Key Insights from the 2026 NAMD Fall Conference and What They Mean for Your Organization
Medicaid leaders have never had the luxury of focusing on one issue at a time, but even by their standards, the current environment is unusually demanding.
Health Management Associates (HMA) leaders attended the National Association of Medicaid Directors (NAMD) Fall Conference, October 21-23, 2026, during which federal and state leaders shared their priorities and implementation plans. Several themes stood out: 1) preparing for community engagement requirements, 2) strengthening program integrity, 3) adapting to major changes in Medicaid financing, 4) demonstrating value and accountability in managed care, and 5) improving quality and outcomes for Medicaid enrollees.
These priorities are arriving alongside revisions to Section 1115 demonstration policy, budget pressures, and, in many states, leadership transitions. Many also reflect long-standing Medicaid challenges, including fragmented data, complex eligibility processes, uneven coordination across agencies, and difficulty connecting payment to outcomes. The insights below highlight how the work in progress can also build the capabilities that Medicaid programs will need in 2027 and beyond.
What We Heard at NAMD
Community Engagement Implementation Can Build Lasting Infrastructure
Community engagement implementation was among the most prominent topics discussed at the conference, highlighting the scale of the work ahead for states and partners. Although the community engagement requirement is an eligibility policy, it touches nearly every part of the Medicaid enterprise, including: verifying eligibility and exemptions, using data from other programs, updating systems and workflows, communicating with beneficiaries, and defining roles for managed care plans, providers, workforce agencies, and community organizations. A process that looks straightforward in policy can still create significant burdens for members and the organizations that support them. In HMA’s work with states, much of the effort goes into connecting policy choices to the realities of data, systems, budgets, and the member experience.
What it means for states and Medicaid partners
Many implementation investments can deliver value well beyond what is prescribed in the requirement itself. Integrating Medicaid and workforce data can streamline verification now and support other cross-program initiatives later. Clear beneficiary notices can improve renewals, and operational dashboards can give leaders early visibility into enrollment disruptions, processing backlogs, and disparities. States and partners that approach implementation strategically can build capabilities that outlast any single federal mandate.
Program Integrity Works Best When It Is Built into the Program
Fraud, waste, and abuse is receiving heightened attention as federal and state leaders focus on payment accuracy, provider and vendor oversight, and the stewardship of public dollars. Medicaid leaders emphasized that the strategic value of program integrity extends well beyond audit and recovery, spanning finance, eligibility, provider oversight, analytics, operations, technology, compliance, and executive decision-making.
Federal officials also signaled a commitment to shift from reactive enforcement to prevention, encouraging states to bring solutions forward and share what they are learning. The challenge, however, is balancing closer scrutiny with protecting access in services where it is already fragile, including behavioral health, personal care services, nonemergency medical transportation, and applied behavior analysis.
What it means for states and Medicaid partners
As states redesign processes and programs, program integrity is most effective when it is embedded in the design from the outset, rather than added later as another layer of oversight. Furthermore, collaboration across states is already driving changes in state approaches. For example, states are increasingly flagging provider enrollment concerns and sharing that information with one another. Clear documentation, robust data, provider education, well-designed payment controls, and meaningful monitoring can reduce improper payments while revealing where policies produce unintended consequences or where services are not reaching members.
Managed Care Value Has to Be Defined Before It Can Be Demonstrated
Discussions at NAMD were candid that managed care has yet to is not yet deliver its full potential, partly because the data needed to show that care is truly being managed are often incomplete. Rather than questioning whether to keep managed care, Centers for Medicare & Medicaid Services (CMS) officials encouraged states leaders to focus on accountability, which also requires reliable encounter data.
Health plans are increasingly expected to demonstrate value beyond managing benefits and financial risk, whether through better access, fewer avoidable hospitalizations, improved maternal health, more effective behavioral healthcare, a better member experience, or lower total cost. What plans can realistically deliver, however, depends on reimbursement levels, financial risk, incentives, available data, partner capabilities, and the time needed to show results, a point that also came through clearly at HMA’s 2026 National Conference.
What it means for states and Medicaid partners
Adding performance measures to managed care contracts is rarely enough on its own. States get further when procurements start with a clear answer to what the state is buying, rate setting is grounded in transparent data, and contracts focus on the outcomes the state most wants to improve. States can then decide what needs to change in payment, what data will show progress, and whether plans, providers, and other partners have the resources, information, incentives, and time to influence results.
Better Outcomes Depend on Doing Fewer Things Well
Quality discussions at NAMD centered on the need for greater focus, as states use 250 unique state-designed quality measures, and 38 states have signed on to CMS’s national Medicaid Quality Pledge. Trying to do everything accomplishes little, especially as burden flows from states to health plans, providers, and vendors. The priority is the conditions driving much of Medicaid spending, including hypertension, diabetes, behavioral health, and maternal health, and whether investments are keeping people healthy and out of the hospital.
What it means for states and Medicaid partners
States that concentrate measures, data collection, and investments on the outcomes that matter most can reduce burden across the system. Federal officials want data treated as core infrastructure and greater standardization so states have the information needed to develop sound policy.
Partnerships Depend on Clearly Defined Roles
Partnership, a hallmark of NAMD meetings, was again a defining theme this year. Medicaid agencies cannot achieve their goals alone, and leaders were focused on practical, shared solutions that deliver better outcomes for members. Community engagement, for example, may require coordination with state labor and workforce agencies, Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) programs, community colleges, employers, community-based organizations, providers, and managed care plans, each with its own systems, responsibilities, and funding streams.
What it means for states and Medicaid partners
Tighter budgets make it more important to be clear about what each partner contributes. For states, health plans, and providers, reaching that understanding requires honest decisions about which capabilities to keep in-house, where a partner is better positioned to deliver, and how those roles fit together around shared goals.
Looking Ahead: Using Today’s Requirements to Build for Tomorrow
Meeting new federal requirements on time remains essential, but how states meet them will determine whether the work creates lasting value. Decisions made early in implementation will shape those results, and they carry added weight as administrations and agency leadership change.
Work on the community engagement requirement will continue well beyond the January 2027 effective date as states, health plans, providers, and community partners monitor results and adapt to evolving federal policy. HMA’s interdisciplinary team brings policy, actuarial, operations, data, and technology expertise to each stage of that work. Our experts help organizations design workable verification processes, model enrollment and financial impacts, build data and program integrity safeguards, align managed care contracts and partner roles, and track outcomes over time. Connect with our experts to discuss your organization’s priorities.