicaid programs. When the ground moves in 2027, teams need to be in place to help states settle in a way that fixes systems rather than relying on individual workarounds to solve systemic problems. In Hawaii, what’s staying is a team of their own.
Leadership Roles We’re Hiring for: Engineering, Product, Design, Delivery, and Engagement
Want to help make this happen? We’re working with eight states in our 2026 cohort and will work with many more in 2027, so Tech Talent is expanding our own delivery team and looking for leaders with five key skill sets:
- Engineering Leadership: knows what good looks like and holds vendors, and the agency itself, to that standard.
- Product Management Leadership: pulls people together across programs to solve the real problem.
- Design Leadership: figures out how a service should work for the people using it, starting with a sludge audit that finds where people get stuck, give up, or make an error.
- Org Delivery Leadership: figures out what tech capacity a state needs to better serve its residents, finds a hiring path the state can fund, and stays until the team is in place. A product or delivery background will help.
- Engagement Leadership: leads our sprint team day to day and runs each state engagement from kickoff to final briefing, making the process better with every state.
Good ideas become outcomes through people: messy, deeply skilled, and definitely caring people. The right folks have grit and experience leading teams through tough challenges. We’re looking for expertise as a baseline, plus brains as big as Saturn and hearts as big as Jupiter.
We’re a small but mighty team, and this search comes as we do important work finding amazing talent for state Medicaid programs in Hawaii and New Jersey. Here’s how it works: fill out the interest form below, and we’ll send those who are interested a link to apply. We’ll review applications quickly, choose the top three candidates for each role, and interview them.
This is some of the hardest and most rewarding work you’ll ever do. We’re looking for candidates to join us as early as October, and by January all hires will be actively working with a state, analyzing data or improving a system that an eligible family needs to keep their coverage. If that’s you, fill out the interest form below.