Weekly Roundup -
January 7, 2026
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The ACCESS Model: Essentials for Applicants
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New Year, New Look for HMA Weekly Roundup
Welcome to the new and improved 2026 HMA Weekly Roundup—your single source for the insights that matter.
This year, we’re bringing together the full strength of Health Management Associates (HMA), including HMA, Wakely, Investor Services, and the Leavitt Partners Digital Health Intelligence Briefing into one modernized, streamlined newsletter designed to keep you ahead of what’s coming next in health and human services.
We’re excited to deliver a clearer, more connected view of the issues shaping 2026 and to support your work with relevant and actionable insights throughout the year.
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CMS Announces Rural Health Transformation Program Awardees
On December 29, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the state awards for the Rural Health Transformation Program (RHTP), a $50 billion federal initiative intended to stabilize rural health systems and support transformation. CMS stated that $10 billion will be available each year from 2026 to 2030, and that first-year (2026) state awards average $200 million, with totals ranging from $147 million to $281 million.
This announcement marks a pivot from planning to execution. In the coming months, states will move rapidly to finalize governance structures, confirm partners, and translate proposed initiatives into operational workplans and measurable outcomes.
Although CMS announced the overall awards for the first budget year, some states have signaled they continue to work with CMS on initiative-specific budgets and planning. In this article, Health Management Associates (HMA) reviews key themes and early trends based on the application initiatives and what is known about the budgets.
What the Awards Suggest About State Priorities
Although each state’s awarded approach reflects local realities, early patterns across awardees’ project abstracts suggest several recurring priorities that may shape implementation activity in 2026.
1) Building the Data, Analytics, and Interoperability Backbone
A number of awardees prioritized shared infrastructure for interoperability, analytics, performance monitoring, and operational backbone capabilities. Examples include:
- Arizona described plans to secure vendors to build secure data pipelines, dashboards, and fiscal tracking tools that meet federal audit standards to support rural transformation.
- New Mexico proposed a Rural Health Data Hub to build a statewide health analytics platform that integrates siloed data sources and expands access to timely, actionable information for providers.
- Alaska described technology-focused investments to strengthen cybersecurity, facilitate data sharing and interoperability, and expand digital tools (including consumer-facing tools and remote modalities).
2) Strengthening Maternal Health and Perinatal Care
Many awardees emphasized stabilizing rural maternity access and strengthening perinatal supports through strategies, such as:
- Alabama proposed a Maternal and Fetal Health initiative featuring digital obstetric regionalization and telerobotic ultrasound to extend specialty access in rural settings.
- Kentucky prioritized maternal and infant health by addressing maternity care deserts, including telehealth-enabled community-based maternal/infant support teams and expanded perinatal care access.
- Ohio proposed legislative reforms to allow low-risk birthing centers in rural hospitals as part of its broader strategy to address maternity care deserts and improve rural access to care.
Why it matters: Rural maternity deserts and workforce constraints remain critical drivers of avoidable complications and adverse outcomes. Approaches piloted in rural settings may inform broader statewide maternity care strategies.
3) Modernizing Emergency Medical Services and Mobile Care
Several awardees included investments intended to strengthen emergency response and build more reliable rural stabilization capacity.
- Alabama proposed statewide emergency medical services (EMS) initiatives, including trauma and stroke routing/diversion improvements and an EMS treat-in-place model for low-acuity patients.
- Wyoming emphasized access to “the basics,” including improvements in the ability of hospitals to effectively treat emergencies and ambulance response, alongside incentives for small ambulance services to consolidate around more sustainable regional funding bases.
Why it matters: EMS and mobile response models can function as connective tissue in rural systems with limited traditional access points.
Why it matters: Data-sharing infrastructure can enable multi-provider coordination, performance tracking, and the operational foundations needed for sustainable transformation.
4) Integrating Behavioral Health and Community-Based Supports
Awards also reflected ongoing efforts to expand behavioral health access and improve integration with physical health and community supports. For example:
- Alabama proposed to improve behavioral health access by converting Community Mental Health Centers into Certified Community Behavioral Health Clinics (CCBHCs).
- Arizona proposed to invest in behavioral health and substance use disorder treatment expansion as part of its Priority Health Initiatives portfolio.
- Wyoming included statewide telepsychiatry and crisis intervention services as part of its health outcomes priorities.
Why it matters: Behavioral health capacity constraints are frequently more acute in rural areas, and integration strategies often require both reliable workforce and technology supports.
What to Watch Next
With awards announced, attention will quickly turn to implementation. Stakeholders should have processes to track the following:
- State governance decisions (including lead agencies, subawards, and regional structures) and funding opportunities
- State partner selection processes (through requests for proposals, vendor onboarding, or other contracting pathways)
- Performance measurement and reporting expectations (including metrics and evaluation approaches)
- Sequencing of the initiatives and where near-term operational activity is most likely to concentrate
CMS also signaled near-term oversight and engagement mechanisms, state-assigned CMS project officers, kickoff meetings, ongoing technical assistance, and regular progress updates, along with a planned annual CMS Rural Health Summit.
Tracking State RHTP Implementation
The Health Management Associates Information Services (HMAIS) team developed a resource to capture available information about state RHTP activities, applications, and initiatives and provide a road map for identifying state-specific proposals, requested funding, governance structures, and other key aspects of state RHTP initiatives.
Following CMS’s award announcement, HMAIS is updating this Rural Health Transformation Program (RHTP) Tracker to incorporate award-specific details as they become publicly available. The resource includes information about FY26 awards by state and initiatives, links to CMS materials and state-posted implementation documentation, and a consolidated view of emerging themes and trends as implementation accelerates in 2026.
Looking Ahead
The award announcement is the beginning of implementation. As states operationalize initiatives in early 2026, organizations that align early to awarded priorities and implementation timelines will be best positioned to support rural-first efforts that deliver measurable and lasting results.
Executive Branch Actions Target Drug Affordability in New Pricing Models
The federal drug pricing landscape continues to undergo significant transformation as executive branch agencies advance an ambitious suite of regulatory and model testing initiatives intended to lower the costs associated with the Medicare and Medicaid programs. In response to ongoing concerns about rising out-of-pocket costs, increasing pressure to align US prices with those paid internationally, and the continued implementation of the Inflation Reduction Act (IRA), federal agencies are reshaping how prescription drugs are priced, reimbursed, and negotiated in federally financed programs.
The current policy environment reflects a growing emphasis on benchmarking drug prices to those in peer nations, referred to as “most favored nation” (MFN) benchmarks, and accelerating actions that require or encourage manufacturers to offer lower net prices. Health Management Associates (HMA), is tracking these developments in the public payer space, replicating Centers for Medicare & Medicaid Services (CMS) payment methodologies, and modeling alternative policies to assist life science companies, payers, and other stakeholders.
In this article, we review the administration’s recent efforts to reduce Medicare and Medicaid spending on drugs and biologics, including confidential manufacturer negotiations and three new models that together could reshape pricing dynamics across federal programs.
Executive Branch Negotiations Seek to Drive Access to MFN Discounts
In 2025, the administration issued an Executive Order directing federal agencies to pursue strategies to establish MFN pricing, linking US prices for certain drugs to the lowest (or second lowest) adjusted net prices among a targeted set of peer countries. Following the order, federal officials sent letters to 17 major pharmaceutical and biotechnology manufacturers, urging them to negotiate agreements that would voluntarily align prices with MFN-based benchmarks.
To date, 14 manufacturers have signed agreements, though full details remain confidential. These agreements are understood to accomplish the following:
- Provide state Medicaid programs with access to MFNbased discounts
- Require that new drugs be launched in the United States at MFNaligned prices
- Offer certain drugs at discounted directtoconsumer prices through a forthcoming “TrumpRx” program, expected to launch later this year
Reports suggest that manufacturers entering these MFN-related arrangements may receive exemptions from several federal actions, including the Center for Medicare and Medicaid Innovation (Innovation Center) demonstration models described below and certain tariff-related policies.
MFNLinked Models Designed to Lower Drug Costs Across Medicare and Medicaid
Along with the negotiation efforts, the CMS Innovation Center has proposed three models that would test MFNbased pricing through structured rebate mechanisms. Each model targets different segments of the market while testing how international benchmarks could be integrated into federal drug payment policy.
New Models Test Alternatives to Inflation Rebates
Announced in December 2025, the Global Benchmark for Efficient Drug Pricing (GLOBE) Model and the Guarding US Medicare Against Rising Drug Costs (GUARD) Model are designed to test alternative approaches to the Inflation Reduction Act’s (IRA) inflation penalty policies. CMS plans to test the models’ potential for market driven price reductions if manufacturers choose to lower list prices instead of paying MFN-based rebates.
Key features of the GLOBE Model are as follows:
- Applies to 25 percent of Medicare fee-for-service (FFS) beneficiaries using certain Part B drugs
- Beginning in October 2026, becomes mandatory for select drugs and targets highspending, physicianadministered Part B categories, excluding products already subject to IRA negotiations, generics, biosimilars, and certain lowspend products
- No changes to physician and hospital reimbursement, although beneficiaries expected to see reduced cost sharing
The GUARD Model will similarly test whether applying MFN-based rebates to Medicare Part D drugs will lower Medicare costs. Key aspects of this model include:
- Fiveyear model that would start January 1, 2027
- Target therapeutic categories with more than $69 million in annual Part D spending
- No impact on plan bids and beneficiary cost sharing
These models rely on pricing data from 19 countries. Manufacturers that voluntarily submit net price information would trigger quarterly benchmark updates; otherwise, CMS will use a fixed list price based benchmark for the entire pilot period.
CMS is seeking comments on whether additional categories, for example cell and gene therapies, should be excluded from GLOBE. GUARD is also open for comment through February 23, 2026.
GENErating cost Reductions fOr US Medicaid (GENEROUS) Model
The GENEROUS model, expected to begin in 2026, creates a voluntary pathway for state Medicaid programs and manufacturers to enter supplemental rebate agreements tied to MFNaligned prices. MFN pricing under this model is based on the second lowest net price in G7 countries plus Denmark and Switzerland. GENEROUS is also expected to align with pricing commitments negotiated through the administration’s manufacturer agreements.
Key Considerations and Potential Impacts
The combined effect of federal negotiations and Innovation Center models could be substantial, though outcomes will depend on manufacturer participation, benchmark stability, and operational feasibility. Key considerations include:
- State Medicaid savings, especially the extent to which MFN‑linked rebates exceed existing supplemental rebates
- Reduced Medicare beneficiary cost sharing for Part B included in GLOBE
- Shifts in manufacturer pricing strategies, including potential changes to US launch prices
- Interactions with the IRA, particularly Part D redesign and Part B inflation penalties
Connect with Us
HMA experts continue to track the federal drug pricing landscape closely as comments, operational details, and implementation timelines evolve across these initiatives. Our team replicates CMS payment methodologies and models alternative policies using the most current Medicare FFS and Medicare Advantage (100%) claims data.
For more information and questions about the policies described in this article, please contact Kevin Kirby and Amy Bassano.
Federal Policy News
Fueled By Leavitt Partners Weekly Health Intelligence
CMS Announces New ACO Model to Replace ACO REACH
The Centers for Medicare & Medicaid Services (CMS) announced on December 18, 2025, the Long-term Enhanced ACO Design (LEAD) Model, which will replace the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. LEAD is a 10-year voluntary Medicare initiative model that runs from January 1, 2027, through December 31, 2036. The request for applications will be released in March 2026.
The LEAD model is intended to include more small, rural, and independent providers and community health centers, enhance evidence-based prevention and care coordination, and allow patients to be more involved in their care. The model will integrate high-needs patients, including patients with complex needs and dually eligible beneficiaries, and provide flexible, capitated population-based payments to support team-based care and downstream value-based care arrangements. During the initial planning phase from March 2026 through December 2027, CMS will also identify two states to partner with to develop a framework for ACO-Medicaid partnership arrangements. ACOs in these states will have the opportunity to enter partnership arrangements with Medicaid organizations.
CDC Finalizes Changes to U.S. Childhood Vaccine Schedule
On January 5, Acting CDC Director Jim O’Neill signed a decision memorandum adopting a revised childhood and adolescent immunization schedule for the U.S. The new schedule recommends fewer vaccines but continues to follow a three-category approach: Immunizations Recommended for All Children; Immunizations Recommended for Certain High-Risk Groups or Populations, and Immunizations Based on Shared Clinical Decision-Making.
As had been reported in the weeks leading up to the release of the memo, HHS seeks to base the U.S. schedule largely off of Denmark’s, and recommends all children receive immunizations for measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (Hib), pneumococcal disease, and human papillomavirus (HPV). The revised schedule also includes the varicella vaccine in Category 1, which is not on the Danish schedule. The revised schedule recommends one dose of the HPV vaccine rather than two.
Vaccines for RSV, hepatitis A, hepatitis B, and meningococcal disease will now be in Category 2 and only recommended for those at high risk. Vaccines for dengue will remain in this category and are recommended for children with laboratory-confirmed previous dengue virus infection and who are living in dengue-endemic areas.
Vaccines for rotavirus, COVID-19, influenza, meningococcal disease, hepatitis A, and hepatitis B will no longer be universally recommended, but shifted to Category 3 in which they are recommended based on “shared clinical decision-making.”
The decision memorandum notes that as all immunizations remain on the schedule they will continue to be covered without cost-sharing by private insurance, Medicaid, CHIP, and the Vaccines for Children program. CDC specifically states in the fact sheet regarding the changes that “All immunizations recommended by the CDC as of December 31, 2025, will continue to be fully covered by Affordable Care Act insurance plans and federal insurance programs, including Medicaid, the Children’s Health Insurance Program, and the Vaccines for Children program.”
Telemedicine Flexibilities for Controlled Medications Extended
On December 31, HHS and the Drug Enforcement Administration (DEA) jointly issued the fourth temporary extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications through December 31, 2026. The agencies had previously extended these COVID-19 pandemic-era flexibilities through the end of 2025. The extension will allow providers to continue to prescribe certain controlled medications via telemedicine, even if the provider has not evaluated the patient in person. In the rule, HHS and DEA state that the year-long extension will provide time for DEA to promulgate a final set of regulations, “to ensure a smooth transition for patients and providers that have come to rely on the availability of telemedicine to prescribe controlled substances to patients for whom they have never had an in-person medical evaluation, and allow sufficient time for providers to come into compliance with any new DEA registration, recordkeeping, or security requirements eventually adopted in a final set of regulations.”
CMS Updates Medicaid and CHIP Quality Measures for 2026–2027
On December 30, CMS issued a State Health Official (SHO) letter outlining updates to the 2026 and 2027 Child and Adult Core Set of Quality Measures for Medicaid and CHIP, with a focus on immunizations. As part of the 2026 revisions, CMS is removing four pediatric and prenatal immunization measures from the Child and Adult Core Sets:
- Childhood Immunization Status (CIS‑CH);
- Immunizations for Adolescents (IMA‑CH);
- Prenatal Immunization Status: Under Age 21 (PRS‑CH); and
- Prenatal Immunization Status: Age 21 and Older (PRS‑AD).
According to the letter, states may continue to voluntarily report results for these four Utilization Measures, enabling CMS to “maintain a longitudinal dataset while evaluating alternative immunization metrics.” Additionally, the Childhood Immunization Status (CIS‑CH) and Immunizations for Adolescents (IMA‑CH) measures will no longer be subject to mandatory stratification in 2026.
In the letter, CMS also notes it plans to develop new vaccine-related measures that assess whether families are informed about “vaccine choices, vaccine safety and side effects, and alternative vaccine schedules.” Stakeholder engagement with states, measure stewards, immunization registry managers, providers, and EHR vendors will help shape these measures, with consideration for religious exemptions. These changes follow a series of vaccine policy shifts initiated under the Trump Administration, including the HHS recommended vaccine schedule changes announced today and recent changes to recommendations for hepatitis B vaccination in newborns, removing universal vaccination recommendations and instead advising vaccination only for infants born to mothers with hepatitis B or unknown infection status.
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State Policy News
Georgia
Georgia Proposes Restructuring 1915c Waiting List for Individuals with IDD. GPB/Georgia Recorder reported on January 2, 2026, that Georgia’s Department of Behavioral Health and Developmental Disabilities is evaluating proposed changes to the state’s 1915(c) Home and Community-Based Services (HCBS) waiver waiting list for individuals with intellectual and developmental disabilities. The recommendations would replace the current single planning list with a three-tiered system based on urgency of need, enhance assessment and data collection, and potentially introduce an additional waiver option for individuals who do not qualify under existing programs such as the New Options Waiver and Comprehensive Supports Waiver Program. The proposals have not yet been finalized or assigned an implementation timeline and are being considered amid broader Medicaid funding constraints.
Illinois
Cityblock, Centene Launch Value-Based Medicaid Partnership in IL. Cityblock Health announced on January 7, 2026, that it has partnered with Centene’s Meridian Health Plan of Illinois to serve approximately 10,000 Medicaid members across 17 counties in the Springfield and St. Louis Metro East regions of Illinois. Cityblock will deliver 24/7 wrap-around, value-based care, including primary, behavioral, social, pharmacy, and care management services, integrated with Meridian’s provider network. The collaboration expands Cityblock’s Illinois footprint and represents the fourth regional partnership between Cityblock and Centene, following New York, Ohio, and Florida. The partnership aims to improve care coordination, access, and outcomes for high-need Medicaid
Nevada
Nevada Implements Medicaid Billing Platform for School Health Services. The Nevada Health Authority announced on December 31, 2025, that it has launched a statewide initiative to help schools access Medicaid reimbursement for eligible student health services by implementing a shared electronic health record and Medicaid billing platform through an external vendor. The program is intended to reduce administrative and billing barriers that have historically limited schools’ ability to claim Medicaid funds, while expanding support for student mental health services, primary and preventive care, and special education. Funded by a federal grant to Nevada Medicaid, the initiative aims to strengthen the sustainability and reach of school-based health services across the state.
Indiana
Indiana Medicaid Forecast Projects Nearly $466 Million in Savings Over FY 2026-27 Biennium. The Indiana Family and Social Services Administration (FSSA) announced on December 18, 2025, that its December 2025 Medicaid forecast shows the state is on track to save $314.1 million in fiscal 2026 and $151.8 million in fiscal 2027, totaling $465.9 million over the biennium. The savings are largely due to declining Medicaid enrollment in the Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW) after changes to eligibility redetermination procedures, which included a ban on Medicaid advertising. State officials are still cautioning of challenges ahead, including economic uncertainty, policy shifts, and high-cost service areas, which could affect Medicaid’s long-term sustainability.
Minnesota
MN Releases Strategy, Supports RFPs for Individuals with Disabilities, SMI. The Minnesota’s Department of Human Services has released a request for proposals (RFP) on January 5, 2026, seeking innovative solutions to improve outcomes for people with disabilities. The solicitation prioritizes projects serving individuals eligible for or receiving Section 1915(c) home and community-based services and supports initiatives focused on integrated housing, competitive employment, accessible transportation, and community-centered, culturally responsive services. Letters of Interest are due January 27, 2026. Separately, the Department of Human Services’ Behavioral Health Administration issued a request for proposals on January 2, 2026, for a one-time $400,000 grant to a women-led organization to provide mental health services and supports to New Americans that are adults living with serious mental illness and residing in Minneapolis. Full proposals for this opportunity are due January 26, 2026.
Private Market News
Fueled By Wakely Consulting Group
FDA Gets Mixed Feedback on Performance Monitoring for AI
Medtech industry groups said the FDA should use existing regulatory and quality tools to monitor performance, while medical groups said device manufacturers should be responsible for monitoring AI. Read more.
Changes to Healthcare Price Transparency Rules Planned
On December 19, CMS, in partnership with the Department of Labor and the Department of the Treasury, released a proposed rule building on healthcare price transparency rules established during President Trump’s first term. The proposed rule specifically seeks to address three key challenges identified by the administration: “inaccessibility due to the large size of the machine-readable files, data ambiguity due to lack of contextual information alongside the raw data, and areas of misalignment with the Hospital Price Transparency rule that make comparing data across disclosures challenging.” The provisions of the rule primarily apply to non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage.
The rule proposes several requirements intended to address the burden of reporting on providers and plans issuers, and simplify the organization and accessibility of the data for consumers and researchers. These include reduced reporting frequency, expanded out-of-network pricing disclosures, and requirements for new change-log and utilization files to improve data usability. CMS also proposes to require issuers to provide personalized cost-sharing estimates via online tool, paper, and (starting for policy years on/after January 1, 2027) by phone, in line with price comparison guidance mandate requirements of the No Suprises Act.
The proposed rule is open for public comment until February 21, 2026.
Our Insights
Fueled By Experts Across Our HMA Companies
Health Management Associates
Webinar: The ACCESS Model: Essentials for Applicants
CMS’s new ACCESS model represents one of the most ambitious federal efforts to modernize chronic care through technology-supported services. This national, voluntary, decade-long model creates a new payment pathway for digital health tools, continuous monitoring, behavioral support, and other tech-enabled interventions that complement traditional care. With beneficiaries able to enroll directly and clinicians eligible for co-management payments, ACCESS introduces a fundamentally different approach to chronic condition management across Medicare.
In this webinar, HMA and Leavitt Partners experts will break down what is known today, what to expect in the forthcoming Request for Applications, and what organizations can do to prepare. We will walk through the model’s four clinical tracks, outcomes-aligned payments, beneficiary engagement expectations, the TEMPO pilot’s implications for digital device manufacturers, and how it relates to the CMS Health Tech Ecosystem initiative.
Webinar: Meeting the Healthcare Needs of Unhoused People Part 1: Service and Care Responses
Join HMA experts and our featured speakers for the first of two webinars exploring how current events are impacting people experiencing homelessness and their access to care. This webinar will highlight the model of care for healthcare for the homeless clinics and medical respite care providers and how these services interact with broader systems of care. Additionally, we will explore how the current environment is impacting delivery and financing of care for some of our most vulnerable neighbors.
Webinar: Meeting the Healthcare Needs of Unhoused People Part 2: State Policy Responses
Recent federal policy changes, such as the 2025 Budget Reconciliation Act (OBBBA), bring significant challenges to retaining the Medicaid coverage gains and added 1115 demonstration services that have been so successful in the last decade. States will be under tremendous pressure to meet new requirements—but they also have options to reduce the negative impact on vulnerable populations and the healthcare providers that serve them. Join HMA and our featured experts for this webinar to discuss state-level policy options, share resources, and consider how to move forward in the current environment.
Wakely
Enrollment Dynamics and Health Care Utilization in the ACA Individual Market
Wakely was retained by America’s Health Insurance Plans (AHIP) to evaluate the potential reasons for reported changes in the percent of non-claimants in some individual health insurance markets over the reported period. This report explains what that statistic measures and how best to interpret it.
To gain additional understanding of potential drivers of the elevated non-claimant ratios in the individual market, Wakely reviewed its ACA database to highlight key dynamics contributing to the higher non-claimant ratios. The paper discusses the data used to measure non-claimant ratios and its limitations, changes in enrollment patterns in 2022 and 2023 in the individual market, as well as how changes in 2025 relative to 2024 may result in lower non-claimant ratios.
ESRD: The Forgotten Group
End-Stage Renal Disease (ESRD) represents one of Medicare’s most medically complex and financially costly populations yet historically has been underserved in both Medicare and Medicare Advantage (MA). Despite representing less than 1% of total beneficiaries, ESRD accounts for a disproportionately large share of Medicare expenditures. Traditional MA plans often lack the specialized networks, care coordination, and benefit designs required to address ESRD patients’ intensive needs. While ESRD Chronic Condition Special Needs Plans (C-SNPs) have begun to fill this gap, their adoption remains extremely limited nationwide.
In 2026, CMS is expanding the C-SNP condition category from ESRD to CKD (chronic kidney disease), allowing plans to serve beneficiaries across the full kidney disease continuum—from earlier-stage CKD to dialysis-dependent ESRD. This policy shift enables MA plans to intervene sooner, coordinate care more effectively, and help patients avoid or delay kidney failure, ultimately improving quality of life and reducing long-term costs. Integrating CKD and ESRD into a single SNP also aligns with CMS’s value-based care strategy and addresses significant equity gaps. This paper outlines the challenges ESRD patients face, the limitations of current MA benefits, the unique requirements of ESRD C-SNPs, and the potential impact of the upcoming CKD-ESRD SNP model.
Summary of CMS’s CY2027 Proposed Rule
On November 25, 2025, the Centers for Medicare and Medicaid Services (CMS) released the “CY2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program”. The deadline to submit comments is January 26, 2026. This summary is primarily focused on the financial and actuarial aspects of the Proposed Rule.
RFP Calendar
RFP Calendar
| Date | State/Program | Event | Beneficiaries |
|---|---|---|---|
| Date: DELAYED | State/Program: Texas STAR & CHIP | Event: Implementation | Beneficiaries: 4,600,000 |
| Date: December 2025 - February 2026 | State/Program: Texas STAR Kids | Event: Awards | Beneficiaries: 150,000 |
| Date: January 1, 2026 | State/Program: Wisconsin LTC GSR 2,7 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: January 1, 2026 | State/Program: Michigan HIDE SNP | Event: Implementation | Beneficiaries: 35,000 |
| Date: January 1, 2026 | State/Program: Nevada D-SNP | Event: Implementation | Beneficiaries: 88,000 |
| Date: January 1, 2026 | State/Program: Ohio Duals | Event: Implementation | Beneficiaries: 250,000 |
| Date: January 1, 2026 | State/Program: Illinois D-SNP | Event: Implementation | Beneficiaries: 79,000 |
| Date: January 1, 2026 | State/Program: Nevada | Event: Implementation | Beneficiaries: 674,000 |
| Date: January 1, 2026 | State/Program: Massachusetts One Care, Senior Care Options | Event: Implementation | Beneficiaries: 120,000 |
| Date: January 6, 2026 | State/Program: Nevada Children's Specialty | Event: Proposals Due | Beneficiaries: NA |
| Date: January 16, 2026 | State/Program: Wisconsin LTC GSR 3 | Event: Proposals Due | Beneficiaries: 56,000 (all GSR) |
| Date: January 21, 2026 | State/Program: Illinois Tailored Care Management Program | Event: Proposals Due | Beneficiaries: 22,400 |
| Date: February 2026 | State/Program: Illinois | Event: Awards | Beneficiaries: 2,400,000 |
| Date: February 19, 2026 | State/Program: Nevada Children's Specialty | Event: Awards | Beneficiaries: NA |
| Date: June 24, 2026 | State/Program: Wisconsin LTC GSR 3 | Event: Awards | Beneficiaries: 56,000 (all GSR) |
| Date: December 2026 - February 2027 | State/Program: Texas STAR Kids | Event: Implementation | Beneficiaries: 150,000 |
| Date: January 1, 2027 | State/Program: Illinois | Event: Implementation | Beneficiaries: 2,400,000 |
| Date: January 1, 2027 | State/Program: Nevada Children's Specialty | Event: Implementation | Beneficiaries: NA |
| Date: January 1, 2027 | State/Program: Wisconsin LTC GSR 3 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: January 1, 2027 | State/Program: Illinois Tailored Care Management Program | Event: Implementation | Beneficiaries: 22,400 |
| Date: January 1, 2028 | State/Program: Wisconsin LTC GSR 4,6 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: Fall 2027 | State/Program: Oregon | Event: RFP Release | Beneficiaries: 1,200,000 |
| Date: 2028 | State/Program: North Carolina | Event: RFP Release | Beneficiaries: 2,200,000 |