Weekly Roundup -
September 2, 2026
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Modernizing and Streamlining Health Plan Prior Authorization
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Closing the Care Continuity Gap in Substance Use Disorder
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Trending: In Focus
Federal and State Medicaid Leaders and VA Assistant Secretary to Discuss Public Healthcare Transformation at HMA Conference
Health Management Associates (HMA) is pleased to announce that Caprice Knapp, PhD, Principal Deputy for the Center for Medicaid & CHIP Services, will participate in two sessions at HMA’s US Healthcare 2026: Signals, Signs & Flashing Lights conference, October 5-7, 2026. in New Orleans, LA. As states, plans, providers, and community partners prepare for a new era in Medicaid and other public healthcare programs, these conversations will focus on practical solutions, implementation realities, and the partnerships needed to move from policy change to sustainable results.
State Medicaid and CHIP Strategies for Applied Behavior Analysis and Autism Services
As the prevalence of autism has increased, state investments in Applied Behavior Analysis (ABA) and related services have grown substantially. This preconference session will examine federal guidance and state strategies for supporting appropriate, high-quality care for children with autism while helping programs strengthen oversight, access, and service delivery.
Medicaid Policy Changes and Their Ripple Effects Across Healthcare
Changes in Medicaid policy and financing will not stay confined to Medicaid. Coverage churn across Medicaid, the Affordable Care Act (ACA) Marketplace, and employer-sponsored insurance can reshape risk pools, influence plan participation, increase provider financial exposure, and leave more people uninsured. This session will bring federal and state leaders together to discuss how Medicaid agencies and their partners are responding, where collaboration is most needed, and what strategies will be needed to navigate the next phase of public healthcare transformation.
The following current and former Medicaid directors will join Dr. Knapp:
- Ann Jensen, Administrator, Nevada Medicaid Nevada Health Authority
- Cheryl J. Roberts, JD, Senior Advisor; Former Medicaid Director, Virginia Department of Medical Assistance Services
- Ryan Schwarz, MD, MBA, Medicaid Director & Assistant Secretary for MassHealth, Massachusetts Executive Office of Health & Human Services
- Scott Partika, Director, Ohio Department of Medicaid
VA Community Care and NextGen Healthcare Innovation for Veterans
As the nation’s largest integrated health system serving military veterans, the VA is working with health plans, providers, health systems, technology firms, and other innovators to bring effective solutions from across the healthcare marketplace to people who have served our nation. Approximately 42 percent of the healthcare services that veterans receive today is delivered through the contracted Community Care program, and that share is expected to grow. Assistant Secretary Richard F. Topping will discuss the VA’s vision for the future of Community Care, the critical role industry partners will play, and how the VA intends to learn from the field, adopt proven practices, leverage emerging technologies, and foster innovation that improves access, quality, and outcomes for veterans.
As Medicaid, VA Community Care, and other public healthcare programs enter a period of significant change, HMA’s conference will focus on the partnerships, operational strategies, and solutions needed to move from policy to implementation.
Register today to join leaders working through the decisions that will shape the next phase of public healthcare.
MESC 2026 Highlights: Medicaid Modernization, AI, Eligibility, and Program Integrity
Key Insights from the 2026 MESC Conference and What They Mean for Your Organization
State Medicaid agencies and partner organizations are facing one of the most consequential periods of operational change in more than a decade. Those challenges were a central focus of the 2026 Medicaid Enterprise Systems Conference (MESC), August 17-20, 2026, in Portland, OR, where state, federal, and industry leaders discussed how technology, data, and operational modernization are becoming essential tools for implementing policy change.
During the conference, leaders of Health Management Associates (HMA) and HealthTech Solutions, an HMA company, reinforced a consistent theme: We have moved beyond the era when Medicaid enterprise systems modernization simply meant replacing aging technology. Instead, states are building the infrastructure needed to manage continuous policy evolution, support more sophisticated program integrity efforts, adapt to changing eligibility requirements, and provide the financial and operational visibility necessary to navigate an increasingly complex Medicaid environment. That direction is also reflected in recent Medicaid Enterprise Systems IT Standards Request for Information that the Centers for Medicare & Medicaid Services (CMS) issued to gather stakeholder input on how to advance a more standardized, interoperable, and cost-effective MES ecosystem.
What We Learned at MESC
Modernization Is Becoming an Ongoing Operating Capability
Medicaid modernization is moving beyond the replacement of legacy systems. States are building the capabilities needed to manage continuous change. That work includes stronger governance through better data and more disciplined implementation practices; clearer ownership for decisions, risks, dependencies, and outcomes; and the development of cross-functional teams. Policy, operations, technology, finance, communications, and program leadership must work together from the beginning.
What it means for states and partners
Modernization programs need a clear operating model that defines decision rights, measures of success, implementation responsibilities, and long-term support. Partners should help build state capability instead of focusing only on system delivery.
Modularity Now Means Managing the Connections Between Systems
Modularity can give states more flexibility, support specialized solutions, and reduce dependence on one large platform. Modularity, however, also creates more connections and business relationships that must be managed. A modular environment involves multiple vendors, systems, interfaces, data flows, release schedules, and support models. Because difficulties can arise when these elements are disconnected, MESC sessions emphasized the need for enterprise integration and coordination. States must manage testing, release planning, architecture, data contracts, vendor handoffs, and incident resolution.
What it means for states and partners
Modularity requires more than modular procurement. States need an enterprise layer that manages the relationships between components. Partners should understand how their work affects the broader Medicaid ecosystem.
Federal Requirements Are Shaping the Modernization Agenda
CMS and other federal requirements continue to influence state priorities. Certification remains important, along with federal reporting, data quality, security, interoperability, and program integrity. The conference also reflected growing pressure to prevent fraud, waste, and abuse earlier in the Medicaid life cycle. States are strengthening provider enrollment, referral intake, payment controls, analytics, and audit preparation. These efforts move program integrity closer to the front door. The goal is to identify risk before it becomes a payment error or an investigation.
What it means for states and partners
Compliance and program integrity should be part of solution design from the beginning. States and partners should build evidence, controls, testing, and monitoring into normal operations. These activities should not be postponed until certification or an audit is approaching.
Eligibility Changes Require New Data and Operational Models
Changes to Medicaid eligibility are creating new demands for states. Workforce and community engagement requirements are one example. States may also need enhanced verification, new exemption processes, shorter response timelines, and stronger outreach.
These changes extend beyond eligibility systems. They shape how states communicate with members, support contact centers and caseworkers, manage appeals, connect data sources, and help people understand what they need to do to maintain coverage. MESC sessions underscored the value of listening to stakeholders and explored how health information exchange data and other sources could support exemption decisions and reduce preventable coverage loss.
What this means for states and partners
Eligibility modernization must connect policy to daily operations. States need reliable data and clear workflows. They also need ways to explain changes and track outreach. Partners can translate policy into decision logic, test cases, notices, training, and operational procedures.
AI Means Governed Support for Real Medicaid Work
AI was a major topic of discussion at MESC. The strongest examples involved practical work rather than general experimentation. States are exploring AI for policy questions, quality assurance, document review, contact center support, knowledge management, and program integrity. These use cases can reduce administrative burden and help staff manage complex workloads. Conference speakers clarified that AI is no substitute for reliable governance structures. States need reliable content, security controls, privacy protections, human review, workforce training, and performance monitoring.
What this means for states and partners
AI adoption should begin with a specific business problem. States should define who is accountable for the outcome and how the tool will be monitored. Partners can support use case selection, governance, procurement, testing, implementation, and workforce adoption.
How HMA Can Help
MESC 2026 reinforced the argument that Medicaid modernization is no longer a discrete technology project. States and their partners are responding to federal requirements, modular system complexity, eligibility changes, AI adoption, and heightened program integrity expectations at the same time.
HMA and HealthTech Solutions help organizations turn that complexity into an actionable modernization strategy. Our teams bring together Medicaid policy expertise, operational experience, technology strategy, procurement support, compliance knowledge, and implementation discipline so clients can make better decisions and execute with confidence.
We support organizations in assessing current systems and capability gaps, prioritizing technology investments, translating policy into operational and technical requirements, managing vendor selection and procurement, strengthening compliance and program integrity, and adopting AI in ways that are effectively governed, practical, and aligned with Medicaid business needs.
Contact HMA experts to get your questions answered.
Federal Policy News
Fueled By Leavitt Partners Weekly Health Intelligence
The House Returns With a Funding Deadline Front and Center
On September 1, the House of Representatives passed a short-term continuing resolution (CR), the Continuing Appropriations and Extensions Act, 2027, to fund the federal government through December 11, 2026. The legislation, which already passed the Senate, also included a provision that temporarily prevents the Office of Management and Budget (OMB) from finalizing its Regulation for Federal Financial Assistance proposed rule that would require senior political appointee review of discretionary awards. The short-term funding bill sets up the need for Congress to vote again this year, after the November mid-term election but before the new Congress is sworn in, to provide additional funding to keep the government open.
Autism Research Roadmap Approved After Divided Vote
On August 27, the Interagency Autism Coordinating Committee (IACC) held its full committee meeting and officially adopted the draft strategic plan. The plan, approved by a vote of 26–1, with 13 abstentions, plans to increase federal autism research funding from $390 million to $747 million and shift priorities beyond the traditional genetics–focused approach to include research on diet, inflammation, metabolic stress, folate, and other environmental and biological factors. While some researchers and advocates welcomed the plan’s focus on co-occurring conditions, such as epilepsy and sleep disorders, others raised concerns about its emphasis on areas with limited supporting evidence, including folate-based therapies, such as leucovorin. Stakeholders also noted that the plan does not address important issues affecting autistic adults, such as employment and independent living. A number of autism and disability organizations cited concerns that the more than 5,000 comments on the plan could not have been adequately considered prior to the vote. The meeting further drew attention because committee members discussed vaccines as a potential cause of autism, despite the scientific evidence debunking causation. The strategic plan will serve as a roadmap for future federal autism research investments and recommendations to Congress and federal agencies, making its implementation and influence on research funding priorities important to monitor.
HHS Tests New Strategies for School Nutrition
On August 26, HHS announced the Developing Evidence for Programs to Ensure Nutrition for Development (DEPEND) initiative, a new $32.5 million effort to support schools in replacing highly processed foods with more nutritious options. The initiative will provide grants ranging from $75,000 to $2.5 million to schools, school districts, and School Food Authorities to test innovative approaches related to food purchasing and supply, workforce and food production, student demand and meal participation, and operational and infrastructure improvements. HHS said DEPEND is intended to address longstanding barriers schools face in providing healthier meals, including procurement, staffing, infrastructure, and financial challenges, while building evidence around which strategies are most effective, scalable, sustainable, and economically viable. Grant applications are expected to be available in mid-September, and HHS has indicated it may expand funding in FY 2027 if the program proves successful.
FDA Clears New Treatment for Pancreatic Cancer
On August 26, FDA approved Rasonque (daraxonrasib), a treatment shown to dramatically extend survival for patients with the most common form of pancreatic cancer. FDA highlighted that the approval was granted “6.5 months before the user fee deadline.” It received a number of designations intended to expedite FDA’s review, including being granted Breakthrough Therapy and Orphan Drug designations, and Priority Review. FDA also states that the application was reviewed under the Commissioner’s National Priority Voucher program, which provides accelerated review to certain manufacturers for efforts deemed by FDA to be in the national interest, established under former Commissioner Marty Makary. Rasonque is manufactured by Revolution Medicines, Inc.
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State Policy News
Indiana Releases Medicaid Managed Care RFP Covering 1.5 Million Beneficiaries
The Indiana Family and Social Services Administration (FSSA) released a request for proposals on August 27, 2026, to reprocure contracts for all four of the state’s managed care programs, covering approximately 1.5 million beneficiaries. The procurement includes Hoosier Healthwise (HHW), Healthy Indiana Plan (HIP), Hoosier Care Connect (HCC), and Indiana PathWays for Aging, making it one of the most significant Medicaid managed care procurements currently underway.
Indiana is seeking managed care organizations (MCOs) that can support the state’s Make Indiana Healthy Again initiative while advancing quality improvement, member engagement, provider collaboration, and fiscal accountability. The RFP also encourages plans to offer targeted enhanced benefits, implement member and provider incentive programs, and expand value-based purchasing arrangements.
The state intends to award contracts for all four Medicaid programs to the same participating health plans. In addition, successful bidders will be required to operate a Dual Eligible Special Needs Plan (D-SNP) beginning January 1, 2029, and throughout the contract term to support integration of care for Medicare-Medicaid beneficiaries enrolled in PathWays for Aging.
Contracts are expected to begin January 1, 2029, and run for four years, with two optional one-year extensions. Current incumbents include Elevance/Anthem, CareSource, Centene/Managed Health Services (MHS), UnitedHealthcare, Humana, and other participating plans across the four programs. Proposals are due November 6, 2026, and Indiana expects to announce award recommendations in July 2027.
For Medicaid health plans, providers, and healthcare investors, the procurement represents a major opportunity to compete for membership across Indiana’s Medicaid market while positioning for the state’s continued focus on quality performance, integrated care, and value-based delivery models.
Elevance’s Healthy Blue to Exit Louisiana Medicaid Managed Care Program
The Louisiana Department of Health (LDH) announced on September 1, 2026, that Elevance/Healthy Blue will exit the state’s Medicaid managed care program effective after December 31, 2026. The departure will affect approximately 290,000 Louisiana Medicaid beneficiaries, who will need to select coverage through one of the other four plans—AmeriHealth Caritas, CVS/Aetna, Centene/LA Healthcare Connections, or Humana. Members who do not select a new plan will be automatically assigned. LDH is coordinating with Healthy Blue and the remaining managed care plans on the transition. The Louisiana exit is part of a broader strategy by Elevance Health to reduce participation in Medicaid markets it has identified as financially unsustainable.
Michigan Releases RFP for Medicaid Non-Emergency Medical Transportation Broker
The Michigan Department of Health and Human Services (MDHHS) released on August 27, 2026, a request for proposals (RFP) to select a non-emergency medical transportation (NEMT) broker for fee-for-service Medicaid beneficiaries in Wayne, Oakland, and Macomb counties, with the potential to expand broker services statewide. The procurement is important for transportation vendors, Medicaid contractors, and healthcare organizations that support access to care, particularly because the selected contractor will manage beneficiary calls, verify eligibility, schedule medically necessary transportation, recruit and oversee a driver network, and determine NEMT reimbursement rates. Bidders must submit separate responses and cost proposals for two geographic regions: one covering Wayne, Oakland, and Macomb counties, and one covering the full state, including both the Upper and Lower Peninsulas. MDHHS currently serves as the fee-for-service NEMT broker in all other counties. The new contract will run from August 1, 2027, through July 31, 2030, with up to five additional one-year extensions. Proposals are due October 30, 2026. ModivCare is the incumbent NEMT broker in Wayne, Oakland, and Macomb counties.
New Mexico Awards $750,000 in Emergency Contracts for Medicaid Outreach
The New Mexico Health Care Authority (HCA) approved on August 25, 2026, two 90-day emergency contracts totaling $750,000 to support rapid Medicaid member communications tied to new federal community engagement requirements and eligibility changes. HCA awarded up to $500,000 to Windlark Studios for multilingual, plain-language materials explaining work requirements, the revised medical-frailty exemption, reporting obligations, and the October 1 transition of certain noncitizens from federal Medicaid to a new state-funded coverage program. HCA also awarded up to $250,000 to XOMAD for digital outreach through New Mexico-based trusted messengers and local creators to reach members who may not engage with traditional government communications. The agency is using the emergency contracts as a bridge while it completes competitive procurements for any continuing communications services.
CMS Approves Oklahoma SoonerCare Section 1115 Waiver Renewal Through 2031
The Centers for Medicare & Medicaid Services (CMS) approved a five-year renewal of Oklahoma’s Section 1115 SoonerCare demonstration on August 28, 2026, extending the program from January 1, 2027, through December 31, 2031. The renewal allows Oklahoma to continue several longstanding Medicaid initiatives, including the Insure Oklahoma Employer-Sponsored Insurance premium assistance program, Health Access Networks, and the Health Management Program, which provides care coordination and disease management services for beneficiaries with complex or chronic health conditions. The renewed demonstration also reflects Oklahoma’s transition to the SoonerSelect managed care program, phases out the Insure Oklahoma Individual Plan, and incorporates updated federal requirements related to budget neutrality, monitoring, and program evaluation.
Private Market News
Fueled By Wakely Consulting Group
Wakely Wire: Medicare Advantage and ACA Markets Take Diverging Paths as Cost Pressures Persist
Moody’s reports that health insurers are taking increasingly different approaches to managing margin pressure across Medicare Advantage and ACA Marketplace businesses. While Medicare Advantage plans are relying on pricing and benefit changes to improve performance, ACA carriers are reevaluating market participation amid enrollment and risk pool challenges. Read the latest Wakely Wire for actuarial insights into the trends shaping payer strategy and financial performance.
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Health Management Associates
Webinar: Modernizing and Streamlining Health Plan Prior Authorization (Sept. 9)
During this webinar, leaders from HMA and NTT DATA will explore the common sources of friction and inefficiency in prior authorization (PA) processes and discuss how modern technology, including artificial intelligence (AI), can help streamline PA operations, improve compliance, and enhance the experiences for health plans, providers, and members. Attendees will gain insights into the evolving regulatory landscape, the root causes of PA administrative burden, and practical strategies for leveraging IT modernization to create more efficient, transparent, and effective prior authorization workflows.
Webinar Replay – Advancing Community Health Through CHWs: Research, Recommendations, and Action
Community Health Workers (CHWs) play a critical role in connecting communities to trusted health information, services, and resources. In this webinar, Health Management Associates (HMA) presented findings from its research examining how health-related information reaches, is interpreted by, and flows through Community Health Workers in Cook County, Illinois. Participants learned about HMA’s key findings and recommendations for strengthening health information systems, elevating the value of the CHW workforce, and advancing partnerships that support equitable, community-centered care.
Wakely
Quantifying the Care Continuity Gap: A $569M Analysis of ACA Marketplace SUD Spending
A new joint analysis from Sober Sidekick and Wakely Consulting Group, an HMA Company, shows that health plans spend $3.64 on acute stabilization and short-cycle services for every $1 spent on services that support sustained recovery in SUD. The analysis found that 51.5% of spending went to acute stabilization and short-cycle services, while 14.1% went to sustained recovery services. ED care represented the largest single concentration of spending at $127.9 million. The brief estimates the opportunity if spending shifts toward recovery sustaining services.
RFP Calendar
RFP Calendar
| Date | State/Program | Event | Beneficiaries |
|---|---|---|---|
| Date: Summer 2026 | State/Program: Illinois Foster Care | Event: RFP Release | Beneficiaries: 33,000 |
| Date: July 28, 2026 (Delayed) | State/Program: Nevada Children's Specialty | Event: Awards | Beneficiaries: NA |
| Date: November 6, 2026 | State/Program: Indiana | Event: Proposals Due | Beneficiaries: 1,400,000 |
| Date: January 1, 2027 | State/Program: Illinois | Event: Implementation | Beneficiaries: 2,400,000 |
| Date: January 1, 2027 | State/Program: Nevada CO D-SNP | Event: Implementation | Beneficiaries: 88,000 |
| Date: January 1, 2027 | State/Program: Wisconsin LTC GSR 3 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: January 1, 2027 | State/Program: Illinois Tailored Care Management Program | Event: Implementation | Beneficiaries: 22,400 |
| Date: July 2027 | State/Program: Indiana | Event: Awards | Beneficiaries: 1,400,000 |
| Date: July 1, 2027 | State/Program: Nevada Children's Specialty | Event: Implementation | Beneficiaries: NA |
| Date: September 2, 2026 | State/Program: Missouri | Event: Proposals Due | Beneficiaries: 1,000,000 |
| Date: Fall 2027 | State/Program: Oregon | Event: RFP Release | Beneficiaries: 1,200,000 |
| Date: January 1, 2028 | State/Program: Wisconsin LTC GSR 4,6 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: 2028 | State/Program: North Carolina | Event: RFP Release | Beneficiaries: 2,200,000 |
| Date: 2029 | State/Program: California | Event: RFP Release | Beneficiaries: NA |
| Date: January 1, 2029 | State/Program: Indiana | Event: Implementation | Beneficiaries: 1,400,000 |