Weekly Roundup -
May 20, 2026
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Unmatched Healthcare Insights from HMA,
Leavitt Partners & Wakely.
Featured:
From Policy to Practice: Exploring CMMI Value Based Care Initiatives and Unlocking Value in Safety-Net Care
ACCESS WEBINAR
The Pediatric Behavioral Health Service Continuum in New Orleans
READ CASE STUDY
Trending: In Focus
Special Alert: CMS Proposes Major Medicaid Payment Reform to Cap State-Directed Payments and Align Rates with Medicare
On May 20, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule aimed at curbing state Medicaid payment practices that federal regulators s have driven excessive federal spending without clear improvements in care. The rule, which implements new statutory requirements approved as part of the 2025 budget reconciliation act (P.L. 119-21, OBBBA) proposes to cap certain state-directed and targeted provider payments and is seeking to better align them with Medicare payment levels. These financial arrangements include healthcare related provider taxes and intergovernmental transfers.
If finalized, CMS projects the rule will result in significant federal savings over time and will refocus Medicaid funding on patient care, strengthen oversight, and ensure that supplemental payments are tied to measurable improvements in quality, access, and outcomes rather than financing strategies that increase costs without corresponding value. Health Management Associates (HMA) experts are continuing to review the proposed rule and will provide additional analysis in future newsletters and communications to interest-holders.
National Collaborative Launched to Strengthen US Behavioral Health Crisis System
National Alliance on Mental Illness (NAMI) and Health Management Associates (HMA) launch the National Collaborative for Crisis Systems Innovation
The United States is facing an escalating behavioral health crisis, with growing demand for mental health and substance use services and persistent gaps in access to timely, appropriate care. In response, the National Alliance on Mental Illness (NAMI) and Health Management Associates (HMA) have launched the National Collaborative for Crisis Systems Innovation, a new initiative focused on improving how the United States responds to people in mental health crisis.
This collaborative effort comes at a critical moment for the national crisis response system, as policymakers, providers, and communities work to build on recent investments and make further progress on sustainable, systemwide changes so that people experiencing a mental health crisis receive the care they need and deserve.
The Crisis Response System Still Needs Improvement
The launch of the 988 Suicide & Crisis Lifeline in 2022 marked a major milestone, making it easier for individuals to access immediate behavioral health support. Although the 988 Suicide & Crisis Lifeline has driven recent progress, significant challenges remain in the US mental health crisis system, including:
- Rising demand for crisis services
- Limited access to community-based behavioral health services
- Fragmentation across crisis responses systems
- Overreliance on emergency departments and law enforcement
Experts increasingly agree that 988 is only one component of a comprehensive crisis system. Effective systems must also include:
- Mobile crisis response teams
- Crisis stabilization facilities
- Ongoing care coordination and follow-up services
The National Collaborative represents the next phase of work and will focus on connecting these pieces into a more integrated and sustainable system.
The National Collaborative Is a New Phase of Crisis System Transformation
Building on four years of foundational work since the 988 Suicide & Crisis Lifeline launched in 2022, the National Collaborative is designed to strengthen the full continuum of behavioral health crisis care, from initial contact to stabilization and follow-up services.
Its overarching goal is to ensure that individuals experiencing a mental health crisis receive timely, appropriate care rooted in dignity and support. The National Collaborative will:
- Serve as a nationwide hub for coordination, learning, and action
- Bring together public and private stakeholders across sectors
- Support states and communities in building coordinated, person-centered crisis response systems
- Advance innovation and shared solutions to improve outcomes
The launch of this collaborative also reflects a broader shift in national focus—from expanding access to improving system performance and long-term sustainability. This approach recognizes that meaningful progress will require coordination across healthcare, social services, and community-based organizations.
Why This Matters
For state Medicaid agencies, health plans, and providers, the collaborative provides a platform to:
- Learn from peers across states and sectors
- Access emerging policy and implementation insights
- Align local strategies with national priorities in crisis care
As crisis system transformation accelerates, coordinated efforts like this one will be essential to sustain momentum and improve outcomes.
In the coming months, NAMI and HMA will engage key interest-holders and experts to identify and elevate the urgent needs in crisis response and ensure alignment on shared outcomes to improve crisis systems. Public and private organizations interested in improving behavioral health crisis systems are encouraged to engage with the National Collaborative for Crisis Systems Innovation.
For more information on HMA’s work in Crisis services, contact Monica Johnson, Managing Director, HMA.
Michigan Health Policy Conference 2026: Medicaid, OBBBA, and State Budget Impacts
Michigan is preparing for significant Medicaid and budget changes under the 2025 federal budget reconciliation law (P.L. 119-21, OBBBA), with more than 200,000 residents at risk of losing healthcare coverage. At the 2026 Michigan State of Reform Conference, state leaders and stakeholders highlighted implementation challenges, fiscal pressures, and strategies to maintain access to care.
On May 5, 2026, State of Reform (SOR), an HMA Company, hosted its annual Michigan health policy conference, bringing together over 200 interest-holders, including providers, policymakers, and community-based organizations to examine how Michigan is adapting to rapid change and implementing new federal requirements.
The conference fostered candid discussion of the implications of the 2025 federal budget reconciliation act (P.L 119-21, OBBBA), with a particular focus on community engagement requirements, behavioral health, Michigan’s budget outlook, and the Rural Health Transformation Program (RHTP).
Michigan DHHS’s Top Health Policy Priorities in 2026
The day opened with a presentation from Meghan Groen, Chief Deputy Director of the Michigan Department of Health and Human Services (DHHS). Ms. Groen shared her department’s priorities and strategies, including implementation of OBBBA requirements and RHTP.
Medicaid community engagement requirements and six-month eligibility redeterminations are the most immediate operational challenges for DHHS. Michigan also is advancing a set of readiness activities, including internal assessments, coordinated planning, leadership alignment, and regular communication with the Centers for Medicare & Medicaid Services (CMS).
Another top priority Ms. Groen identified was expanded access to behavioral health. In a discussion focused on programmatic changes in behavioral health, panelists discussed how Michigan is using multiple tools, including Certified Community Behavioral Health Centers (CCBHCs), crisis stabilization units, and psychiatric residential treatment facilities (PRTFs), to address access gaps. Panelists Kristen Morningstar, Director of Michigan’s Bureau of Specialty Behavioral Health Services and Robert Sheehan, Chief Executive Officer, Community Mental Health Association of Michigan, shared how DHHS continues to collaborate with behavioral health providers to optimize service delivery and better meet member needs.
How OBBBA Will Affect Michigan Medicaid Coverage and the State Budget
Across sessions, speakers—including Danielle Devine, Market President at McLaren Health Plan, and Jen Flood, Budget Director for the State of Michigan—highlighted how OBBBA is already reshaping Michigan’s Medicaid program and broader fiscal outlook. These changes have direct implications for Medicaid financing and long-term planning and are a driver for the state’s $1 billion budget shortfall. Significantly, Michigan Gov. Gretchen Whitmer has recommended approximately $800 million in new taxes from tobacco and vaping to supplement the budget. The governor has also formed a working group of hospitals, health plans, providers, and other stakeholders to identify options for saving $150 million.
DHHS projects that more than 200,000 individuals in Michigan are at risk of losing Medicaid coverage. Panelists discussed the downstream effects, including disruptions in care, a rising rate of uninsured residents, and increased financial strain on families and providers. Stakeholders shared concerns about increases in uncompensated care, food insecurity, and household debt.
Panelists emphasized that navigating this environment will require close collaboration across the delivery system.
How Michigan Is Using the Rural Health Transformation Program
Amid the broader changes in the healthcare landscape, RHTP is emerging as a key strategy for sustaining and strengthening access to care in Michigan’s rural communities. Speakers such as Lauren LaPine-Ray, DrPH, MPH, Vice President, Policy & Rural Health at the Michigan Health & Hospital Association, emphasized the importance of aligning financing strategies, partnerships, and policy levers to optimize the impact of these investments. Michigan has already awarded RHTP funding to multiple entities to support implementation at the local level.
Looking Ahead
The challenges that Michigan is facing are not unique, and the need for shared insight and practical solutions is only growing.
If you are looking for strategies and solutions to address urgent healthcare policy and operational challenges, HMA experts are available to help navigate these complex changes and identify practical paths forward.
Health Management Associates (HMA), State of Reform brings together state leaders, providers, plans, and community organizations to surface real-world strategies for navigating federal change. Join us in Baltimore, MD, on May 21, 2026, or visit the SOR website to view the full conference schedule and register for an upcoming event.
State of Reform develops its conference agendas through collaboration with HMA subject matter experts/market leads and stakeholders across the public and private sectors, including state officials, community-based organizers, providers, payers, and more.
Federal Policy News
Fueled By Leavitt Partners Weekly Health Intelligence
FDA Undergoes Major Leadership Transition Following Makary Exit
Last week, FDA Commissioner Marty Makary formally resigned from his role after leading the agency for 13 months. An unnamed White House official reportedly told Politico that HHS Secretary Robert F. Kennedy Jr. made the decision to remove Commissioner Makary. Kyle Diamantas, who was serving as the Deputy Commissioner for Food and Senior Counselor for FDA in HHS, has stepped in as Acting Commissioner, while the Administration seeks to identify and nominate a permanent replacement. While Mr. Diamantas does not have a medical degree, which recent FDA commissioners have had, he is a lawyer and previously represented Abbott in litigation after its infant formula recall. It has been reported that Mr. Diamantas has achieved a favorable rapport within HHS, the Make America Healthy Again (MAHA) movement, and among career staff at the agency, being viewed as a non-controversial pick to temporarily fill the commissioner role.
Commissioner Makary’s tenure at FDA was marked by significant leadership turnover, layoffs, and high-profile policy battles, such as the recent authorization of flavored vape products, which was reportedly a source of tension between the Commissioner and President Trump.
The President will need to nominate a candidate for FDA Commissioner, but the outlook for Senate confirmation is unclear, particularly since the Senate HELP Committee’s list of nominations to consider includes Surgeon General, CDC Director, and Assistant Secretary for Preparedness and Response. This is further complicated by the impending retirement of Senate HELP Committee Chair Bill Cassidy (R-LA) after his loss in Louisiana’s May 16 Senate Primary, whose position on these nominations from the President remains unclear.
In addition to the departure of Commissioner Makary, there were several other changes in FDA leadership last week, with the departure of Tracey Beth Høeg, the Acting Director of the Center for Drug Evaluation and Research (CDER), who posted on social media that she had been fired on May 15. Following Høeg’s departure, Acting Commissioner Diamantas announced that Dr. Michael Davis, the Deputy Center Director of CDER, would be taking over as Acting CDER Director. Diamantas also announced Karim Mikhail, a former Senior Advisor in the Office of the Commissioner, will serve as the Acting Director of the Center for Biologics Evaluation and Research (CBER). FDA had recently announced that Dr. Katherine Szarama would serve as the Acting Director of CBER, following the departure of Dr. Vinay Prasad.
Additionally, Lowell Zeta, the FDA’s Deputy Commissioner for Strategic Initiatives, will serve as Acting Chief of Staff, replacing former Chief of Staff Jim Traficant.
HHS to Convene First Meeting of New Federal Healthcare Advisory Committee
On May 18, HHS will hold the first meeting of the new federal Healthcare Advisory Committee. According to the agenda, during the initial meeting, committee members will be introduced to the public, the committee will establish its bylaws, and it will discuss committee working groups. Additionally, the meeting includes a 30-minute period for public comment. First announced in August 2025, the committee was created to advise Secretary Kennedy and CMS Administrator Oz on “ways to improve how care is financed and delivered” across CMS programs. The inaugural committee members include healthcare executives, state health officials, and health technology innovators. Dr. Clive Fields, the co-founder and previous chief medical officer of VillageMD, a value-based care platform, will serve as chair. The meeting will be held via a public virtual forum and recorded, to be posted publicly.
CMS Revises ACA Marketplace Standards and Finalizes 2027 Exchange User Fees
On May 15, CMS released the “HHS Notice of Benefit and Payment Parameters for 2027; Basic Health Program Final Rule.” The final rule sets plan year 2027 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE–FPs). For the 2027 benefit year, CMS is finalizing an FFE user fee rate of 1.9 percent of monthly premiums and an SBE-FP user fee rate of 1.5 percent of monthly premiums, which are lower than the current benefit year 2026 user fee rates and those initially proposed. Additionally, in the rule, CMS finalized several policy and technical changes to the ACA Marketplace, including those intended to implement certain provisions of the FY 2025 budget reconciliation law (Public Law No: 119-21), the stayed provisions from the 2025 Marketplace Integrity and Affordability Rule, and other Trump Administration policy priorities related to reducing improper enrollment and addressing the affordability of coverage in the individual market. This includes:
- Codification of CMS’s September 2025 guidance expanding hardship exemption eligibility to individuals who are over 30 years of age and ineligible for APTCs or CSRs due to projected household income below 100 percent or above 250 percent FPL;
- Expanded flexibility for issuers of catastrophic coverage to enroll individuals in multi-year plans with periods of up to 10 years;
- Discontinuation of the “full suite of standardized plan option policies,” including the requirements for FFE and SBE-FP issuers to offer standardized plan options, the requirement for these plans to meaningfully differ from one another, and the differential display of standardized plan options on HealthCare.gov and by approved web-broker and QHP issuer enrollment partners; and
- Reversal of certain Marketplace policies finalized by the Biden Administration including the inclusion of “routine non-pediatric dental services” as an Essential Health Benefit (EHB) and certain reporting requirements related to issuers’ approach to health disparities.
Though CMS issued a Request for Information (RFI) on the impact of the federal medical loss ratio (MLR) standard on insurance premiums in the individual market and market stability in the proposed rule, it did not make any changes in response to public comments. Rather, CMS noted that it will take these comments into consideration as it continues to “consider potential adjustments to the Federal MLR standard for particular States’ individual health insurance markets.”
As a result of the rule, CMS estimates that average enrollment for 2027 will decrease by between 1.2 and 2 million individuals from the baseline scenario, with enrollees either losing coverage due to no longer being eligible for subsidies and as healthier enrollees discontinue coverage.
U.S. Restricts Travel From Central Africa Following Ebola Outbreak Declaration
On May 17, CDC issued a statement and held a subsequent media call related to the agency’s response to an Ebola outbreak in Ituri Province, Democratic Republic of the Congo (DRC) and several cases in Uganda. The World Health Organization (WHO) has identified the outbreak as a public health emergency of international concern (PHEIC), though not a pandemic emergency. CDC reports that there have been 10 confirmed cases, 336 suspected cases including 88 deaths in DRC, and 2 confirmed cases including 1 death in Uganda. In the CDC’s statement, the agency states that the risk to the American public remains low, while CDC offices in the DRC and Uganda are coordinating with the ministries of health and other international partners “to support response operations, including surveillance, laboratory diagnostics, infection prevention and control, and other outbreak containment efforts.” CDC also noted that it is supporting “interagency partners who are actively coordinating the safe withdrawal of a small number of Americans who are directly affected by this outbreak.” On the May 17 call led by Captain Satish K. Pillai, the CDC Ebola Response Incident Manager, members of the press inquired about American individuals who may have been exposed, with one individual noting “two or three of those people may have had high risk exposure.” Dr. Pillai declined to comment on the disposition of individuals. They also noted there is no FDA approved vaccine or treatment specifically for the Bundibugyo strain, but proactive supportive care and treatment of complications is an effective strategy for optimizing patient outcomes.
On May 18, CDC and the Department of Homeland Security implemented a 30-day restriction on entrance into the U.S. for non-US passport holders if they have been in Uganda, DRC, or South Sudan in the previous 21 days. In the announcement, CDC notes that this outbreak of Ebola disease is caused by the Bundibugyo virus and that the order will enable the U.S. government time to conduct a full assessment of risks and develop a “comprehensive mitigation and containment strategy in consultation with other stakeholders.”
Additionally, on May 14 and May 15 media calls, CDC provided updates on the federal response to the Hantavirus outbreak on the M/V Hondius cruise ship and the effort to repatriate 18 passengers in the U.S. During the update, Dr. Bhattacharya said that the risk to the public remains “extremely low.” The agency noted on the May 14 call that 41 total people across the U.S. are under monitoring including the 18 passengers being monitored at Nebraska and Emory centers. In addition to those 18 individuals, CDC is monitoring passengers who had already left the ship and returned home before the outbreak was identified, or who may have been exposed on flights where a symptomatic case was present. These individuals will be monitored over a 42-day period.
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State Policy News
Arizona Medicaid to Launch AI Fraud Detection Tool in July
KJZZ Pheonix reported on May 15, 2026, that Arizona will launch an artificial intelligence tool in July 2026 to review medical records before paying Medicaid claims, with the goal of detecting fraud, waste, and abuse in the Arizona Health Care Cost Containment System (AHCCCS). The governor’s office said the tool will rank submitted claims by fraud and waste risk, while AHCCCS Inspector General Venessa Templeman emphasized that flagged claims will still receive human review.
CMS to Defer $1.3 Billion in California Medicaid Payments Over Fraud Concerns
The Los Angeles Times reported on May 13, 2026, that the Trump administration will defer $1.3 billion in Medicaid reimbursements to California over fraud concerns. Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz also announced a six-month moratorium on new Medicare enrollment for hospices and home health agencies, citing widespread fraud in the Los Angeles region, and said CMS had shut down 800 providers that billed $1.4 billion last year. California officials, including Governor Gavin Newsom’s office and Attorney General Rob Bonta, pushed back, arguing the actions are politically motivated and could harm programs that help seniors and people with disabilities remain in their homes.
Indiana Receives Federal Approval for Revised Hospital Assessment Fee, State Directed Payment Programs
The Indiana Capital Chronicle reported on May 15, 2026, that Indiana has received approval from the Centers for Medicare & Medicaid Services (CMS) for both a revised Hospital Assessment Fee program and a State Directed Payment program. The hospital assessment fee, which is retroactive to July 1, 2025, ties Medicaid reimbursement increases to average commercial prices, incentivizing hospitals to lower their prices to receive higher Medicaid payments. The State Directed Payment program will distribute approximately $1.9 billion in supplemental Medicaid payments next year across hospitals participating in Medicaid. Both programs are part of a broader effort to address healthcare costs and rapid Medicaid spending growth.
Ohio Governor Announces Medicaid Fraud Oversight Initiatives
Cleveland.com reported on May 13, 2026, that Ohio Governor Mike DeWine announced multiple initiatives meant to strengthen Medicaid oversight and eliminate fraud, waste, and abuse. The new measures including requesting permission from the Centers for Medicare & Medicaid Services (CMS) to issue a six-month moratorium on new home health and hospice providers, immediately suspending payments to providers flagged as “high-risk,” mandating GPS verification of all electronic visit verification (EVV) home health providers, and requiring live-in caregivers to use EVV. DeWine also intends to release an executive order requiring Ohio’s Medicaid program to revalidate high risk providers more frequently.
Wyoming Receives Federal Approval for Updated RHTP Plan
Wyoming Governor Mark Gordon announced on May 19, 2026, that the state has received approval from the Centers for Medicare & Medicaid Services (CMS) for its updated Rural Health Transformation Program (RHTP) application that it submitted in early May 2026. Wyoming was awarded $205 million for the first year of RHTP. The state now has until October 31, 2026, to obligate first year funds and one year to spend the funds. Future funding will be based on Wyoming’s approved plan and performance.
Private Market News
Fueled By Wakely Consulting Group
New ACA Marketplace Report Uses Wakely’s Premium Analysis
On March 19, KFF published analysis that draws on data from the Centers for Medicare & Medicaid Services (CMS) and state-based Marketplace (SBM) Open Enrollment reports, as well as KFF survey data and individual market enrollment estimates from Wakely Consulting Group. KFF’s report examines early indicators of how the expiration of enhanced premium tax credits has affected effectuated enrollment levels (i.e., enrollment among people who have paid their premiums), plan selections, and out-of-pocket costs in 2026. The average Marketplace deductible grew by about $1,000 per person in 2026, with more enrollees shifting to higher-deductible bronze plans as the ACA’s enhanced tax credits expired.
Trump and Kennedy Seek to Relax Safeguards for AI Healthcare Tools
There is an emerging policy shift toward faster adoption of AI in healthcare through reduced regulatory barriers, while there are ongoing questions about how best to preserve safety, privacy, and oversight as use expands. This policy debate is a balance between encouraging innovation and maintaining safeguards for patients and clinicians.
Our Insights
Fueled By Experts Across Our HMA Companies
Health Management Associates
Expanding School-Based Behavioral Health Access for Children
As schools increasingly serve as the venue where many children and families first access Behavioral Health supports, HMA has worked with cross-sector partners to align roles and coordination practices so students experience timely referral and smooth handoffs to community-based and clinical services—especially in rural and smaller counties. This work is relevant to behavioral health professionals working in schools, county and state agencies, and clinical settings who are strengthening prevention, early intervention, and referral pathways for children, youth, and families ages 0–25.
Landscape Assessment and Gap Analysis of School-Based Primary Care and Behavioral Health for Medicaid-Eligible Youth
Health Management Associates (HMA) completed the first-ever integrated view of the pediatric behavioral health system in New Orleans, spanning school-based health centers/clinics, community providers, and facility-based care—and translating findings into practical options to improve access, care navigation, and crisis stabilization for Medicaid-eligible youth. For behavioral health professionals working in schools, state agencies, and clinical settings, the assessment produced an actionable picture of where the system breaks down—and where investments and operational changes can measurably improve access and outcomes for Medicaid-eligible youth and public school students.
2026 Maryland State of Reform Health Policy Conference | May 21, 2026
The 2026 Maryland State of Reform Health Policy Conference will be taking place in-person on May 21st, 2026 at the Baltimore Marriott Waterfront! Managing constant change in healthcare takes more than just hard work. It takes a solid understanding of the legislative process and knowledge about intricacies of the healthcare system. That’s where State of Reform comes in.
SAVE THE DATE: Fall State of Reform Health Policy Conference Dates Announced
State of Reform pulls together practitioners, thought leaders, and policymakers – each working to improve the healthcare system in their own way – into a unified conversation in a single place. These conferences are sure to be some of the most diverse statewide gatherings of senior healthcare leaders, and some of the most important events in state healthcare.
Join us for one of our fall events:
- September 3, 2026 – Southern California
- September 16, 2026 – Pennsylvania
- September 30, 2026 – Minnesota
- November 10, 2026 – North Carolina
- November 17, 2026 – Illinois
Registration Open: HMA 2026 Conference
Registration is open for HMA’s annual conference, US Healthcare 2026: Signals, Signs & Flashing Lights—Oct 5–7 in New Orleans. Join leaders from payers, providers, and the public sector to cut through the noise and focus on what’s working to address financial pressures, performance expectations, and AI and new technologies.
HMA Conference 2026
Join Us for HMA’s National Conference US Healthcare 2026: Signals, Signs & Flashing Lights
Register Here
RFP Calendar
RFP Calendar
| Date | State/Program | Event | Beneficiaries |
|---|---|---|---|
| Date: February 2026 - DELAYED | State/Program: Illinois | Event: Awards | Beneficiaries: 2,400,000 |
| Date: May 1, 2026 | State/Program: Nevada Children's Specialty | Event: Proposals Due | Beneficiaries: NA |
| Date: May 12, 2026 | State/Program: Nevada CO D-SNP | Event: Awards | Beneficiaries: 88,000 |
| Date: June 24, 2026 | State/Program: Wisconsin LTC GSR 3 | Event: Awards | Beneficiaries: 56,000 (all GSR) |
| Date: Summer 2026 | State/Program: Illinois Foster Care | Event: RFP Release | Beneficiaries: 33,000 |
| Date: July 1, 2026 | State/Program: Hawaii Community Care Services | Event: Implementation | Beneficiaries: 5,500 |
| Date: July 28, 2026 | State/Program: Nevada Children's Specialty | Event: Awards | Beneficiaries: NA |
| Date: August 2026 | State/Program: Indiana | Event: RFP Release | Beneficiaries: 1,400,000 |
| Date: January 1, 2027 | State/Program: Illinois | Event: Implementation | Beneficiaries: 2,400,000 |
| Date: January 1, 2027 | State/Program: Nevada CO D-SNP | Event: Implementation | Beneficiaries: 88,000 |
| 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: July 1, 2027 | State/Program: Nevada Children's Specialty | Event: Implementation | Beneficiaries: NA |
| 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 |
| Date: 2029 | State/Program: California | Event: RFP Release | Beneficiaries: NA |