September 10, 2025
This week's roundup:
- In Focus: Building Bridges: Key Insights from the 2025 HCBS Conference and What They Mean for Your Organization
- Florida Seeks Input on Rural Health Transformation Program Funding
- Montana Submits 1115 Demonstration for Medicaid Expansion Work Requirements
- New York Proposes to End Section 1332 Waiver, Reinstate Basic Health Program by July 2026
- Oregon Seeks Feedback on Providence, Compassus Home Health Joint Venture
- CMS Releases Preliminary Guidance for Medicaid Managed Care State Directed Payments
- CMS Pauses New Mid-Year MA Unused Supplemental Benefits Notice
- SCAN Health Plan to Enter Washington Medicare Advantage Market, Expand in California and Texas
In Focus
Building Bridges: Key Insights from the 2025 HCBS Conference and What They Mean for Your Organization
This week, our In Focus features insights from the team of Health Management Associates (HMA) experts who attended the 2025 Home and Community-Based Services (HCBS) Conference. Over a handful of days, aging and disability leaders, state officials, health plans, providers, and advocates gathered to explore strategies to transform long-term services and supports. The event celebrated advances in cross-sector collaborations, evidence of program value, seamless access to care for older adults and people with disabilities, member engagement, and integrated care plans for dually eligible individuals.
HMA participants identified seven cross-cutting themes that are reshaping the aging and disability landscape. We examine how these themes connect to ongoing federal policy changes and provide actionable guidance for stakeholders looking to stay ahead of the curve in this evolving field.
Key Cross-Cutting Themes from the Conference
Executive Leadership Is Making the Difference
State leaders are developing new partnerships to continue progress toward meeting the needs of people with disabilities and aging adults across the lifespan. Examples include:
- Pennsylvania’s aging department, though small, leverages lottery funding and executive support to coordinate across departments.
- North Carolina’s policy leadership in the governor’s office has been instrumental in aligning aging goals across state agencies.
- 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 Agin
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 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. For example:
- States are deploying integrated workforce platforms that combine multiple solutions, including worker registries that promote workforce access and transparency and job matching that enhances access to quality care. States are engaging direct support workers in developing the solutions, for example, by including them in official advisory entities.
- Forward-thinking organizations are breaking down silos through cross-sector partnerships, 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. States are building ecosystems and partnerships to enhance reach and effectiveness. Wisconsin’s new Certified Direct Care Professional certification, with career ladder pathways, exemplifies how evidence-based strategies can address critical workforce shortages while improving quality.
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. Medicare now covers Activities of Daily Living/Instrumental Activities of Daily Living 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. Several states have demonstrated successful integration strategies, such as aligning funding streams, creating shared governance structures, and using common metrics across traditionally separate systems.
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 leadership, quantify return on investments, and build partnerships across sectors—including workforce and transportation. Invest in credentialing and tech-enabled training to strengthen the direct care workforce.
Health Plans and Payers
Support caregivers with digital tools and coaching. Use Medicare coding to fund skill-building programs. Invest in provider tech infrastructure to improve care coordination and MLTSS effectiveness.
Providers and Community Organizations
Adopt high-tech, high-touch service models. Pursue credentialing programs with career pathways. Partner with nontraditional allies to expand support networks and participate in shared workforce initiatives.
Technology Vendors
Develop tools that enhance—not replace—human services. Build platforms for cross-system coordination and remote caregiving. Support workforce development with credentialing and job matching features.
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 Marcey Alter, Ellen Breslin, Madeleine Shea, and Aaron Tripp.
HMA Roundup
Florida
Florida Seeks Input on Rural Health Transformation Program Funding. The Florida Agency for Health Care Administration (AHCA) announced in September 2025 that it is seeking stakeholder input for its application for funding from the federal Rural Health Transformation Program. Florida is seeking specific feedback in three areas: the development of new delivery strategies, such as alternative payment models or mobile care, to enhance access and address gaps; the adoption of technology to improve care delivery in rural areas; and strategies for enhancing the rural healthcare workforce to recruit and retain clinicians to serve in rural areas for at least five years. Responses are due September 16, 2025.
Montana
Montana Submits 1115 Demonstration for Medicaid Expansion Work Requirements. The Montana Department of Public Health and Human Services (DPHHS) submitted on September 2, 2025, a new Section 1115 Health and Economic Livelihood Partnership (HELP) demonstration request, which would authorize work requirements for certain Medicaid expansion adults. The proposed five-year waiver would authorize community engagement requirements and monthly premiums for certain Medicaid expansion adults. The policy would apply to non-exempt individuals ages 19–55, potentially affecting up to 25,000 people. Participants must complete at least 80 hours per month of qualifying work, education, or service activities, with suspension or disenrollment for noncompliance. The application includes exemptions and good-cause provisions for those who are medically frail, pregnant, in treatment for substance use disorder, caring for a dependent with a disability, experiencing a crisis, or facing other hardships.
New York
New York Proposes to End Section 1332 Waiver, Reinstate Basic Health Program by July 2026. The New York State of Health announced on September 10, 2025, that it is seeking to terminate its Section 1332 State Innovation Waiver due to reduced federal pass-through funding under H.R. 1 and intends to reinstate its Basic Health Program (BHP). The state plans to end the waiver by July 1, 2026, transitioning affected Essential Plan members to Qualified Health Plans or BHP coverage depending on eligibility, with BHP enrollees experiencing no change. A public comment period will run from September 10 through October 10, 2025, before New York submits its formal request to the Centers for Medicare and Medicaid Services (CMS). The draft termination request also outlines a four-phase transition process including planning, consumer outreach, a special enrollment period, and program close-out, with a request for federal approval by December 31, 2025, to allow sufficient time for implementation.
Oregon
Oregon Seeks Feedback on Providence, Compassus Home Health Joint Venture. The Oregon Health Authority (OHA) announced on September 9, 2025, that it is reviewing a proposed joint venture in which Tennessee-based Compassus would take a 50 percent ownership stake and manage Providence’s home health and hospice operations in Oregon. The partnership, branded “Providence at Home with Compassus,” is already in effect in Washington. To inform its review, OHA is surveying staff in Washington about how the change has affected operations, employees, and services. The agency is also gathering feedback from current and recent Providence at Home with Compassus employees in Washington through September 30.
National
CMS Releases Preliminary Guidance for Medicaid Managed Care State Directed Payments. The Centers for Medicare & Medicaid Services (CMS) issued on September 9, 2025, preliminary guidance on the implementation of new federal payment limits for State Directed Payments (SDPs) in Medicaid managed care as outlined in H.R. 1. For rating periods beginning on or after July 4, 2025, SDPs for inpatient and outpatient hospital services, nursing facility services, and qualified practitioner services at an academic medical center cannot exceed 100 percent of Medicare rates in Medicaid expansion states, or 110 percent of Medicare rates in non-expansion states. The guidance states that certain SDPs submitted or approved before July 4 may qualify for a temporary grandfathering until the January 1, 2028, rating periods, followed by phased reductions until they meet new limits. Additionally, states will need to revise SDPs that do not meet the new requirements. CMS is working on a notice of proposed rulemaking, which may include changes to the total payment rate limit for SDPs beyond the four services identified in this guidance letter.
CMS Pauses New Mid-Year MA Unused Supplemental Benefits Notice. The Centers for Medicare & Medicaid Services (CMS) announced on September 8, 2025, that it will delay enforcement of new Medicare Advantage (MA) rules that would have required plans to send beneficiaries a mid-year notice about unused supplemental benefits. The regulations were set to begin January 1, 2026, mandating annual notices between June 30 and July 31. CMS said the pause is needed to address implementation challenges raised by MA organizations and to reconsider the requirements. The enforcement suspension applies to contract year 2026 and beyond, though plans may voluntarily send the notices. Other obligations, such as Evidence of Coverage, remain in effect until CMS issues further guidance.
Industry News
SCAN Health Plan to Enter Washington Medicare Advantage Market, Expand in California and Texas. Health Payer Specialist reported on September 3, 2025, that SCAN Health Plan announced it will enter the Washington Medicare Advantage market in 2026, starting in Pierce, Spokane, and Thurston counties, while also expanding in California and Texas. The nonprofit, which already serves over 310,000 members in five states, is awaiting CMS approval for these new offerings. The move comes as other major insurers, including Aetna, Humana, and UnitedHealthcare, scale back certain Medicare Advantage products.
RFP Calendar
Actuaries Corner
ACOs Saved $2.4 Billion in 2024, Data Shows. 2024 had the highest share of ACOs receiving performance payments and most savings for ACOs and Medicare. Editor’s Note: Out of 476 ACOs, 75 percent of them, representing 80 percent of the 10.3 million assigned beneficiaries, are earning performance payments totaling $4.1 billion, data showed.
Discover other developments in the Wakely Wire here.
Company Announcements
MCG Press Release
Smile Digital Health Partners with MCG to Advance HL7® FHIR®-Based Prior Authorization Modernization. Smile Digital Health will integrate MCG Path, a FHIR-based API (application programming interface) solution that delivers MCG care guideline content, with the Smile CMS Suite. Through the combination of these solutions, payer organizations will be able to meet the requirements of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), which is scheduled to take effect in January 2027. Read More
HMA News & Events
HMA Webinar
Navigating Medicaid Managed Care Shifts: Financial Pressures, Federal Policy, and Medicaid MCO Implications. Wednesday, September 17, 2025, 12 PM ET. Medicaid managed care organizations face mounting pressure as enrollment patterns shift, federal policy evolves, and state budgets tighten. In this timely webinar, experts from HMA, Wakely, an HMA Company, and HMA’s Information Services team will share exclusive analysis of Medicaid Managed Care Organization (MCO) financial performance, explore the implications of HR 1 and other federal policies, and offer State and MCO perspectives. This webinar is for Medicaid managed care leaders, state officials, vendors, budget officers, and investors navigating financial pressures and policy shifts.
Beyond Bundles: Preparing Hospitals for Success in TEAM and the Next Generation of Value-Based Models. Tuesday, September 30, 2025, 12 PM ET. Hospitals and health systems are under growing pressure to succeed in new value-based models that demand both operational transformation and strategic alignment. In this webinar, advisors from Health Management Associates, Wakely, an HMA Company and Nixon Peabody will break down the latest regulatory and contractual developments, explore lessons learned from the Comprehensive Care for Joint Replacement (CJR) model, and discuss how organizations can prepare for upcoming opportunities.
Speakers will share practical insights on:
- The regulatory, operational, and actuarial considerations hospitals must navigate
- Key takeaways from bundled payment initiatives like CJR
- How to leverage data and design strategies to build partnerships that position organizations for success in new Medicare models
This session is designed for hospital executives, provider organizations, payers, and policy leaders seeking to better understand how emerging value-based models will shape the future of care delivery and payment.
Medicaid 1115 Justice Involved Reentry Demonstration Opportunities: Engaging Key Stakeholders. Wednesday, October 22, 2025, 12 PM ET. This webinar will explore how states, local agencies, and community organizations can maximize Medicaid’s new 1115 demonstration authority to improve reentry outcomes for justice-involved individuals. Presenters will discuss practical strategies for assessing health and social needs, building strong collaborations with community providers, and implementing effective Medicaid enrollment processes. Attendees will gain 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.
NEW THIS WEEK ON HMA INFORMATION SERVICES
(Exclusive Access for HMAIS Subscribers):
HMAIS Medicaid Market Overviews, Reports, and Data
- Updated H.R. 1 Rural Health Transformation Program State Tracker
- Updated HMA Federal Health Policy Snapshot
- New Medicaid enrollment, RFP documents, and other market intelligence resources for dozens of states
- Updated Wisconsin State Overview
A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services.
If you’re interested in becoming an HMAIS subscriber, contact Andrea Maresca at [email protected].