The director of Maryland’s Medicaid program will be leaving the job this summer as federal lawmakers consider cuts that state officials have estimated could reach $1 billion.

Ryan Moran will start a new position as director of the Washington State Health Care Authority this August. He has headed Medicaid, the state health program for low-income residents, for just over two years.

“I look forward to advancing the work and mission of the agency in such a critical time for health care nationally and am committed to ensuring those we serve receive access to integrated, person-centered care,” Moran said in a statement released by the office of Washington Gov. Bob Ferguson.

Moran is Maryland’s deputy secretary for health care financing in addition to its Medicaid director. He’s the second departure of a deputy health secretary from the Maryland Department of Health after Dr. Meena Seshamani took over in April as health secretary.

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She announced that Dr. Nilesh Kalyanaraman, deputy secretary for public health services, was “leaving state service” in a message to staff in May about leadership changes. He served for just over two years.

The high-level exits come as federal health leaders consider major changes to vaccine guidance and opioid treatment programs. The state health department is also working to rewrite its own opioid treatment program regulations.

Kalyanaraman also oversaw for a time the Office of Health Care Quality, which is responsible for health facility inspections. The office has come under scrutiny for failure of proper and timely inspections and currently faces a lawsuit by the Public Justice Center and other advocates on behalf of disabled residents.

“No doubt she inherited a lot of problems,” said State Sen. Pamela Beidle, chair of the Senate Finance Committee, about Seshamani. They include the lack of nursing home inspections, lapses in oversight of opioid treatment programs and the poor conditions at state’s top forensic hospital, as well as the potential Medicaid shortfalls.

Beidle said it makes sense that Seshamani would want to replace some staff and others would choose to go during the transition. Other key people who left the department, include Erin McMullen, the chief of staff, and communications director Chase Cook.

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But it’s the Medicaid leadership that may be top of mind for the state’s lawmakers, who will be faced with trying to plug some massive gaps in the program that serves some 1.7 million Marylanders, or 1 in 4 residents.

“I am really concerned,” Beidle said. “We know changes are coming and we’re going to lose coverage for people. It’ll affect everything, our health exchange, our emergency rooms.”

Beidle noted that Seshamani was a deputy administrator at the U.S. Centers for Medicare & Medicaid Services during the Biden administration. Beidle felt confident she’d find competent replacements for the state’s deputy health secretaries.

Del. Joseline Peña-Melnyk, who chairs the House of Delegates committee that oversees health issues, described the outgoing deputies as “easy to work with and extremely knowledgeable. They will be hard to replace.”

In a statement on Friday, the department wrote that its officials were committed to preserving access to health care coverage and would “continue to collaborate with federal partners and advocate for policies that safeguard the health and well-being of all Maryland residents.”