September 24, 2025
Navigating the Post-Subsidy Cliff—Mitigating Premium Increases After Enhanced ACA Subsidies Expire
1307 Results found.
Is the ACA Marketplace Built to Survive Another Decade of Change?
Michelle Anderson, director and senior consulting actuary at Wakely, an HMA Company, joins Vital Viewpoints on Healthcare to unpack the state of the Affordable Care Act (ACA) marketplace. From the market’s volatile beginnings to today’s uncertainty around subsidies, Michelle shares how insurers, states, and consumers have adapted and what challenges lie ahead. We explore the forces shaping affordability, coverage options, and consumer behavior, as well as the critical policy decisions that could redefine the individual market in 2026 and beyond.
MAHA Children’s Health Strategy Report: Driving a New Era for Child Health Policy
The September 2025 release of the “Make Our Children Healthy Again Strategy Report” marks a pivotal moment in the Trump Administration’s effort to address childhood chronic disease. Building on the work of the Make America Healthy Again (MAHA) Commission—established by executive order in February 2025 and led by US Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr.—the Strategy Report provides a proposed road map for federal, state, and local action.
The MAHA child-focused Strategy Report is already driving the Trump Administration’s healthcare agenda. Though the report sets ambitious goals, public health entities, state governments, and other experts have raised concerns that several recommendations run counter to established scientific research or lack sufficient evidence.
In this article, Health Management Associates (HMA) experts highlight the areas of focus in the Make Our Children Healthy Again Strategy Report and offer specific recommendations, initiatives, and considerations for stakeholders. Earlier editions of In Focus have addressed the commission’s formation, initial assessment, and the administration’s growing focus on childhood health (Spotlight on Development of President Trump’s Children’s Health Strategy).
Key Components of the MAHA Strategy
Advancing Critical Research to Drive Innovation
The strategy identifies broad areas of research to inform healthy outcomes and positions HHS to direct initiatives in collaboration with the US Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and other agencies. Examples include:
- Support the MAHA Chronic Disease Initiative, advance the Real-World Data Platform linking data from claims, electronic health records (EHRs), and wearables
- Establish a working group on mental health diagnosis and prescription, led by several HHS agencies, to focus on SSRIs (selective serotonin reuptake inhibitors), antipsychotics, mood stabilizers, and stimulants
- Study food for health, with the National Institutes of Health (NIH) Office of Nutrition coordinating research initiatives across HHS and the US Departments of Agriculture and Veterans Affairs (VA)
- Identify opportunities to strengthen the use of repurposed drugs for chronic disease
- Address vaccine injury data collection and analysis, as well as mental health research focused on screen time and prescription practices
Realigning Incentives and Systems to Drive Health Outcomes
The report recommends improvements to transparency and efficiency in regulatory processes to address nutrition, fitness, pharmaceuticals and vaccines, and care delivery and payment to address chronic disease. Specific initiatives include:
- Updating the Dietary Guidelines for Americans and developing an “ultra-processed food” definition
- Promote breastfeeding through the Special Supplemental Nutrition Program for Women, Infants, and Children
- Updating hospital food service nutrition guidance
- Developing options to get “MAHA boxes” of healthy food to Supplemental Nutrition Assistance Program (SNAP) enrollees
- Support states with SNAP waivers to encourage healthy food purchases among SNAP participants
- Enhance oversight of direct-to-consumer pharmaceutical advertising and develop a new vaccine framework
- Establish Medicaid managed care quality metrics for nutrition coaching and fitness, and work with states to develop prescribing safeguards for school-age children
- Promote evidence-based prevention and wellness initiatives and restructure agencies to reduce conflicts of interest
Increasing Public Awareness and Knowledge
Major campaigns will involve:
- Launching the “Make American Schools Healthy Again” initiative to assist states with promoting physical activity and nutrition in schools
- Expanding education on environmental exposures, fluoride, and pesticide safety
- Increasing awareness of opioid dangers, vaping, and screen time impacts
- Training school and library staff to respond to opioid overdoses
Fostering Private Sector Collaboration
The strategy emphasizes the administration’s work to advance private sector partnerships aligned with MAHA priorities, including partnerships to achieve the following:
- Improve nutrition in government-funded programs (schools, VA hospitals, prisons)
- Support community-led initiatives to reduce chronic disease in children
Key Considerations for Partners and Stakeholders
Early engagement is critical as federal agencies begin implementing over 120 recommended actions.
States, providers, health plans, and community organizations should identify how their current approaches to children’s health could align with the MAHA initiative and strategy report, as well as where these new ideas might conflict with present policies. This assessment will identify opportunities to maximize new federal funding opportunities and additional resources.
Progress toward the Strategy Report’s specific goals will require coordinated efforts across agencies, sectors, and communities. Stakeholders should consider how and when to engage in research, policy development, and public awareness campaigns outlined in the report.
Connections to Trump Administration Priorities and Broader Opportunities
The report’s recommendations are already influencing federal agency actions and are driving congressional hearings and new legislation at the federal and state levels.
The US Department of Agriculture’s (USDA), for example, is working with states to approve SNAP waivers to restrict the purchase of junk food with federal benefits. HMA experts are tracking the SNAP waiver actions, and as of September 2025, a total of 12 states have received USDA approval for waivers that restrict the purchase of soda, candy, and other unhealthy foods with SNAP benefits. Other states are considering similar waivers, and the USDA is providing technical assistance to support these efforts.
The FDA has enhanced oversight of direct-to-consumer pharmaceutical advertising, including new enforcement activities and rulemaking on drug safety disclosures in ads. This approach aligns with MAHA recommendations and Trump Administration priorities for transparency and consumer protection.
HHS is also pursuing a new vaccine framework; however, states retain significant authority over school-based immunization requirements, and several are considering alternative approaches or maintaining broader vaccine recommendations than those outlined in the MAHA report. Recent legislative actions in some states seek to shift authority for determining school-based immunization requirements solely to the legislature, reflecting ongoing debate and federal-state dynamics.
Connect with Us
As implementation of the Make Our Children Healthy Again Strategy Report advances, all stakeholders must be ready to engage, partner, innovate, and drive change that will shape the future of child health.
HMA guides state and local government, providers, plans and other partners through the multi-pronged strategies and recommendations in the report as well as the complexities of federal funding opportunities, such as the new Rural Health Transformation Program. We are helping state and local policymakers plan for MAHA and Trump Administration priorities, which includes guidance on how to leverage innovative approaches like SNAP waivers to promote healthy food access for children and families.
With deep expertise in policymaking and operational management, HMA consultants are enabling states and their partners to accelerate their work, build sustainable models for child health improvement, and position themselves to take advantage of new federal, state, and local policy opportunities driven by the MAHA report. To discuss questions about the impact of the report contact our experts below.
Rural Health Transformation Program Represents a One-Time Opportunity to Reshape Rural Care
The Centers for Medicare & Medicaid Services (CMS) has officially opened the application window for the Rural Health Transformation Program (RHTP)—a $50 billion federal initiative designed to stabilize and transform rural health systems across the country. This one-time opportunity allows states to submit a comprehensive plan that could redefine how rural communities access care, manage chronic conditions, and sustain their healthcare infrastructure.
As outlined in our earlier In Focus article, States Begin to Engage with the Rural Health Transformation Program, RHTP represents one of the most significant federal investments in rural health in decades.
Applications must be signed by governors and submitted by November 5, 2025, and awards are expected by December 31, 2025, providing states with a very narrow window to act.
The remainder of this article explains key aspects of the RHTP application, including the evaluation and scoring aspects. Notably, the structure of the scoring system will reward states that are already aligned with these federal priorities, as well as those willing to implement new initiatives or make state policy changes to achieve alignment.
Program Overview and Funding Structure
Created under HR.1, the 2025 Budget Reconciliation Act, the RHTP allocates $10 billion annually from federal fiscal year (FY) 2026 to FY 2030, totaling $50 billion over five years. Funding is split into two tranches:
- Tranche 1 (Baseline funding): $25 billion distributed evenly across all states with approved applications.
- Tranche 2 (Workload funding): $25 billion distributed based on CMS scoring criteria, which include:
- The percentage of the state population in rural census tracts
- The proportion of rural health facilities in the state
- The financial and operational status of hospitals
- Other factors explained in the RHTP application notice
States must submit a single, one-time application that covers the full five-year period. Stand-alone provider applications will be declined. Hence, states must coordinate across agencies, providers, and stakeholders to develop a unified transformation strategy.
Importantly, this award is not a grant; rather, it is a cooperative funding agreement, which means CMS will play an active role in oversight and collaboration. States must be prepared to meet higher standards of accountability, transparency, and performance monitoring. According to the RHTP application, continued funding requires states to demonstrate satisfactory progress toward implementing their plan.
Application Requirements and Strategic Priorities
To be eligible for funding, states must submit a Rural Transformation Plan that addresses eight core priorities as follows:
Within these core priorities, state plans must propose activities that address several specific issues.
Technical Factor Weighting for Workload Funding Reflects Federal Policy Priorities
CMS outlines the eligibility criteria for baseline funding and the scoring components for workload funding. Baseline funds will be distributed equally among states, while workload funding will be based on each state’s rural facility and population score as well as their technical score. Evaluators will score technical factors based on state policy actions and initiative-based plans for each state.
The technical factors, and the weighting of these factors, in the RHTP application are not just neutral scoring mechanisms; rather, they are closely linked to the Trump Administration’s health policy priorities.
- Weighting Structure: The RHTP funding is split evenly between baseline funding (50%) and workload funding (50%). Although baseline funding ensures all states receive support, the workload funding is directly tied to technical scores that reflect how well a state’s plan aligns with federal objectives and demonstrates readiness to implement transformative change that furthers federal objectives.
- Scoring Criteria: Technical factors, such as rural population share, facility density, hospital financial status, scope of proposed activities, administrative capacity, stakeholder engagement, evaluation framework, and especially alignment with federal priorities, all contribute to the overall score. States that have already adopted or are willing to adopt federal policy priorities are positioned to score higher and receive more funding.
- Annual Recalculation: CMS will recalculate each state’s technical score and workload funding annually to incentivize ongoing alignment with federal priorities and measurable progress toward transformation goals.
- Alignment with Federal Priorities: One of the explicit scoring factors is “Alignment with Federal Priorities,” which measures the degree to which a state’s plan supports CMS goals for rural health transformation and sustainability. Under the Trump Administration, these priorities may include promoting value-based payment models, encouraging technology adoption, advancing adoption of Supplemental Nutrition Assistance Program (SNAP) food restriction waivers that prohibit the purchase of non-nutritious items, availability of integrated care plans for the Medicare-Medicare dually eligible population, reporting of full Medicaid T-MSIS data, and align policies with federal guidance on short-term limited duration insurance plans.
Preparing for What Happens Next: Implications for States, Providers, and Health Plans
The RHTP offers a rare opportunity to reshape rural healthcare. But success will require strategic coordination and a commitment to long-term change. States in the short and long term should consider include:
- Identifying stakeholders who will be involved: Hospitals, rural health clinics, federally qualified health centers (FQHCs), behavioral health providers, and community organizations must be part of the planning process.
- Reexamining priorities: States will need to reconcile competing needs across regions and provider types, balancing infrastructure investments with service delivery redesign.
- Understanding infrastructure needs to support their project: Technology, workforce, and models of care must be strengthened to support long-term transformation.
- Designing evaluation frameworks: States must include robust performance monitoring and reporting mechanisms to meet CMS expectations and secure future funding.
Providers and other stakeholders should also prepare to align with state strategies. Examples include:
- Participating in regional partnerships
- Adopting new care models and payment arrangements
- Investing in technology and workforce development
- Contributing data and insights to support evaluation efforts
The scoring structure also incentivizes states that may not yet be fully aligned to implement new initiatives or make policy changes that would improve their technical scores and secure greater funding. States and their partners will need to be united on the goals and initiatives, disciplined about implementing and evaluating the plans based on data informed reports, nimble and willing to make strategic pivots based on feedback and experiences.
Connect With Us
States that are already aligned with Trump Administration priorities—such as those with established value-based payment models, short-term limited duration plan options, preferred technology infrastructure, or strong rural hospital support policies—are positioned to be rewarded in the scoring and funding process.
Health Management Associates (HMA), is actively supporting states in developing compliant and compelling RHTP applications. Our advisory services include:
- Strategic assessments and stakeholder engagement
- Program design and grant writing
- Implementation support and technical assistance
- Actuarial support
- Evaluation and performance monitoring
We help clients navigate the complexities of federal funding, align transformation goals with community needs, and build sustainable models for rural care delivery. For details about the RHTP, including the HMAIS State Action Tracker, contact HMA experts below.
September 17, 2025
Rural Health Transformation Program Represents a One-Time Opportunity to Reshape Rural Care
Webinar Replay- Beyond the Bill: How Pair Team and MCOs Are Meeting Community Needs Under HR 1
This webinar was held on October 2, 2025.
As Medicaid evolves under HR 1, Managed Care Organizations face increasing pressure to meet new engagement requirements while ensuring vulnerable communities don’t fall through the cracks. This shifting landscape demands scalable, innovative care models that go beyond compliance – focusing instead on meaningful connections, coordinated support, and whole-person care.
In this session, Jami Snyder, former HHSC Commissioner of TX and Medicaid Director of AZ, joined Neil Batlivala, CEO and Co-Founder of Pair Team, and Dr. Nate Favini, Chief Medical & Strategy Officer, to explore how Pair Team and its MCO partners are meeting this moment. Learn how their model combines technology, care coordination, and community-based partnerships to engage hard-to-reach members and address social drivers of health.
We heard real-world examples of how payers and partners can come together in smarter, more connected ways. By aligning efforts and building trust, they can drive better outcomes and create stronger community connections for the people who need support the most.
Learning Objectives:
- Briefly break down HR 1’s most critical provisions and what they mean for Medicaid and MCO operations.
- Discover how Pair Team and MCOs are co-designing solutions leveraging technology.
- Identify best practices for engaging populations facing barriers such as behavioral health needs, housing instability, and transportation challenges.
Featured Speakers:
Carter Kimble, Principal (Moderator) Health Management Associate
Jami Snyder, Former HHSC Commissioner, Texas; Former Medicaid Director, Arizona
Neil Batlivala, Founder and Chief Executive Officer Pair Team
Nate Favini, MD,MS, Chief Medical Officer Pair Team
Building Bridges: Key Insights from the 2025 HCBS Conference and What They Mean for Your Organization
This week, our In Focus features insights from the team of Health Management Associates (HMA) experts who attended the 2025 Home and Community-Based Services (HCBS) Conference. Over a handful of days, aging and disability leaders, state officials, health plans, providers, and advocates gathered to explore strategies to transform long-term services and supports. The event celebrated advances in cross-sector collaborations, evidence of program value, seamless access to care for older adults and people with disabilities, member engagement, and integrated care plans for dually eligible individuals.
HMA participants identified seven cross-cutting themes that are reshaping the aging and disability landscape. We examine how these themes connect to ongoing federal policy changes and provide actionable guidance for stakeholders looking to stay ahead of the curve in this evolving field.
Key Cross-Cutting Themes from the Conference
Executive Leadership Is Making the Difference
State leaders are developing new partnerships to continue progress toward meeting the needs of people with disabilities and aging adults across the lifespan. The conference showcased the significant progress that states have made by engaging governors and cabinet-level leaders. Pennsylvania’s aging department, for example, though small, leverages lottery funding and executive support to coordinate across departments and various strategic planning initiatives such as their Aging Our Way, PA multisector plan for aging.
North Carolina’s policy leadership in the governor’s office has been instrumental in aligning aging goals across state agencies such as the Department of Commerce on workforce initiatives and Department of Transportation which includes specific older adult needs in its planning.
Tennessee exemplified this approach by merging its Commission on Aging and Disability with the Department of Intellectual and Developmental Disabilities to establish a single cabinet-level Department of Disability and Aging.
This executive engagement enables what Kathy Greenlee, former ACL Administrator, emphasized: building partnerships beyond traditional aging and disability networks including connections with children and families programs that share common goals around caregiver support and prevention.
Technology Is Extending Human Capacity, Not Replacing It
Technology took centerstage as one of the major solutions to providing personalized caregiver supports and extending the capacity of human services. States are embracing AI (artificial intelligence)-powered tools for routine tasks like call transcription and resource database management, while maintaining human oversight for complex client interactions.
The most successful approaches recognize what MIT AgeLab’s Joe Coughlin highlighted, “High tech won’t replace the need for high touch, but high touch is in short supply.” Technology networks can stretch caregiver capacity, but the human element remains essential. The next generation of service professionals must be tech-savvy integrators who combine digital tools with caring relationships. Key technological advances include digital and virtual coaching platforms, AI precision analytics for risk identification, and “home intelligence” systems that support aging in place. Success, however, depends on ensuring these tools enhance rather than replace human connection.
Direct Care Workforce Crisis Demands Immediate Action
Leading states are not just attempting to manage workforce shortages; they are working on comprehensive workforce infrastructure solutions. Wisconsin’s Certified Direct Care Professional program enrolled over 3,400 workers in its first year, reduced turnover rates, and created a statewide registry where employers actively recruit graduates. Michigan developed four-level stackable credentials that transform direct care into respected career pathways.
States are deploying integrated workforce platforms that combine multiple solutions, including worker registries that promote workforce access and transparency, learning management systems that strengthen development through credentialing, and job matching that enhances access to quality care, and data insights that support evidence-based decisions.
Missouri demonstrates effective stakeholder engagement through its Direct Support Worker Advisory Panel, where 15 workers provide feedback on rates, documentation, scheduling, and professional development while being compensated in developing the solutions, for example, by including them in official advisory entities.
Forward-thinking organizations are breaking down silos through cross-sector partnerships. Area Agencies on Aging and Centers for Independent Living are cross-training workers to serve both populations, effectively expanding the available workforce capacity. Technology integration scales solutions through online, self-paced training that accommodates work schedules and diverse learning needs, while states use federal funding and Medicaid rate increases to boost wages and implement recognition strategies that elevate professional status.
Evidence-Based Investment Strategies
States shared the power of systematic, data-driven approaches to secure aging and disability investments. Ohio’s disciplined four-step process—identify priorities, determine evidence-based interventions, quantify return on investment, and operationalize results—resulted in $40 million in legislative funding for Healthy Aging Grants.
Under this reframing, aging can now be seen as an opportunity rather than a burden. States are building ecosystems and partnerships to enhance reach and effectiveness. This positions aging investments as competing priorities capable of delivering measurable returns. Wisconsin’s new Certified Direct Care Professional certification with career ladder pathways exemplifies how evidence-based workforce strategies can address critical shortages while improving quality.
The Urban Institute’s research on benefit uptake reveals that nearly 9 million older adults are eligible for programs they don’t receive. Success factors include coordinated state agencies, streamlined applications, community trust-building, and staff training—all areas where evidence-based approaches can guide improvement.
Holistic Support for Caregivers and Care Members
The conference emphasized a fundamental shift from viewing caregivers as invisible helpers to recognizing them as partners who require comprehensive support. Key elements for achieving caregiver-driven outcomes include providing support, guidance, and assistance while measuring burden, resilience, satisfaction, and finally, the intent to remain in home settings. Medicare now covers ADL/IADL supports through new coding structures, reflecting growing recognition of how caregiver skill-building adds value. This holistic approach extends to addressing the question of who replaces the family caregiver, as older adults increasingly live alone. The answers rest with the development of new partnerships with retailers, pharmaceutical companies, and employers, plus technology that enables remote family support.
Cross-Sector Collaborations: Systems Integration as Survival Strategy
Breaking down silos that have historically separated aging, disability, children and families, and health services resonated throughout the conference. Kentucky observed that states struggle with multiple uncoordinated plans, each with different goals and measures.
Several states have demonstrated successful integration strategies, such as aligning funding streams, creating shared governance structures, and using common metrics across traditionally separate systems. North Carolina’s approach of embedding aging considerations in transportation planning and commerce workforce development shows how integration can extend beyond human services.
From a federal perspective, integration has support. As Greenlee noted, the Administration for Children, Families, and Communities includes “communities” in its title as a signal of broader inclusion. States that build partnerships across these traditionally separate areas will be better positioned for future federal funding and policy changes.
MLTSS as a Critical Vehicle for Whole-Person Care
Managed Long-Term Services and Supports (MLTSS) programs are evolving an infrastructure for providing coordinated and integrated care delivery care. As this transformation occurs, states must have adequate oversight capacity to manage MLTSS programs effectively.
Effective MLTSS programs can help people early enough to prevent nursing facility placement by integrating all services including medical, behavioral, and HCBS and social supports through capitation. Plans should allocate resources to support provider technological investments that facilitate improved care coordination. This technological support becomes essential to maintaining the high-touch, personalized services that MLTSS members require while achieving the scale necessary for program sustainability.
Policy Connections: From Conference Themes to Federal Action
These conference themes reflect broader federal policy shifts, including:
- New funding must be used more strategically. The $10 billion annually for rural health transformation (2026‒2030) can also create opportunities to integrate aging services into the broader health infrastructure.
- Resource constraints sparks innovation. As the Administration for Community Living faces resource constraints with significant staff reductions, states must be more proactive and resourceful in developing innovative programs.
- Advocacy must be timed. Upcoming budget cycles require strategic timing for advocacy efforts.
The Road Ahead for Stakeholders
Organizations across the aging and disability ecosystem must prepare for a more integrated, technology-enhanced, and evidence-driven environment. Success will require executive leadership, strategic partnerships, and measurable value.
State Agencies
- Engage executive orders establishing aging as a priority across all state departments.
- Developing systematic evidence-based investment strategies that quantify return on investment for aging initiatives, using Ohio’s four-step methodology as a template.
- Building partnerships beyond traditional aging and disability networks, including with children and family services, workforce development, and transportation agencies.
- Implementing workforce development strategies that include investing in credentialing and tech-enabled training, and cross-sector partnerships to address to strengthen the direct care workforce.
Health Plans and Payers
- Implementing holistic caregiver support programs that combine digital tools with human coaching, measuring outcomes like burden reduction and care member satisfaction.
- Leveraging new Medicare coding opportunities for ADL/IADL supports to pay for evidence-based caregiver training and skill-building programs.
- Partnering with technology companies to deploy AI-powered risk identification tools while maintaining human oversight for member interactions.
- Investing in provider technology infrastructure that enables better care coordination and supports MLTSS program effectiveness.
Providers and Community Organizations
- Developing technology-enhanced service delivery that extends human capacity while preserving personal connection, following the “high tech, high touch” principle.
- Pursuing evidence-based training and credentialing programs with clear career pathways.
- Building partnerships with non-traditional allies like retailers, pharmaceutical companies, and employers to expand aging-in-place support networks.
- Participating in workforce development initiatives that create shared worker pools across aging and disability services.
Technology Vendors
- Developing AI-powered tools that enhance rather than replace human service delivery, focusing on routine tasks like documentation and risk assessment.
- Creating integrated platforms that support cross-system coordination between aging, disability, health, and family services.
- Building home intelligence systems that enable remote family caregiving and professional monitoring while preserving independence and dignity.
- Designing workforce development platforms that support credentialing, job matching, and career advancement tracking.
Moving Forward Together
The 2025 HCBS Conference revealed a field that is embracing innovation and integration. States leading this transformation share common characteristics: executive leadership, evidence-based investment strategies, technology that enhances human connection, holistic support approaches, and systems that collaborate to break down traditional silos.
The path forward requires strategic planning, rigorous evaluation, cross-sector partnerships, and sustained political will. Organizations that can integrate evidence-based approaches with compassionate care, leverage technology to extend human capacity, build partnerships that transcend traditional boundaries, and develop sustainable workforce solutions, will be best positioned to serve the growing population of older adults and people with disabilities.
Connect with Us
The HCBS Conference highlighted significant momentum toward integrated service delivery, evidence-based investment, and technology-enhanced care. Stakeholders should expect continued federal policy evolution, including new funding opportunities and partnership requirements in the coming years. Organizations that wait will miss critical opportunities. HMA works with state agencies, health plans, providers, and community organizations to design and implement aging and disability initiatives. We help clients engage executive leadership, develop evidence-based business cases, deploy appropriate technology solutions, build cross-sector partnerships, and create sustainable workforce development strategies. To discuss how these trends affect your organization and explore next steps, contact our featured experts below.
September 10, 2025
Building Bridges: Key Insights from the 2025 HCBS Conference and What They Mean for Your Organization
Understanding Substance Use Disorders & the Use of Medications for Treatment
Education Materials for Patients, Families, Educators and Non-Prescribing Providers
This is a comprehensive set of substance use disorder (SUD) education materials for patients, families, educators, and non-prescribing providers. In recognition of September being National Recovery Month, this document is fully downloadable for community use without restriction.
The toolkit was made available through a joint effort of the California Department of Health Care Services Opioid Response Project and Health Management Associates. Coaching and technical assistance for this project was funded through DHCS by State Opioid Response Funds from SAMHSA. The bilingual patient education materials are written in accessible language for most audiences, in both Spanish and English.
The materials can be used to broadly disseminate information across a community or with individual patients, family members and non-prescribing providers. These SUD educational materials were created using the latest research and information available. They are meant to be concrete and easily accessible with simple language that promotes increased understanding of each topic. Some of the topics touched upon include evidenced-based treatment options such as Medications for Addiction Treatment (MAT) and Medications for Opioid Use Disorder (MOUD).
Webinar Replay – Medicaid 1115 Justice Involved Reentry Demonstration Opportunities: Engaging Key Stakeholders
This webinar was held October 22, 2025.
This webinar explored how states, local agencies, and community organizations can maximize Medicaid’s new 1115 demonstration authority to improve reentry outcomes for justice-involved individuals. Presenters discussed practical strategies for assessing health and social needs, building strong collaborations with community providers, and implementing effective Medicaid enrollment processes. Attendees gained insights into designing and operationalizing reentry programs that promote continuity of care, reduce recidivism, and support successful community reintegration. This session is ideal for State Medicaid agencies, carceral facilities, correctional healthcare companies, health plans, community-based organizations, and federally qualified health centers.
Learning Objectives:
- Understand the health and resource needs of returning citizens (health, behavioral health and social issues).
- Identify key partners and formalize collaborations to strengthen the quality of transitions, care and support provided to individuals transitioning to the community.
- Develop Medicaid enrollment strategies that apply to your state and local framework.
From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems
HMA Spotlight
From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems
Hospitals across the country are facing unprecedented levels of behavioral health (BH) challenges that impact every facet of operations, from the emergency department to discharge planning. Extended lengths of stay, ED boarding, workplace violence, and staff burnout present clinical issues and pose operational, financial, and reputational risks.
Individuals with BH needs arrive in emergency departments daily, even if the hospital lacks a dedicated BH inpatient unit. These patients require coordinated care across all clinical sites.
HMA offers an end-to-end partnership helping hospitals identify and implement solutions in ways that build internal capacity and deliver measurable results.
Rapid assessments to identify high-impact opportunities
Financial modeling and reimbursement optimization
Strategic and operational planning for BH integration
Partnership development and M&A advisory for BH service lines
Implementation support with measurable results
Effective Strategies
HMA partners with hospitals to address these challenges with a vision of improving care and operations. Our team offers practical, high-impact solutions that enhance patient care, support your workforce, streamline operations, and promote financial stability. Contact us to discuss how solutions can be tailored to your hospital’s unique needs. Let’s address your most urgent behavioral health challenges now, before they impact care delivery and financial stability.
Six Priority Areas
While every hospital faces unique behavioral health challenges, the pressures they create are consistent. HMA partners with your leadership and frontline teams to focus on six proven priority areas that create lasting impact. Together, we develop solutions that improve care, strengthen operations, and build resilience across your organization.
- Rapid stabilization protocols
- Integration of psychiatric expertise into acute care workflows
- Boarding reduction strategies
Value: Reduce length of stay, improve throughput, and protect staff safety.
- Cross-continuum care pathways
- Partnerships with community providers
- Readmission prevention frameworks
- Accreditation readiness (The Joint Commission, DNV (Det Norske Veritas))
Value: Improve continuity, patient satisfaction, and reduce high-cost utilization.
- Optimizing reimbursement (e.g., unbundled billing for injectables)
- Service line financial assessment
Value: Unlocking new revenue streams.
- Joint ventures with behavioral health providers
- Sell-side preparation and merger and acquisitions support
- Community and payer alignment
Value: Expand service capabilities while sharing risk and resources.
- Staffing models to provide effective and efficient care while reducing burnout
- Data-driven performance management
- Technology-enabled workflows
Value: Increase efficiency and retention through optimized operations.
- Medication Assisted Treatment (MAT) and Medication for Opioid Use Disorder (MOUD) implementation in ED and inpatient settings
- Peer navigation programs
- Integration with primary and specialty care
Value: Reduce mortality, avoidable readmissions to EDs, and improve community health outcomes.
Proven Results
Our work with hospitals across the country delivers measurable, lasting improvements that strengthen care delivery, operational performance, and financial health.
- Reduced ED boarding times by up to 40% through targeted intervention models.
- Increased reimbursement for behavioral health services by optimizing billing practices for long-acting injectables and other high-value services.
- Delivered $1.2M in annual savings for a regional hospital through integrated behavioral health response planning.
HMA Differentiators
Many of our team members are former executives and clinical leaders from the behavioral health sector. They bring decades of experience leading behavioral health care in inpatient, outpatient and emergency department settings. HMA provides the depth, agility, and collaborative approach that hospitals need to address today’s most urgent behavioral health challenges while also building capacity for the future. Our proven track record includes hospitals of all sizes and structures, ensuring that solutions are tailored to your market, patient mix, and resources.