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Solutions

HMA’s Experts Support States in Rural Health Initiatives

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HMA Solutions

HMA’s Experts Support States in Rural Health Initiatives

RHTP Requirements and Opportunities: Now What?

As of November 5th, each state should have applied for the Rural Health Transformation Program (RHTP) designed to support communities across the United States who face unique and persistent healthcare challenges. Residents in rural areas often have limited access to care, a shortage of service providers—primary care, behavioral health, emergency services, and clinical specialists—and significant barriers in transportation, connectivity and care coordination among providers.

The Centers for Medicare & Medicaid Services (CMS) will announce funding by the end of the year, with states receiving notice of their allocations and potentially feedback on their application content. States are now tasked with developing comprehensive plans to enhance rural healthcare infrastructure, improve access, integrate care, and demonstrate measurable outcomes within tight timelines. The RHTP requires:  

A strong management structure at the state level, including dashboards and oversight of programs funded through this award

Defined goals and sustainable initiatives in chronic disease management, primary care, behavioral health, maternal health, digital innovation, workforce initiatives, and other topics

Demonstrated outcomes that evidence improvements in rural access and health outcomes, as well as the care experience of rural residents

The short turnaround and wide range of components and requirements in the RHTP application process will mean there is a lot of detail left to be decided. States should be prepared to engage in a planning process that capitalizes on near-term opportunities and lays the groundwork for implementing sustainable transformation initiatives. HMA is ready to provide support with practical, field tested solutions for immediate effect and support the development of last reforms. 

HMA’s Rural Track Record

HMA is a national leader in healthcare consulting, with a multidisciplinary team of over 700 experts experienced in policy, finance, clinical services, analytics, and community engagement. HMA has supported a diverse array of clients serving rural and frontier communities, including state and local governments, health systems, federally qualified health centers, tribal organizations, providers of every specialty, and community-based groups.

Examples of some of HMA’s past work in rural health include:  

Primary Care improvement: HMA partnered with New Mexico Human Services Department to reform primary care payment models, addressing sustainability and fiscal soundness for rural providers. This work involved designing, testing, and evaluating new models, engaging stakeholders, and supporting implementation through provider training and analysis.

Tribal Behavioral Health Systems: In Montana, HMA assessed gaps and provided the state recommendations to improve behavioral health systems for tribal communities, focusing on culturally competent, integrated care models.

Strengthening the financial health of rural providers: In Colorado and Georgia, HMA supported the development of value-based payment strategies for rural providers by analyzing fiscal operations and performance and creating operational pathways to enhance sustainability and care quality.

Supporting rural residents through community interventions: HMA developed a toolkit for tackling access challenges for dually eligible individuals in rural areas, offering actionable solutions for policymakers and providers to improve care and outcomes. 

Workforce Development: HMA has led numerous initiatives to address workforce shortages in rural settings, providing solutions for recruitment, retention, and care coordination, particularly in behavioral health. As a founding member of the Workforce Solutions Partnership, we have captured near- and longer-term solutions to behavioral health workforce shortages. 

How HMA Can Assist States in Executing RHTP

HMA offers a comprehensive suite of services to help states and their partners successfully implement RHTP initiatives, all under one roof. From actuarial and financial skills to clinical and operational expertise, policy, and analytics, HMA can support successful implementation of your State’s Rural Health Transformation program.

Here are some of the ways we can support your efforts:  

Program integrity and effectiveness

Design robust oversight tools to monitor state programs, ensuring transparency in funding flows, program goals, and outcomes.

Provide data-driven insights, program monitoring, and evaluation to demonstrate impact and guide continuous improvement.

Conduct financial assessments and provide recommendations to improve the solvency of rural healthcare systems.

Initiative design and implementation

Support and coach providers and health systems in operational change, clinical organization, e-health adoption, and integrated care models tailored for rural settings.

Leverage proven strategies to address workforce shortages, integrate behavioral health with primary care, and implement scalable solutions.

Design and help execute chronic disease management programs tailored to rural populations and systems.

Help implement the maternal “hub-and-spoke” model and other efforts to improve birth outcomes and access to care

Offer field-tested tools for community engagement and assessment like the HEARD Toolkit for rural residents and other resources to address disparities, improve access, and ensure the needs of vulnerable rural populations are met.

Design, test, and scale innovative models and pilots that align with state and community RHTP goals.

Sustainability

Develop and facilitate effective partnerships and information exchange among government entities, providers, payers, and community organizations to align efforts and maximize the impact of RHTP investments.

Provide a range of financial, revenue, and operational tools for states and rural providers. These tools can help make grant-funded activities sustainable, lasting change.

Conduct a range of workforce development initiatives to enhance access and optimize virtual and in-person care experiences.

A unique HMA differentiator is our team of clinicians – primary care and specialty care physicians, nurse practitioners and physician assistants, registered nurses, behavioral health providers among others – who bring years of direct care delivery experience and the ability to engage other clinicians to effect change and innovation across the delivery system. All of our clinicians have worked in rural and economically disadvantaged communities, and most have worked on rural health initiatives in Alaska, Idaho, South Dakota and other states. This team has been instrumental in developing solutions that encompass a deep understanding of the interplay between medical, behavioral health and social determinants of health as they all contribute to the individuals’ and communities’ wellbeing. Moreover, this team has helped design innovative solutions that incorporate telehealth, remote monitoring, patient apps, and other technologies that engage patients in their care, facilitate care team collaboration, and ultimately close care gaps and reduce instances of avoidable, costly care.

With extensive hands-on experience and a deep understanding of the rural health landscape, HMA is uniquely positioned to help states navigate the complexities of the RHTP, drive sustainable change, and improve health outcomes for rural communities nationwide.

Contact our experts:

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R.J. Briscione

Principal

R.J. is an expert in operations and patient/member engagement across government-sponsored plans, with a focus on Social Determinants of Health … Read more
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John Eller

Managing Principal

John Eller is a seasoned executive with more than 23 years of service in public administration and health and human … Read more
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Farah Hanley

Managing Principal

Farah Hanley is a healthcare executive with more than 30 years of experience with state Medicaid programs, policies, and budget … Read more
Headshot of Alicia Johnson

Alicia M. Johnson

Managing Principal

Alicia M. Johnson is a visionary leader with nearly three decades of experience driving transformative change in the public and … Read more
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Beth Kidder

Managing Principal

Beth Kidder is a transformative and innovative health care leader with more than 20 years of experience working within the … Read more
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Andrea Maresca

Managing Director, Information Services

With nearly two decades of experience in healthcare, Andrea Maresca is a skilled legislative and regulatory analyst and strategy developer. … Read more
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Juan Montanez

Managing Director

Effectively applying information technology (IT) solutions and optimizing information management processes, Juan Montanez has driven operational and service delivery improvements … Read more
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Tonya Moore

Associate Principal

Tonya Moore is a lawyer and public healthcare professional with more than 28 years of government experience at the Centers … Read more
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Kathleen Nolan

Senior Advisor

Kathleen Nolan has been actively engaged in the national dialogue during one of the most transformative periods in the history … Read more
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Robin A. Preston

Senior Regional Vice President

Robin Preston is dedicated to improving access to healthcare for low-income populations. She has been working in the policy and … Read more
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Lina Rashid

Principal

Lina Rashid is a nationally recognized expert in public policy, communications, and outreach, with over 15 years of federal leadership … Read more
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Jay Reiser

Principal

Jay Reiser is a healthcare executive with extensive experience driving growth and operational excellence across Medicare, Medicaid, and ACA programs. … Read more
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Matt Roan

Senior Regional Vice President

Matt Roan brings a valuable perspective having worked for the past 15 years on issues impacting healthcare stakeholders in the … Read more
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Bill Snyder

Principal

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Margaret Tatar

Vice President, Client Solutions

Margaret Tatar has more than 25 years of public and private sector experience in managed care program and policy development, … Read more
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Patrick Tigue

Senior Vice President, Practice Groups

Patrick Tigue is an accomplished executive with experience leading and managing critical efforts to achieve strategic health policy goals on … Read more
Blog

The Future of Integrated Care Programs for Dually Eligible Individuals in Massachusetts: Key Takeaways from the Fall 2025 MAHP/HMA Policy Forum

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Health Management Associates (HMA) recently co-hosted a policy forum with the Massachusetts Association of Health Plans (MAHP), entitled Advancing Better Outcomes: How the One Care and SCO Programs Improve Health for Older Adults and People with Disabilities on Medicare and Medicaid. More than 100 key decision makers from MassHealth (Medicaid), health plans, providers, community-based organizations, and advocacy organizations attended the conference, elevating the value of the MassHealth One Care and Senior Care Options (SCO) programs to dually eligible individuals. The policy forum also provided an important opportunity for state legislators and their staff to learn about these complex programs.

MassHealth One Care and SCO Programs

Massachusetts’ One Care and the SCO programs currently serve more than 125,000 individuals covered under MassHealth and Medicare, also known as dually eligible individuals. One Care is a population-specific program for dually eligible adults 21-64 years of age. SCO is a population-specific program for dually eligible older adults 65 and older, tailored to the needs of older adults. The One Care and SCO programs serve individuals with complex chronic conditions and disabilities, including mental health and substance use disorder needs, and high home-and-community-based service (HCBS) needs. The One Care and SCO programs advance independent living, recovery, and community living goals. Approximately 99 percent of One Care enrollees, and 95 percent of SCO enrollees, live in the community.

The One Care program is currently authorized as a Financial Alignment Initiative (FAI) demonstration program. The FAI demonstration ends December 31, 2025. MassHealth will continue the One Care program as a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) model. This transition from the FAI to a FIDE SNP model introduces changes to the program. A FIDE SNP model is a type of Medicare Advantage (MA) Dual Eligible Special Needs Plan (D-SNP).

HMA’s Role: Bringing National and State Expertise

In addition to creating the forum in partnership with MAHP, HMA shared its national and state policy expertise and local market insights with attendees during a series of presentations. HMA outlined ways in which the One Care and SCO programs offer more value to dually eligible individuals than the state’s fee-for-service (FFS) system.

The event focused on three key topics:

  • The national landscape for Medicare-Medicaid integrated care programs.
  • The value of the One Care and SCO programs and the role that health plans play in improving outcomes for adults who are eligible for both Medicare and Medicaid (“dually eligible”), and
  • The upcoming changes to the One Care and SCO programs, as reflected in the 2026 state Medicaid agency contracts (SMACs) with MassHealth.

Key Takeaways from the MAHP-HMA Conference

Key Takeaway #1. Nationwide trends suggest that Medicare-Medicaid integrated care programs will face competition and financial pressures.

Forum attendees were very interested in the national trends. At the national level, D-SNPs have bipartisan support. At the same time, D-SNPs should expect competition from Chronic Condition Special Needs Plans (C-SNPs) and innovation models developed by the Centers for Medicare and Medicaid Innovation (CMMI). CMMI models such as the Guiding an Improved Dementia Experience (GUIDE) Model and Accountable Care Organizations (ACO) Realizing Equity, Access, and Community Health (REACH) Model will compete with D-SNP models in some markets. Finally, presenters and panelists alike raised concerns about the financial risks that D-SNPs will face due to rising pharmacy costs and changes in Medicare payment methodologies.

Key Takeaway #2. The Massachusetts One Care and SCO programs provide significant value to dually eligible individuals in Massachusetts.

The One Care and SCO programs provide significant value to enrollees. As compared to FFS, Medicaid-Medicaid integrated care programs like One Care and SCO provide care coordination, a personal care plan, bundling prescriptions through a single provider, and other services.

Many forum attendees pointed out that the One Care program is one of the most advanced integrated care programs in the nation. One Care’s success is tied in part to the active and critical role that the One Care Implementation Council plays in shaping program policy. For more than a decade, the One Care Implementation Council and MassHealth have worked in partnership to improve the program. As shared by the Massachusetts Medicaid Policy Institute (MMPI): “The Commonwealth intends to preserve the Implementation Council’s role in the next phase of One Care, and to continue engaging the council as an essential partner in policy and program change, monitoring, and oversight.”

Key Takeaway #3. Over the last two decades, SCO and One Care plans have established many innovations.

The forum highlighted many innovations in these programs, from primary and urgent home care to place-based supports. It also provided an opportunity to talk about the important role and commitment that the plans have in emergency situations to ensure that members are safe in the face of a community crisis.

Panelists see many opportunities for plans to continue to evolve and improve outcomes and equity. For example, the One Care program has significant opportunities to address the behavioral health needs of dually eligible adults. Dually eligible adults with mental health and/or substance use disorder diagnoses are at higher risk of an emergency department visit and inpatient stay than other enrollees. Health plan per member per month (PMPM) spending on inpatient services for those with a behavioral health condition is much higher as a share of the total PMPM than other populations. The HMA data pointed to a need for further innovation in the mental health arena to advance better outcomes of quality of life and costs.

Key Takeaway #4. Conference attendees focused on the importance of addressing enrollees’ social determinants of health needs.

Throughout the day, the importance of community and addressing the social determinants of health (SDOH) was a common theme. Aging and disability leaders spoke about the importance of community organizations such as Aging Services Access Points (ASAPs), independent living centers (ILCs), recovery learning communities (RLCs) including peer support since most  One Care and SCO individuals live in the community.

Many One Care and SCO eligible individuals are often just one unmet health related social need away from the risk of hospitalization or institutionalization. Other attendees underscored the risk that enrollee living situations and recovery can become instantly unstable due to the death of an important family member. One aging leader described her role as “triaging risk.” Other leaders from the disability community urged plans to use z codes to improve plan and provider attention to identify and address the SDOH needs.

Looking Ahead

As Massachusetts prepares for the 2026 One Care and SCO contract year, the forum underscored the progress made over the past decade and the opportunities ahead to improve care coordination, collect z codes, and invest in outcomes-driven partnerships. Massachusetts is well-positioned to continue leading the nation in designing integrated care programs that improve health and support community living for older adults and people with disabilities.

HMA looks forward to supporting all organizations including state Medicaid programs and health plan and provider associations as they convene stakeholders to improve their integrated care programs. Our expertise includes program planning, strategy and implementation, technical support and evaluation, and state-specific knowledge to make projects successful. Please contact Ellen Breslin, Rob Buchanan, and Julie Faulhaber for more information on how HMA can help your organization.

Summary Facts About the One Care and SCO Programs
The One Care and SCO programs are population-specific programs, serving more than 125,000 individuals with MassHealth plus Medicare coverage.   MassHealth designed the One Care and SCO programs around the specific needs, preferences and goals of adults and older adults.The One Care program enrolls dually eligible adults with disabilities, ages 21-64 at the time of enrollment, covered under MassHealth Standard or CommonHealth and Medicare (Parts A and B, and eligible for Part D). Enrollees in One Care have multiple chronic conditions and disabilities including significant mental health and substance use disorder needs. The SCO program enrolls dually eligible adults ages 65 and older, covered under MassHealth Standard and Medicare (Parts A and B, and eligible for Part D). SCO enrollees have significant chronic conditions, many of which are associated with aging.
MassHealth launched the SCO program in 2004 and One Care in 2013.   The One Care program currently operates as a Financial Alignment Initiative (FAI) demonstration. The One Care and the SCO programs combine MassHealth & Medicare benefits into a single plan with one card and one care team. One Care covers medical, mental health, and prescription medications, plus support for daily tasks and independent living and recovery. Care coordinators help members stay healthy and get the services they need.
The One Care and SCO Programs Continue to Evolve. The FAI demonstration authority ends in 2025. Massachusetts will shift from the demonstration to a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) structure. The SCO program currently operates as a FIDE SNP model. The state reprocured the One Care and SCO plan network. The state selected five One Care plans and six SCO plans. New contracts for One Care and SCO plans start January 1, 2026.The new contracts create several changes including changes in eligibility for the program and enrollment processes, benefits, and financial payment provisions.
Blog

Rewriting the Playbook: State Budgeting in the Era of OBBBA

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As of October 22, 2025, all but two states—North Carolina and Pennsylvania—had enacted budgets covering fiscal year (FY) 2026, even as the federal landscape has shifted dramatically throughout the year. In particular, passage of the 2025 Budget Reconciliation Act (OBBBA) and the ongoing federal budget impasse are creating significant downstream pressures on state budgets and the programs they support.

A new report from Health Management Associates Information Services (HMAIS) examines enacted state budgets. Of the 48 enacted budgets, 16 cover the 2025‒27 biennium, and three states—Kentucky, Virginia, and Wyoming—approved budgets in 2024 for the FY 2024‒26 biennium.

The HMAIS report highlights state Medicaid funding priorities, initiatives states are pursuing to adapt to new federal Medicaid and other healthcare policy changes, and reforms to strengthen and ensure the sustainability of programs, particularly in states that expect a reduction in the federal share of their Medicaid program.

OBBBA’s Impact on State Budgets

Congress has yet to reach agreement on the federal fiscal year 2026 spending bills, and there are emerging signals of the challenges this impasse will create for states and federally funded public services. For example, this week the US Department of Agriculture’s Food and Nutrition Service notified every state that Supplemental Nutrition Assistance Program (SNAP) benefits will be withheld because of the funding lapse. This unprecedented situation puts immediate pressure on states and community organizations, which may need to intervene to fill gaps in essential services and benefits.

In addition to the funding impasse, OBBBA introduces major changes, particularly for the Medicaid program, including:

  • Medicaid Community Engagement/Work Requirements: All states must implement these requirements for certain Medicaid members by December 31, 2026, requiring rapid infrastructure and system changes.
  • Eligibility and Redetermination: States must conduct Medicaid eligibility redeterminations every six months for expansion populations, with new verification requirements and narrowed definitions for “qualified” immigrants. States will need to pressure test their systems for increased volume and may need additional capacity to prevent and minimize backlogs.
  • Cost Sharing: By 2028, states must apply a cost sharing requirement for Medicaid expansion adults with incomes above 100 percent of the federal poverty level, with some service exemptions. In 2026, states will need to begin efforts to ensure their systems can track this requirement.
  • Provider Taxes and Payments: Freezes on provider tax programs, phased reductions in allowable tax rates, and caps on state-directed payments will reduce flexibility and funding.

In addition, the Rural Health Transformation Program and new federal drug pricing initiatives present both opportunities, such as new funding streams, and risks, including administrative complexity and compliance expectations.

Given the scope of federal changes, states face urgent decisions. They must quickly assess and act on these opportunities, often without dedicated budget allocations.

These federal changes, combined with the budget impasse, are forcing many states to revisit approved budgets, adapt policies, and plan for new initiatives and revise programs that were already in effect—often within short timelines and with limited resources.

State-Level Challenges and Adjustments

Notably, most states enacted their budgets before the passage of OBBBA. As a result, these budgets do not fully account for the new federal requirements, funding changes, and administrative expectations that OBBBA introduces. While many OBBBA provisions will not take effect for at least a year, states must now accelerate planning and make rapid adjustments to comply with new mandates. For example, states are expected to expediently and efficiently implement systems and policies to ensure compliance with OBBBA’s statutory requirements, particularly for the Medicaid program.

HMAIS has examined state budgets that will guide states through the next fiscal year, while also watching closely how they respond to new demands during the first full state legislative cycle under OBBBA.

The HMAIS report describes a mix of budget conditions and actions. Many states continue to invest in ongoing healthcare priorities as well as new initiatives, including targeted rate increases for behavioral health, dental, and maternal health services. In addition, states are addressing inefficiencies in program administration broadly. In healthcare specifically, they are revisiting approaches to financing healthcare service delivery to drive more value from organizations, such as implementing alternative payment models in Medicaid programs, as well as considering tools to improve patient outcomes and consumer experiences.

States are using a variety of tools in their Medicaid budgets to manage these pressures, as well as implementing more general cost-reduction and efficiency measures, including:

  • Special Legislative Sessions. Some state legislatures, including Colorado’s and New Mexico’s, have reconvened to address emerging gaps.
  • Hiring Freezes. Several states, including Alaska, Colorado, Maryland, Massachusetts, New Hampshire, and Washington, have announced hiring freezes, which could complicate OBBBA preparation efforts.
  • Pausing or Ending Planned Programs and Benefit Coverage. Oregon announced that it will end its juvenile justice Medicaid reentry program to conserve funding. North Carolina will not cover new weight-loss drugs because of its budget shortfall. The HMAIS report indicates that officials in other states also have signaled that they are planning for similar updates to their programs if required to address budget shortfalls.
  • Medicaid Provider Rate Updates. Colorado rolled back a planned Medicaid provider rate increase, while Idaho is decreasing all Medicaid provider rates by 4 percent.
  • Coalitions and Advisory Groups. Other states, including Rhode Island, are convening groups charged with analyzing how the federal cuts may affect their state programs and advising the legislature on feasible responses to the changed landscape.

What to Watch

Healthcare organizations are essential partners as states navigate the current federal budget uncertainty and implement OBBBA requirements. Given the challenges cited above, healthcare organizations should be prepared to collaborate and position to anticipate future needs as the exact components of the various policies are in development.

Recommendations for states and healthcare organizations include:

  • Do not delay planning. While federal policymakers are developing guidance and regulations, the OBBBA language provides significant information on what states need to do and initial expectations for reporting. States and their partners should be developing options and contingency plans to make expeditious decisions once details are available.
  • Monitor and anticipate state actions and develop responses that are ready to go if needed. For example, states may need to make rate reductions, limit enrollment for optional programs, and communicate with beneficiaries about new requirements. Partners should plan to adapt to these changes and assist providers and beneficiaries as needed.
  • Prepare for changes in workload. States will need to design, develop, implement, and report on new Medicaid eligibility and enrollment requirements. They will need a workforce that is trained and can read into the policies, systems, and related needs. States will expect their partners to collaborate on efficient approaches to meet workload demands.
  • Engage with state officials. States need thoughtful partners to manage and implement the forthcoming changes that will affect Medicaid partners and beneficiaries. Healthcare organizations should bring experience and data-informed ideas and input to facilitate state approaches and decision-making.

Connect with Us
With federal funding reductions and ongoing uncertainty at the national level, states need to pay heightened attention to the frontline of essential healthcare and human services, implementation of OBBBA, and means of addressing gaps left by federal delays. As we approach the 2026 election year—with many governors up for reelection—state budgets will serve as a blueprint for leadership and policy priorities in the next cycle.

HMA is on the frontlines, working with states and healthcare partners to navigate these complexities. HMA has expertise, tools, and insights—from budget contingency planning supports to analysis of public coverage program enrollment and market insights.

The full report is available to HMAIS subscribers. For questions contact our experts below.

Blog

CMS Clarifies Grandfathering Rules for State Directed Payments

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The Centers for Medicare & Medicaid Services (CMS) last month issued a letter to states providing preliminary guidance on Medicaid State Directed Payments (SDPs), which outlines new federal payment limits, clarifies grandfathering provisions, and signals significant changes ahead for Medicaid financing and policy. The letter is part of CMS’s implementation of Section 71116 of the Budget Reconciliation Act of 2025 (OBBBA, P.L. 119-21)—the portion of the legislation that focuses on curbing SDP spending and reinforcing program integrity.

Though CMS describes the guidance as preliminary, it is the view of Health Management Associates (HMA) experts—including former state officials, actuaries, and policy strategists—that it signals directionally new policy for Medicaid agencies, managed care organizations (MCOs), and providers. CMS is working on two proposed SDP-related regulations, which are in the final stages of federal review. The preliminary guidance and forthcoming rules will likely reflect long-standing concerns for several years, even over shifting congressional control and multiple presidential administrations.

This article addresses key clarifications in the letter; the impact of the preliminary guidance on states, MCOs, and providers; and how the directive may influence Medicaid budgets, financing strategies, and future policy reforms.

Guidance Clarifies Timeframes for SDPs

Grandfathering Limited to Specific Rating Periods

CMS will allow states to maintain SDP spending amounts, up to the average commercial rate ceiling, that were in place for state fiscal year (SFY) 2025, calendar year (CY) 2025, and SFY 2026 rating periods. Nonetheless, new or expanded SDPs above Medicare equivalent levels in expansion states and 110 percent of Medicare in non-expansion states—even those based on legislation passed in 2025—are ineligible for grandfathering if they apply to rating periods starting after July 4, 2025. These grandfathered spending amounts will need to phase down with rating periods beginning on or after January 1, 2028.

Preliminary Grandfathering Determinations

CMS has begun notifying states whether a preprint is “likely eligible” for grandfathering. Because these are preliminary determinations, states should prepare for further review and revisions.

Submission Cutoff Date Clarified

In response to confusion around the May 1, 2025, submission deadline, CMS clarified that July 4, 2025, is the cutoff for grandfathering eligibility, provided the state fully completed the preprint. States may have rushed to meet a July 4 submission deadline and may have left questions on the preprint unanswered. In these instances, it is possible—if not likely—that CMS will consider the application incomplete and thus ineligible for grandfathering. Since this is a developing area with limited precedent, states may still seek clarification or reconsideration, though CMS has not yet issued definitive guidance or a formal process for resolving these situations.

No Increases Allowed Until 2028

States are prohibited from increasing the total dollar amount of grandfathered SDPs—the “expected spend”—until January 1, 2028. This restriction limits flexibility for states to expand their programs and may require that they reassess their SDP strategies. For example, using percentage-based calculations tied to average commercial rates, will no longer capture year-to-year growth because of utilization or acuity changes.

10 Percent Phasedown Unaddressed

CMS has yet to provide official guidance on the 10 percent phasedown of SDPs. Stakeholders remain in a holding pattern, awaiting a forthcoming proposed rule that will clarify how reductions will be calculated.

What It Means for States and Healthcare Organizations

SDPs have become a critical tool for states to stabilize provider networks through increased Medicaid reimbursement. This authority will be significantly limited, and states will need to reduce many existing programs. Medicaid enrollment losses resulting from other Medicaid policy changes, such as work requirements and minimum semiannual redetermination, will likely compound the strain on provider payments.

Providers and states need to start planning for these losses in revenue now. Strategic planning for SDP sustainability and close monitoring of upcoming CMS rulemaking is essential.

While the guidance imposes constraints, it also opens the door for policy innovation. For example, some states may use this moment to reform Medicaid financing, streamline supplemental payments, and reconfigure provider incentives to better reflect quality and access, advancing value-based care goals and achieving total cost of care savings through efficiency and aligned incentives.

Connect with Us

HMA is uniquely positioned to support states, MCOs, and providers as they navigate the evolving landscape of Medicaid SDPs. Our team includes former state Medicaid directors, actuaries, and policy strategists with deep expertise in designing sustainable financing arrangements and guiding public engagement processes. We bring robust modeling capabilities to clients seeking to assess the financial impact of CMS’s new restrictions, including the 10 percent phasedown and interactions with provider tax limitations. Our experts are actively engaged with CMS and understand how to translate federal guidance into actionable strategies that align with state goals and operational realities.

Whether revising preprint submissions, evaluating quality frameworks, or rethinking provider incentives, HMA delivers the technical and policy insight needed to move forward with confidence.

For questions about the federal guidance and considerations for your organization, contact our experts below.

Blog

Turning HR 1 Medicaid Work Requirements into Workforce Development Opportunities: Lessons from HMA’s Recent Webinar

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As State Medicaid Agencies prepare for the operational and policy shifts introduced by HR 1’s Medicaid Work Requirements, the stakes could not be higher. While the intent of these provisions is to encourage workforce participation, their real-world implementation risks leaving behind those who already face systemic barriers—particularly rural communities, people of color, and individuals with chronic conditions.

In a recent HMA webinar, “Work That Works: Creating Sustainable Employment Pathways for Medicaid-Enrolled Communities,” Shannon Joseph, Senior Consultant and Workforce Development expert at Health Management Associates (HMA), and Dr. Alicia Johnson, Managing Principal and strategic advisor on Medicaid transformation at HMA, led a dynamic conversation for state leaders and Medicaid stakeholders. Their core message was clear: with thoughtful design, states can transform work requirements from punitive compliance metrics into powerful tools for workforce development and economic mobility.

The Policy Landscape: HR 1 and State Readiness

HR 1 establishes new federal standards that require states to verify that certain Medicaid enrollees are meeting minimum work or community engagement hours as a condition of continued coverage. While exemptions exist for specific populations, the administrative lift, data infrastructure, and interagency coordination needed to operationalize these requirements are significant.

Historically, states that have experimented with work requirements, such as Arkansas, Kentucky, and New Hampshire, have seen coverage losses not because beneficiaries were unwilling to comply, but because systems were unprepared to support them. Barriers such as limited broadband access, low literacy rates, unstable employment markets, and health disparities disproportionately impacted rural residents and people of color.

Key Challenge #1: Avoiding Disproportionate Impact on Vulnerable Communities

One of the most pressing concerns is that work requirements may exacerbate disproportionate access. In rural communities, jobs that meet hour thresholds are often scarce, transportation options are limited, and childcare access is inconsistent. For people of color, historic and systemic barriers to employment persist, from lack of work credentials, to lack of tailored workforce programs. For individuals with chronic conditions or disabilities not formally classified as exempt, participation can be difficult or intermittent.

Dr. Johnson emphasized the importance of a community-based approach that leverages local resources and local social safety nets to increase participation and outcomes but developing targeted strategies that address the varying needs of the Medicaid community.

“We cannot simply apply a one-size-fits-all model. States must design implementation strategies that close population health gaps and overcome the social structural gaps in their systems, not widen them. Social Determinants of Health are not just passive background factors; they actively shape people’s ability to achieve and maintain good health and life outcomes.”

Best Practice: Conduct community-level impact assessments prior to implementation to identify geographic, demographic, and health-related disparities. Use this data to tailor outreach, exemptions, and workforce partnerships accordingly.

Key Challenge #2: Shifting from Compliance to Workforce Integration

Too often, states have approached work requirements as a compliance exercise—tracking hours, verifying exemptions, and ensuring federal reporting—without connecting to broader workforce development ecosystems. This narrow focus misses the opportunity to align Medicaid with labor, education, and economic development systems.

Shannon Joseph pointed to states like Louisiana, where cross-agency partnerships have begun to link Medicaid beneficiaries to workforce boards, training programs, and supportive services, “The most successful models are those where Medicaid is not working alone. When states braid resources and align objectives, work requirements can become a springboard for meaningful employment.”

Best Practice: Develop formal MOUs between Medicaid agencies, state workforce boards, Departments of Labor, and community colleges to share data, coordinate referrals, and leverage federal funding streams like SNAP E&T and WIOA.

Key Challenge #3: Building Administrative Infrastructure and Data Systems

Another central theme of the webinar was the need for robust data infrastructure. Many states lack integrated eligibility systems capable of tracking employment hours, exemptions, and participation across multiple programs. Without this integration, states risk errors, delays, and unnecessary disenrollments.

HMA highlighted the value of interoperable data systems and FHIR-based architecture that allow Medicaid agencies to exchange information with workforce agencies in real time. Digital equity must also be part of the conversation, especially in rural areas where broadband access remains a challenge.

Best Practice: Prioritize system modernization investments and interoperability pilots to build the technical backbone for equitable and efficient implementation such as the one in Georgia launched for the Pathways program.

Key Challenge #4: Partnering with Communities for Culturally Responsive Implementation

Dr. Johnson underscored that states cannot achieve equitable implementation from the statehouse alone. Partnerships with community-based organizations (CBOs), faith institutions, and local employers are critical to reaching populations who may be distrustful of government systems or unaware of new requirements.

Community partners are trusted messengers. They can bridge gaps in communication, help with navigation, and ensure that people understand both their obligations and opportunities,
– Dr. Alicia Johnson

Best Practice: Create local implementation collaboratives that include Medicaid staff, CBOs, workforce entities, and providers to co-design outreach and support strategies tailored to community needs.

Key Challenge #5: Aligning Metrics with Meaningful Outcomes

Finally, both speakers cautioned against relying solely on compliance metrics (e.g., hours reported, exemptions processed) to evaluate success. Instead, states should track workforce and health outcomes, such as employment stability, income growth, retention in coverage, and health status improvements. Shannon Joseph noted, “If our only measure of success is whether someone uploads their work hours, we’ve missed the point. The goal should be sustainable pathways to economic mobility and improved health.”

Best Practice: Develop a multi-dimensional performance dashboard that blends compliance data with workforce outcomes, health equity indicators, and beneficiary experience measures.

Solutions & Strategies for States: A Roadmap

Drawing from the discussion, HMA outlined a set of strategic recommendations for state Medicaid agencies:

  1. Conduct Equity Impact Assessments: Identify populations at risk of adverse impacts and tailor exemptions and support services accordingly.
  2. Align with Workforce Systems: Establish data-sharing agreements and coordinated referral pathways with workforce boards and community colleges.
  3. Invest in Data Modernization: Build interoperable systems to reduce administrative burden and ensure real-time verification.
  4. Engage Trusted Community Partners: Leverage CBOs and local institutions for outreach, navigation, and culturally responsive engagement.
  5. Shift Metrics to Outcomes: Measure employment stability, economic mobility, and health outcomes—not just compliance.
  6. Pilot, Learn, Scale: Start with targeted pilots in high-need communities, evaluate rigorously, and scale strategies that work.

HMA’s Role: Strategic Partner to States Developing Public/Private Partnerships to Build Genuine Pipelines of Work

HMA has deep expertise helping states design, implement, and evaluate Medicaid work requirement policies in ways that are operationally sound, legally defensible, and Medicaid Member-centered. Our team has supported states in:

  • Conducting 1115 waiver design and evaluation,
  • Integrating Medicaid and workforce systems,
  • Designing targeted outreach strategies for rural and underserved populations,
  • Implementing digital modernization projects, and
  • Developing performance dashboards that focus on outcomes.

HMA brings both policy acumen and on-the-ground implementation experience, enabling states to navigate complex regulatory landscapes while advancing population health and real-world outcomes.

Learn More & Partner with HMA

If you missed the live webinar, you can watch the replay here.

You might also be interested in attending the HMA National conference, Adapting for Success in a Changing Healthcare Landscape.in New Orleans October 14-16, for our session on Making Medicaid Work Requirements Work, where we will draw on lessons from states like Georgia.  Panelists will explore what to watch for in program design, including strategies to support workforce readiness, reduce administrative burden, and maintain access to care.  Speakers include:

Online registration closes October 10, but if you act now, you can use the code FLASH25 for up to $475 off the standard registration fee for the full conference. 

For more information about how HMA can support your state in strategic planning, operational design, impact analysis, and workforce integration, please contact our experts below.

Blog

HMA Enrollment Update: Medicaid Managed Care Organizations See Drop in Enrollment in 2Q25

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This week, our second In Focus provides insights into Medicaid managed care enrollment in the second quarter of 2025. Health Management Associates Information Services (HMAIS) obtained and analyzed monthly Medicaid enrollment data in 30 states,[1] offering a reliable baseline and timely view of the immediate impact of the current policy landscape as new federal policies take effect.

This analysis presents a snapshot of HMAIS’s comprehensive detailed quarterly Medicaid managed care enrollment report (available by subscription), which includes plan-level information for nearly 300 health plans in 41 states, corporate ownership, for-profit versus not-for-profit status, and similar information regarding publicly traded plans. Table 1 provides a sample of enrollment trends, representing 57 million Medicaid managed care enrollees of a total of 66 million Medicaid managed care enrollees nationwide. Data reporting periods and program coverage vary by state, so figures may not be fully comparable.

Key Insights from 2Q25 Data

The 30 states included in our review have released monthly Medicaid managed care enrollment data—via a public website or in response to a public records request from HMAIS—for April through June of 2025. This report reflects the most recent data posted or obtained from states. HMA has made the following observations regarding the enrollment data:

  • Year-over-year decline. As of June 2025, in the 30 states reviewed, Medicaid managed care enrollment declined by 1.6 million members year-over-year, a 2.7 percent drop from June 2024.
  • Widespread decreases. Of the 30 states, 27 experienced enrollment declines in June 2025 compared to June 2024. Oregon and the District of Columbia saw modest growth, while California remained flat (Table 1).
  • Sharpest contractions. Arizona and Maryland reported double-digit percentage drops in enrollment in June 2025 (Table 1), underscoring the uneven impact of redeterminations and eligibility policy changes.
  • Difference among expansion and non-expansion states. Among the 24 states included in the analysis that expanded Medicaid, enrollment fell by 1.2 million—a 2.5 percent drop—to 49.2 million. The six non-expansion states saw a steeper proportional decline of 4.2 percent, to a total of 8 million enrollees.

Table 1. 2Q25 Monthly MCO Enrollment by State, April–June 2025

Note: “+/- m/m” refers to the enrollment change from the previous month, and “% y/y” refers to the percentage change in enrollment from the same month in the previous year.

The data in Table 1 should be viewed as a sampling of enrollment trends across these states rather than as a comprehensive comparison, which cannot be established based solely on publicly available monthly enrollment data. It is also important to note the limitations of the data presented. For example, not all states report data at the same time during the month, resulting in a range of snapshots from the beginning to the end of the month. Second, in some instances, the data cover all Medicaid managed care programs, while in others they reflect only a subset of the broader managed Medicaid population, depending on what data is publicly available.

Market Share and Plan Dynamics

HMAIS’s report includes plan-level details for nearly 300 plans, covering corporate ownership, program participation, and tax status. As of June 2025, Centene continues to lead the national Medicaid managed care market with 17.8 percent share, followed by Elevance (10.4 percent), United (8.6 percent), and Molina (6.2 percent; see Table 2).

Table 2. National Medicaid Managed Care Market Share by Number of Beneficiaries for a Sample of Publicly Traded Plans, June 2025

What to Watch

The OBBBA (P.L. 119-21) calls for significant changes to Medicaid eligibility and enrollment policies, including work requirements and more frequent eligibility redeterminations. Projections indicate that Medicaid and Children’s Health Insurance Program enrollment could decline by up to 7.5 million people by 2034. In addition, the Centers for Medicare & Medicaid Services (CMS) has announced that it will not approve or extend waivers for multi-year continuous eligibility for adults or children.

As these policies are implemented, state governments and healthcare organizations should prepare for increased administrative complexity, potential coverage disruptions, and the resulting effect on MCO revenue and value-based care arrangements.

Connect with Us

HMA is home to experts who know the Medicaid managed care landscape at the federal and state levels. As the Medicaid landscape continues to evolve, HMAIS equips stakeholders with timely, actionable intelligence, including enrollment data, quarterly by-plan and by-state enrollment reports, financials, Medicaid demonstration and Rural Health Transformation program tracking, and a robust library of publicly available Medicaid-related documents. HMAIS combines publicly available information with HMA expert insights on the structure of Medicaid in each state, as well as our comprehensive, proprietary State Medicaid Overviews.

For questions about the HMAIS enrollment report and information about the HMAIS subscription, contact our experts below.

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Navigating the Government Shutdown: Safeguarding the RHT and “Make Rural America Healthy Again” Initiatives

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As of October 1, 2025, federal budget negotiations have led to a temporary government shutdown, prompting healthcare leaders to monitor potential impacts on programs administered by the Centers for Medicare & Medicaid Services (CMS). While federal agencies have contingency plans in place, to date CMS has not announced any potential impacts, including to the timelines for the application and award dates for the Rural Health Transformation (RHT) Program.

State governments and healthcare leaders should continue to develop and prepare to submit their applications for the RHT program, which provides a significant opportunity to revitalize rural healthcare infrastructure through strategic investments in access, workforce, innovation, and technology.

Strategies for States to Efficiently Develop Winning Applications

To maintain momentum and optimize their resources during this period of uncertainty in federal government funding and operations:

1. Strengthen Internal Coordination

  • Establish cross-agency working groups to manage RHT program planning and execution
  • Use internal policy experts to interpret the Notice of Funding Opportunity (NOFO) guidance and align initiatives with CMS priorities

2. Leverage Existing Data and Evidence

  • Use state-level health data to identify high-impact areas for investment
  • Prioritize initiatives that align with the RHT program’s five strategic goals:
    • Prevention and chronic disease management
    • Sustainable access
    • Workforce development
    • Innovative care models
    • Technology innovation

3. Utilize Project Management Tools

To support strategic planning and initiative tracking, Health Management Associates (HMA) is offering a free RHT Project Management Tool. This resource helps states:

  • Organize and manage initiative development
  • Cross-reference projects with NOFO categories
  • Track progress and performance metrics
  • Facilitate collaboration across stakeholders

Access the RHT Project Management Tool from HMA:

Complete the form to download
the RHT Project Management Tool

Engage with CMS Resources Proactively

States and their partners can continue to refer to key CMS resources:

States can also submit questions to [email protected].

Final Thoughts

While the government shutdown presents challenges for many federal programs, it remains unclear whether there will be any direct impact on CMS’s engagement with states regarding the Rural Health Transformation Program. Regardless of federal circumstances, this moment highlights the value of state-level leadership and innovation. By leveraging tools like HMA’s project management platform and aligning with CMS’s strategic goals, states can continue advancing rural health transformation and position themselves for success, even in uncertain times.

Brief & Report

Medicaid Financing for Social Health: A Resource Compendium for Illinois Community-Based Organizations & Networks

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Health Management Associates (HMA) prepared this compendium in September 2025 on behalf of the Chicago Department of Public Health. It was developed at a pivotal moment, as Illinois was poised to take action on multiple program initiatives of critical importance to community providers: reprocure its Medicaid Managed Care system, initiate provider training for 1115 Medicaid Waiver services that address social determinants of health (SDOH), prepare a new Community Health Worker (CHW) benefit, continue implementation of Doula services as a Medicaidcovered benefit, and establish a Third Party Administrator (TPA) support system to promote statewide access to new services, potentially via regional hubs.

A team of subject matter experts with deep experience in Illinois’s social health and healthcare sectors, as well as national social health integration efforts, created this resource to help organizations evaluate how these program initiatives will affect the services they provide, understand their opportunities to successfully participate in the Medicaid delivery system, and support their ability to effectively serve the needs of their communities. The team brings extensive knowledge of how community-based organizations (CBOs) deliver Medicaid-financed CHW and SDOH services, as well as the alternative payment methodologies managed care organizations (MCOs) use as they engage CBOs to promote population health.

In this context, this compendium is intended to address the following targeted needs identified by stakeholders across the Illinois community-based social health service ecosystem:

  • Guidance to support CBOs’ understanding of their value in advancing population health improvement goals, aligning with regional healthcare providers and payers, and identifying opportunities to sustainably fund social health services through Medicaid
  • Insights for CBOs, CBO networks, and emerging CBO hubs and Community Care Hubs (CCHs), with a focus on governance, shared IT infrastructure, financing and integration into the healthcare delivery system
  • Strategic considerations for contracting with Managed Care Organizations to provide social health care services Information to clarify the roles, scopes, and opportunities for collaboration/dual certifications within the community-based workforce that delivers Medicaid services, specifically CHWs, Doulas, and Peer Support Specialists
  • Information from other states on their Doula benefits implementation and Doula hubs to support Medicaid service delivery

Complete the form to receive a copy of the report

Webinar

Webinar Replay- Beyond the Bill: How Pair Team and MCOs Are Meeting Community Needs Under HR 1

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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

Blog

Building Bridges: Key Insights from the 2025 HCBS Conference and What They Mean for Your Organization

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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.

Webinar

Webinar Replay – Medicaid 1115 Justice Involved Reentry Demonstration Opportunities: Engaging Key Stakeholders

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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.
Webinar

Webinar Replay – Navigating Medicaid Managed Care Shifts: Financial Pressures, Federal Policy, and Medicaid MCO Implications

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This webinar was held on September 17, 2025.

Medicaid managed care organizations face mounting pressure as enrollment patterns shift, federal policy evolves, and state budgets tighten. In this webinar, experts from HMAIS, Wakely, and HMA shared exclusive analysis of Medicaid Managed Care Organization (MCO) financial performance, explored the implications of HR 1 and other federal policies, and offered State and MCO perspectives.

Learning Objectives

  • Interpret 2024 Medicaid MCO financial trends and historical benchmarks to anticipate future market performance.
  • Assess how federal policy changes, including HR 1, are reshaping Medicaid enrollment and creating new fiscal pressures for States and MCOs.
  • Evaluate state considerations around risk corridors, medical loss ratios (MLRs), and similar mechanisms in a challenging budget environment.
  • Identify strategies and planning initiatives that promote resilience, sustainability, and adaptation for Medicaid managed care organizations in a shifting landscape.

This webinar was for Medicaid managed care leaders, state officials, vendors, budget officers, and investors navigating financial pressures and policy shifts.

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