The Policy Stack Podcast #Ep 2: Key Lessons from Nikita Singareddy

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Nikita Singareddy founded Fortuna Health to build the "Turbo Tax for Medicaid" after becoming obsessed with the bureaucratic maze that causes 20% of Medicaid enrollees to lose coverage annually, not because they're ineligible but because they can't navigate the paperwork. Singareddy’s deep dive into the 56-system complexity of American Medicaid offers crucial insights for anyone working on healthcare policy implementation and government technology. Here are key lessons from Lisa Bari's conversation with Nikita Singareddy on the Policy Stack Podcast:

1. Every Case is an “Edge Case” in Government Systems

Most tech companies build for common use cases and handle edge cases later. But Singareddy discovered that in Medicaid, almost every case is an edge case. With 56 different state systems, each having unique rules, the traditional tech approach fails completely. Counties add another layer of complexity, while beneficiaries navigate complex life circumstances. Therefore, success requires building systems that consider complexity as the norm, not the exception.

2. Technology Problems Require Policy Decisions First 

Singareddy learned that AI and automation only work after states make fundamental design decisions. When eligibility workers are trained differently and have conflicting information, technology can't solve underlying confusion. States must decide the right pathway before automation can take over. Putting technology before policy decisions leads to expensive failures.

3. Legacy Infrastructure Cannot be Ignored

Many state Medicaid systems are over a decade old, with some running 2-3 concurrent systems simultaneously. These government websites literally become unavailable outside business hours, which is unthinkable in modern web design. They don't work on mobile phones and take 10-15 days to process simple requests. Rather than pretending these constraints didn't exist, Singareddy's team built around them while pushing for modernization.

4. Ensure That Data Exists Before Formulating Policies 

When states implement work requirements, they discover needed verification systems simply don't exist. PEO systems track income but not hours worked. Self-employed workers, seasonal employees, and cash-paid jobs create verification nightmares that policy designers never considered. Successful policy implementation requires understanding these ground-truth realities before writing the rules.

5. Optimize Tech for the Enrollees

While others get caught up in political battles or vendor relationships, Singareddy's team maintains one principle: always optimize for the enrollee experience, regardless of who pays the bills. This clarity helps them navigate complex stakeholder relationships and build trust across political divides. Sometimes they help people navigate to outcomes the beneficiary doesn't like. But they still follow this north star.

6. Crises Requires Collaboration Over Competition

The complexity of Medicaid is simply too great for any single entity to solve alone. With H.R. 1 introducing work requirements and increased recertification creating new pressures on Medicaid systems, Singareddy believes unprecedented collaboration is needed. Instead of traditional adversarial procurement where vendors compete against each other, she advocates for "Tiger teams." These cross-sector teams can iterate quickly when implementations fail.

Want to hear how Singareddy navigated building technology for America's most complex policy landscape? Discover principles for government technology that actually serves people? Listen to the full Policy Stack Podcast episode here.