Insights

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. 

Minnesota’s efforts to keep people covered while addressing Medicaid fraud were central to discussions at the September 30, 2026, Health Policy Conference in Minneapolis. Hosted by State of Reform, an HMA company, the conference brought together lawmakers, state officials, providers, community-based organizations, and policy experts to discuss the healthcare landscape. Specific topics covered included how to respond to the 2025 budget reconciliation legislation (commonly referred to as OBBBA or the Working Families Tax Cut Act [WFTCA]) and address fraud, waste, and abuse (FWA) without disrupting coverage or weakening provider capacity. 

Particularly for the Medicaid program, discussions connected immediate implementation decisions with how healthcare leaders could introduce more accountability into the program without making healthcare harder to access or weakening an already strained delivery system. 

Key Discussions: Coverage, Oversight, and Continuity of Care 

Federal Medicaid changes put pressure on coverage continuity. 

An estimated 140,000 Minnesotans could lose Medicaid coverage as provisions of the WFTCA take effect, including work requirements, six-month redeterminations, and cost-sharing for the expansion population, and coverage changes affecting some lawfully present immigrants. State lawmakers, including Sen. Alice Mann, Vice Chair of the Health & Human Services Committee, and Rep. Mohamud Noor, Co-Chair of Human Services Finance & Policy, shared their concerns about the coverage losses and steps they are taking to soften the effects; for example, requiring a one-month lookback period for the work requirements instead of three. 

Discussions at the conference also made clear that Minnesota leaders are focused on how people experience Medicaid changes in practice. Representative Noor emphasized the need for practical support, including guidance around work requirements, help for people who qualify for emergency medical assistance, and attention to people in long-term care. He also stressed the importance of keeping counties involved because they will experience much of the operational and financial impact of federal policy changes. 

In Minnesota, the state can set policy and build eligibility systems, but counties, health plans, providers, and community organizations are the ones that recognize when someone is at risk of losing coverage. Former Minnesota Department of Human Services Deputy Commissioner Chuck Johnson suggested that, as Minnesota implements federally required eligibility changes, it should also think about redesigning the eligibility process itself and using the federally-driven eligibility changes as an opportunity to make the state’s system easier to navigate. 

Program Integrity Activities Earlier 

Minnesota’s Medicaid fraud concerns have brought greater scrutiny to how the state manages providers and protects public funds. In December 2025, the Centers for Medicare & Medicaid Services (CMS) requested a corrective action plan (CAP) to address concerns regarding FWA within the state’s public benefits programs. The Minnesota Department of Human Services (DHS) submitted a CAP on December 31, 2025 and CMS approved a revised version of the plan March 19, 2026. The state’s response has included revalidating high-risk Medicaid providers, establishing a moratorium on new service providers in certain high-risk areas, creating a public program integrity dashboard, and discontinuing the Housing Stabilization Services benefit. Minnesota also secured funding to expand DHS’s program integrity workforce by more than 400 positions over two years. 

Speakers at the conference agreed that addressing those problems also means helping providers build stronger operations. Mr. Johnson acknowledged both the fraud that needs to be stopped and the politically charged perceptions surrounding it. He also encouraged offering support to providers so they can improve integrity within their own operations. 

That emphasis on prevention carried into the discussion with Health Management Associates (HMA) Associate Principal Jen Bridgeforth and Regional Director Clint Eisenhower. Both focused on the work that happens before an improper payment is made—from everyday compliance practices within provider organizations to the way states design programs. 

Written compliance procedures, staff with the right expertise, and technology that supports oversight can help organizations identify risks earlier. Ms. Bridgeforth emphasized that responsibility extends across an organization. Those safeguards take time and money, she noted, but the administrative burden and costs increase substantially when audits uncover fraud. Mr. Eisenhower connected that day-to-day work to policy decisions, adding that program integrity needs a place in program design. 

Speakers also emphasized that Minnesota’s anti-fraud efforts should account for what happens to people receiving care, noting, for example, ongoing behavioral health provider capacity gaps and the risk of deepening access challenges. This theme of involving providers in discussions extended into conversations about medical respite, homelessness, and complex discharge where problems have emerged when healthcare and community systems are misaligned. 

The Bottom Line: Practical Solutions, Collaboration, and Shared Responsibility 

The key takeaway from the conference was that Minnesota’s healthcare coverage and delivery system challenges require practical solutions. These efforts should focus on: 1) cross-sector approaches to helping people retain Medicaid coverage, 2) a more systematic statewide approach to program integrity, and 3) new initiatives to improve complex discharge for children and adults, which could provide lessons for broader policy change. 

Another theme that emerged across sessions was the need for shared responsibility in designing, implementing, and sustaining responses to changes and pressures stemming from the WFTCA, as well as other pressures on the healthcare system. This coordinated response calls for respecting each other’s unique roles and perspectives while recognizing the interconnected nature of the work. For example, Minnesota counties will need support from the state as Medicaid eligibility requirements change. Health plans, providers, and community organizations can reach people before administrative issues turn into coverage losses. State program integrity officials can work with providers to identify vulnerabilities upstream instead of relying primarily on audits after payments have been made. Hospitals, behavioral health providers, housing organizations, and community partners can build clearer pathways for people who otherwise become caught between systems. 

Looking Ahead 

If you are looking for strategies and solutions to address urgent healthcare policy and operational challenges, HMA experts are available to help you identify practical paths forward. 

Through the HMA National Conference, State of Reform partnership events, and other HMA convenings across the country, we connect state leaders, providers, health plans, and community stakeholders to share insights, elevate lessons, and advance solutions. Join us at one of our next SOR events—November 10, 2026, in Raleigh, NC, or November 17, 2026, in Chicago, IL—or explore additional opportunities to engage with HMA and access the full schedule of conferences and resources. 

State of Reform develops its conference agendas through collaboration with HMA subject matter experts/market leads and stakeholders across the public and private sectors, including state officials, community-based organizations, providers, payers, and more. 

The Centers for Medicare & Medicaid Services (CMS) has launched the Investing in Health Outcomes initiative with a founding group of 37 states, establishing a voluntary Medicaid Quality Pledge intended to shift Medicaid and Children’s Health Insurance Program (CHIP) quality strategy toward outcomes that matter to beneficiaries. The initiative is an effort to redirect policy, tools, data, and improvement resources away from an expansive inventory of process-oriented requirements and toward a more focused system that can demonstrate progress in prevention, chronic disease management, and behavioral health. 

That direction matters now because Medicaid agencies, managed care entities, providers, and vendors are being asked to improve outcomes while managing extensive and often duplicative performance reporting expectations. CMS reported that its review of managed care programs in 42 states identified approximately 450 reporting requirements corresponding to roughly 260 unique quality measures, many focused on processes and utilization. A smaller, more coherent portfolio could reduce administrative burden, but only if the measures selected are meaningful, the data are trusted, and accountability is built into the policy and contractual structures that drive delivery-system behavior. 

Through this voluntary pledge, CMS is encouraging, rather than requiring participating states to apply the four principles, as they develop health outcome targets and consider outcomes-oriented measures for state quality strategies and upcoming procurements. A disciplined, multiyear approach focused on a limited number of priorities is therefore best understood as an implementation strategy that states can use to make the pledge actionable and establish a credible performance trajectory. 

To learn more about the four principles for an outcome-focused Medicaid quality system access the full report. 

State of Reform (SOR), an HMA Company, hosted its inaugural Pennsylvania Health Policy Conference in Harrisburg on September 16, 2026, bringing together more than 170 interest-holders, including state health and human services departments leaders, policymakers, providers, health plans, community‑based organizations (CBOs), and others to discuss the most pressing health-related issues in the commonwealth. 

The conference focused on how federal Medicaid policy changes, managed care challenges, and workforce shortages, are reshaping Pennsylvania’s healthcare landscape while highlighting prevention and cross-sector collaboration as essential to building a more sustainable system. Key discussions are highlighted below. 

Central Discussions: Federal Medicaid Policy, Managed Care, and the Workforce 

Pennsylvania Medicaid 

Valerie Arkoosh, MD, Secretary of the Pennsylvania Department of Human Services (DHS) opened the conference by examining how federal policy and fiscal pressures are likely to affect Pennsylvania’s health and human services system. She discussed the anticipated loss of Medicaid coverage for approximately 310,000 enrollees due to the 2025 budget reconciliation act (P.L 119-21, now known as the Working Families Tax Cut Act [WFTCA]) and the resulting strain on individuals, providers, and the broader healthcare system. 

WFTCA and broader financial pressures also raise concerns about the sustainability of hospitals, with closures threatening access to care, especially in rural and underserved communities. Hospitals and safety-net facilities are consistently working against staffing shortages, capacity constraints, and shifting payer dynamics. Pennsylvania is using funds from the Rural Health Transformation Program (RHTP) to support struggling rural hospitals as best it can. DHS has awarded $42 million in RHTP grant fund awards so far to support various rural facilities. 

Medicaid managed care 

Community HealthChoices (CHC), Pennsylvania’s Medicaid managed long-term services and supports (MLTSS) program, has been at the forefront of the healthcare conversation in the state as a result of the cancellation of its 2024 contract awards for the program. In June 2026, DHS released a request for information seeking responses on several topics that could shape a new CHC re-procurement, including the number of Medicaid managed care organizations (MCOs) within CHC, regional versus statewide coverage, length of contract terms, strategies to align coordination of Medicare and Medicaid, artificial intelligence (AI), and other program recommendations. 

During the managed care discussion, Sally Kozak, Deputy Secretary of the Office of Medical Assistance Programs, and Emily Katz, Executive Director of Pennsylvania Medicaid MCOs, joined health plan leaders in assessing how well the physical health managed care program is improving access, quality, and cost management. 

The conversation centered on persistent challenges involving provider participation, care coordination, the complexity of administering the programs, and the variation in performance by region. There are opportunities to reform or refine managed care to better align incentives with patient needs and system sustainability. 

Workforce shortages 

Like all states, Pennsylvania is facing a health professional shortage across all sectors. Jennifer Hale, Director of the Bureau of Policy and Regulatory Management in the Office of Long-Term Living, and Garry Pezzano, President and Chief Executive Officer of LeadingAge PA, highlighted how this issue is affecting people who need long-term care. Speakers emphasized that Pennsylvania’s ability to meet the needs of an aging population will depend largely on strengthening the workforce that delivers these services. They explained several of the strategies underway and being discussed to achieve this goal, for example by improving wages and benefits for direct care workers, strengthening education and training pipelines, expanding loan repayment programs, prioritizing recruitment, and investing in technology for telehealth services and AI-assisted workflows. 

Advancing Change: Upstream Interventions and Collaboration 

Paying for care continues to be a chief concern. While many of the financial pressures come from within the healthcare system as the result of policy and budgetary challenges, throughout the conference speakers emphasized that many of Pennsylvania’s most pressing healthcare challenges begin outside the healthcare system. Food insecurity, unstable housing, transportation barriers, limited caregiver support, and lack of social and community supports worsen health outcomes and lead to increased healthcare expenditures. 

Panelists called for greater investment in upstream prevention services that help people remain healthy and independent before their needs become more acute to contain costs over time. Speakers recommended approaches such as expanding housing supports, food as medicine initiatives, community health worker investments, caregiver supports, reentry services, and technology that allows people to receive care at home, as well as other initiatives to ensure people can remain healthy and independent. 

Pennsylvania has already begun investing in several of these areas. The fiscal 2027 budget allocated $1.9 million to the Investments in Health pilot program for housing stability services and reentry supports for incarcerated individuals. Federal matching dollars for the first year of this program total $5.2 million. Another tool, PA Navigate, connects people with CBOs, state agencies, and providers that can help people access basic necessities. 

Speakers also stressed that these efforts will have limited reach if organizations operate separately. Better coordination among healthcare providers, MCOs, CBOs, hospital systems, and state agencies can reduce the fragmentation, make services easier to navigate, and help funding and data systems support common goals. That message was consistently expressed throughout the conference: Pennsylvania’s healthcare challenges cannot be addressed by one sector alone, and progress will depend on sustained collaboration among the organizations that serve individuals and communities. 

Looking Ahead 

If you are looking for strategies and solutions to address urgent healthcare policy and operational challenges, Health Management Associates (HMA) experts are available to help you navigate these complex changes and identify practical paths forward. 

Through the HMA National Conference, State of Reform partnership events, and other HMA meetings across the country, we connect state leaders, providers, health plans, and community stakeholders to share insights, elevate lessons, and advance solutions. Join us at an upcoming event—including our next HMA National Conference in New Orleans, LA, October 5–7, 2026—or explore additional opportunities to engage with HMA and access the full schedule of conferences and resources. 

State of Reform develops its conference agendas through collaboration with HMA subject matter experts/market leads and stakeholders across the public and private sectors, including state officials, community-based organizations, providers, payers, and more.