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红领巾瓜报 Insights鈥攊ncluding briefs, webinars, and our podcast鈥攇ives you easy access to 红领巾瓜报鈥檚 deep expertise, helping you stay current on the latest healthcare trends and topics. Search for a topic of interest or browse the latest insights below.

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Webinar

Political Checkpoint 2026: Straight Talk on Election Results for Healthcare Leaders

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Join experts from 红领巾瓜报 and Leavitt Partners for a timely post-election analysis of the 2026 midterm results and what they mean for federal and state healthcare policy 鈥� including ongoing Medicaid changes. This webinar will examine the outcomes of key congressional and state races, shifts in leadership, and the evolving health policy agenda following the November 3 election.

Attendees will gain practical insights into the political landscape and the policy decisions likely to shape the healthcare environment in the year ahead.

Learning Objectives:

  • Understand the implications of the 2026 congressional election results for the federal health policy agenda.
  • Assess how gubernatorial election outcomes and leadership changes may influence state healthcare priorities and Medicaid policy.
  • Identify key federal and state policy developments likely to shape the Medicaid landscape in 2027.
  • Evaluate the political and policy trends that healthcare organizations should monitor as the post-election agenda takes shape.
Blog

Five Takeaways on Medicaid, AI, Financial Sustainability, and Program Integrity from 红领巾瓜报鈥檚 2026 National Conference

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From financial sustainability and program integrity to value, technology, and cross-sector collaboration, healthcare leaders are being challenged to rethink how their organizations operate. 

Healthcare leaders are entering a period in which the decisions they make now will shape their organizations for years to come. During the 红领巾瓜报 (红领巾瓜报) 2026 National Conference, US Healthcare 2026: Signals, Signs & Flashing Lights, conversations repeatedly touched on a common question: How do healthcare organizations adapt their strategies and operating models to deliver better outcomes in a more constrained environment? 

Across discussions on financial sustainability, program integrity, technology, AI, access, and the future of public programs, a clear imperative emerged: Organizations face more difficult choices about where to invest, how to define and demonstrate value, and how to work across traditional silos. The implications extend well beyond any one program or sector. 

Five takeaways stand out for healthcare leaders looking ahead.

1. Financial sustainability requires organizations to get much clearer about where they create value

Financial pressure was an ongoing topic of discussion at the conference, though conversations diverged from the traditional focus on managing tighter budgets. Instead, leaders are reconsidering where their organizations can have the greatest impact and the expertise they need to protect and strengthen, and where partnerships can improve effectiveness of service delivery. 

The conversation about sustaining access to care brought that challenge into sharp focus. Safety-net providers are confronting growing needs while also reassessing how far they can stretch their existing resources. Panelists emphasized the need for organizations to stay anchored to their mission, continually assess priorities and resources, and resist the temptation to pursue every potential opportunity or funding stream. Partnerships with government, philanthropy, schools, community organizations, and other healthcare organizations can help extend reach while allowing organizations to concentrate resources where they are uniquely positioned to deliver. 

What healthcare leaders should be thinking about

The organizations that emerge stronger will be clear about their mission and where they create distinctive value. Executive teams should be asking whether their resources, partnership, and operating models reflect those priorities.

That shift will require difficult decisions. Sustainability cannot be achieved by cutting costs indiscriminately or expecting existing models to absorb additional pressure indefinitely. Organizations will need a clearer view of the services and capabilities they must preserve, where operational models need to change, and which investments can produce meaningful results for the communities they serve.

2. Program integrity is moving closer to the center of healthcare operations

Program integrity is receiving heightened attention, particularly as public programs face greater scrutiny over how healthcare dollars are spent. Federal and state leaders highlighted the tension healthcare leaders must manage, specifically, improving stewardship of public dollars while preserving access to necessary services and avoiding undue burden on legitimate providers. They also highlighted the importance of provider management, including using data analytics to determine utilization and payment, quality, and member outcomes鈥攁ll of which can help organizations identify problems earlier and make better decisions about where intervention is warranted. 

Across the sessions, healthcare leaders spoke of program integrity as a component of operations, signaling a movement away from the historical framing of program integrity as a stand-alone function. The shift creates an opportunity to connect program integrity more deliberately with quality and value.

 What leaders should be thinking about

Expect program integrity to become more integrated with operational and financial strategy. Organizations that strengthen data, governance, provider oversight, and cross-functional coordination now will be better positioned as federal and state expectations continue to evolve.

3. Managed care entities must create value across the healthcare ecosystem

Expectations for managed care delivery systems are changing, particularly for Medicaid managed care entities. Conversations throughout the conference centered on how to achieve value. Speakers discussed concepts for a financial framework that gives plans and their partners enough time, resources, and flexibility to demonstrate value. The number of years available to show results, the structure of incentives, reimbursement levels, and the allocation of financial risk all shape what plans, providers, and community partners can realistically deliver. As expectations rise, states and managed care entities will need to align these factors more deliberately so that accountability for outcomes is matched by the conditions needed to produce them. 

Plans need a clear understanding of where each partner can make a meaningful contribution, whether by strengthening primary and specialty care, addressing behavioral health and social needs, improving data exchange, or reaching members who remain disconnected from care. The value comes from how well those capabilities work together around shared priorities.

What healthcare leaders should be thinking about

Medicaid managed care leaders should not wait for the next contract cycle to determine whether their financial and partnership models can deliver the outcomes now expected of them. They should identify where incentives, reimbursement, risk, timelines, or data constraints are working against shared goals and address those gaps with states and partners.  

4. Technology strategy needs to start with the problem, not the tool

Throughout the AI preconference session and the main event, healthcare organizations grappled with the immediate challenge of deciding where AI adds value and whether they are prepared to use it responsibly. 

The AI preconference discussion focused on a framework to support key decisions and the need to put readiness before adoption. Core components of the readiness framework include reliable data, workforce preparation, engaged leadership, governance, and clear operational processes. Both technology experts and clinical leaders encouraged organizations to prioritize practical, high-value use cases rather than implementing AI broadly for its own sake. 

And, as the conference discussion of the Office of the National Coordinator鈥檚 Trusted Exchange Framework and Common Agreement (TEFCA) and the Centers for Medicare & Medicaid Services (CMS) Health Tech Ecosystem demonstrated, simply connecting more data is too little. The next step is making that information usable in ways that improve decisions, coordination, and care without creating additional work.

What leaders should be thinking about

Before making the next technology investment, organizations should be clear about the problems they are trying to solve. The strongest use cases will connect technology to a defined operational or clinical need, supported by the governance, data workforce, and measurement needed to determine whether is is actually working.  

5. Some of the biggest opportunities are emerging between programs, sectors, and traditional lines of business

Healthcare may be organized around programs and sectors, but the problems leaders are trying to solve rarely respect those boundaries. 

That was particularly evident in conversations about behavioral health. People with complex needs often interact with not only healthcare providers, but also housing, social services, and criminal justice systems. Better outcomes, therefore, depend in part on connecting services and organizations that historically have operated separately. 

The same concept surfaced during the discussion about sustaining access. Speakers challenged organizations to move beyond a siloed mindset and focus more broadly on what patients and communities need while using partnerships to extend their reach. 

A conversation with leaders from the US Department of Veterans Affairs (VA) offered another perspective on this opportunity. The VA is taking steps to make its healthcare data more actionable and to ensure its Community Care program draws on core capabilities of industry and to ensures its approach is informed by both Medicare and Medicaid. 

There is an important strategic implication here. Expertise developed in Medicaid managed care, value-based purchasing, population health, provider networks, data analytics, program integrity, interoperability, and implementation does not necessarily have to remain within the business or program where it originated. Leaders have an opportunity to look across the healthcare ecosystem for proven approaches and consider where those capabilities can solve problems in new settings. 

What healthcare leaders should be thinking about

The next opportunity may site outside the line of business in which an organization has traditionally operated. Leaders who can identify where their expertise translates, and where partners bring complementary capabilities, may find new ways to address longstanding challenges.

From Responding to Change to Shaping What Comes Next 

The discussions at 红领巾瓜报鈥檚 2026 National Conference point to a healthcare environment that is entering a different phase. Understanding policy change remains essential. The work ahead, however, needs to be strategic and transformational. 

The leaders best positioned for what comes next will know where their organizations create value, be able to demonstrate it, and recognize when bringing that expertise into a new partnership, program, or market can be transformative. 

红领巾瓜报 can help leaders move this work forward by bringing the right partners to the table and connecting strategy with execution. As a convener and strategic advisor, 红领巾瓜报 combines market and policy expertise with data analysis and technology capabilities to help organizations assess changing expectations, align financial and operating models, and build partnerships that deliver measurable value. 

These conversations continue in 2026 through 红领巾瓜报鈥檚 events, where policymakers, health plans, providers, community organizations, and other stakeholders come together to examine state and local market realities and develop practical solutions. 红领巾瓜报鈥檚 next national conference will be held October 12-14, 2027, in Nashville, TN. 

Blog

What CMS鈥檚 New Medicaid Quality Pledge Means for the Future of Measurement

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The Centers for Medicare & Medicaid Services (CMS) has launched the Investing in Health Outcomes initiative with a founding group of 37 states, establishing a voluntary Medicaid Quality Pledge intended to shift Medicaid and Children鈥檚 Health Insurance Program (CHIP) quality strategy toward outcomes that matter to beneficiaries. The initiative is an effort to redirect policy, tools, data, and improvement resources away from an expansive inventory of process-oriented requirements and toward a more focused system that can demonstrate progress in prevention, chronic disease management, and behavioral health. 

That direction matters now because Medicaid agencies, managed care entities, providers, and vendors are being asked to improve outcomes while managing extensive and often duplicative performance reporting expectations. CMS reported that its review of managed care programs in 42 states identified approximately 450 reporting requirements corresponding to roughly 260 unique quality measures, many focused on processes and utilization. A smaller, more coherent portfolio could reduce administrative burden, but only if the measures selected are meaningful, the data are trusted, and accountability is built into the policy and contractual structures that drive delivery-system behavior. 

Through this voluntary pledge, CMS is encouraging, rather than requiring participating states to apply the four principles, as they develop health outcome targets and consider outcomes-oriented measures for state quality strategies and upcoming procurements. A disciplined, multiyear approach focused on a limited number of priorities is therefore best understood as an implementation strategy that states can use to make the pledge actionable and establish a credible performance trajectory. 

To learn more about the four principles for an outcome-focused Medicaid quality system access the full report here. 

Brief & Report

CMS鈥檚 Medicaid Quality Pledge Is Redefining How Health Outcomes Will Be Measured

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What states, health plans, providers, and Medicaid partners need to know about the shift toward outcome-focused quality measurement. 

CMS鈥檚 Investing in Health Outcomes initiative signals a significant change in the future of Medicaid and CHIP quality measurement. 

The voluntary Medicaid Quality Pledge encourages participating states to move beyond extensive process and utilization reporting and focus more directly on whether Medicaid programs are helping people become healthier. 

That means prioritizing meaningful outcomes, rationalizing quality-measure inventories, expanding digital quality measurement, and aligning financial accountability with demonstrated improvement. 

Download the report to understand what this shift means, and how your organization can prepare. 

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Why this matters now聽

Medicaid agencies, managed care organizations, providers, vendors, and associations are being asked to improve outcomes while managing complex and often duplicative reporting requirements. 

CMS鈥檚 review of managed care programs in 42 states identified approximately 450 reporting requirements corresponding to roughly 260 unique quality measures. The pledge creates an opportunity to replace fragmented measurement with a more focused and actionable system, but only if measures are meaningful, data are trusted, and accountability is aligned with the realities of care delivery. 

The report examines the four principles shaping this transition and the implications for organizations across the Medicaid ecosystem. 

What the report examines聽

1. Prioritizing outcomes over process 

The future of Medicaid quality measurement will require greater emphasis on measurable changes in health, not simply whether a healthcare activity occurred. 

That shift raises important questions about attribution, risk adjustment, benchmarks, social needs, and shared accountability across providers, plans, community organizations, and other partners. 

2. Rationalizing quality-measure inventories 

Fewer measures will not automatically mean less work. A smaller portfolio will be expected to do more: support improvement, enable accountability, work across diverse populations, and increasingly inform payment. 

States will need to match each measure to its intended use, whether learning, public reporting, contractual accountability, or payment. 

3. Using digital quality measurement as an enabler 

Digital quality measures, FHIR APIs, interoperability, and near-real-time data can improve timeliness and help organizations identify gaps earlier. 

Technology alone, however, will not produce trusted results. Successful digital measurement will also require common specifications, data-quality governance, validation, documentation, and practical feedback loops. 

4. Aligning financial accountability with outcomes 

As states and plans connect payment more directly to outcomes, methodological rigor and data trust will become increasingly important. 

Organizations will need to address questions such as: 

  • Who should receive credit for an outcome?聽
  • How should performance be assessed when members receive care across multiple organizations?聽
  • How can accountability promote improvement without penalizing organizations serving populations with greater needs?聽
  • How should contracts and incentives reflect measure maturity, time horizons, and stakeholder control?聽

What this means for Medicaid stakeholders聽

The pledge will affect organizations differently, but all stakeholders will need to translate broad principles into practical decisions about policy, contracts, operations, data, and accountability. 

For states 

States will need to align quality strategies, managed care procurements, contracts, external quality review, value-based payment, data investments, and oversight around a prioritized set of outcomes. 

Key areas of preparation include: 

  • Defining priority outcomes聽
  • Assessing stakeholder readiness聽
  • Establishing governance聽
  • Addressing attribution and risk adjustment聽
  • Setting credible benchmarks聽
  • Creating phased implementation roadmaps聽

For health plans 

Health plans will experience the pledge through new contract terms, reporting specifications, performance targets, and procurement expectations. 

Plans should evaluate their readiness across: 

  • Data infrastructure聽
  • Quality measurement capabilities聽
  • Care management聽
  • Provider partnerships聽
  • Value-based payment arrangements聽
  • Data-sharing and interoperability聽
  • Performance improvement operations聽

For providers 

Providers will be central to translating outcome priorities into clinical practice and measurable improvement. 

They will need clear expectations, aligned measures, practical workflow support, and data capabilities that enable care coordination and performance management. 

For associations 

Health plan and provider associations can help shape implementation by developing shared positions on measure selection, attribution, risk adjustment, phased timelines, and realistic data expectations. 

This collective perspective will be particularly important for local and safety-net providers serving members with complex medical and social needs. 

Key takeaway聽

The Medicaid Quality Pledge is not simply a reporting-modernization effort. 

It represents a broader opportunity to create a more focused, trustworthy, and actionable quality-measurement ecosystem, one that connects policy, measurement science, technology, governance, operations, and quality improvement. 

The defining question is simple: 

Are Medicaid programs helping people become healthier? 

This report explains what it will take to answer that question with confidence. 

Blog

Pennsylvania Health Policy Conference 2026: What鈥檚 Next for Medicaid Enrollees, Rural Hospitals, and the Workforce

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State of Reform (SOR), an 红领巾瓜报 Company, hosted its inaugural in Harrisburg on September 16, 2026, bringing together more than 170 interest-holders, including state health and human services departments leaders, policymakers, providers, health plans, community鈥慴ased organizations (CBOs), and others to discuss the most pressing health-related issues in the commonwealth. 

The conference focused on how federal Medicaid policy changes, managed care challenges, and workforce shortages, are reshaping Pennsylvania鈥檚 healthcare landscape while highlighting prevention and cross-sector collaboration as essential to building a more sustainable system. Key discussions are highlighted below. 

Central Discussions: Federal Medicaid Policy, Managed Care, and the Workforce 

Pennsylvania Medicaid 

Valerie Arkoosh, MD, Secretary of the Pennsylvania Department of Human Services (DHS) opened the conference by examining how federal policy and fiscal pressures are likely to affect Pennsylvania鈥檚 health and human services system. She discussed the anticipated loss of Medicaid coverage for approximately 310,000 enrollees due to the 2025 budget reconciliation act (P.L 119-21, now known as the Working Families Tax Cut Act [WFTCA]) and the resulting strain on individuals, providers, and the broader healthcare system. 

WFTCA and broader financial pressures also raise concerns about the sustainability of hospitals, with closures threatening access to care, especially in rural and underserved communities. Hospitals and safety-net facilities are consistently working against staffing shortages, capacity constraints, and shifting payer dynamics. Pennsylvania is using funds from the Rural Health Transformation Program (RHTP) to support struggling rural hospitals as best it can. DHS has $42 million in RHTP grant fund awards so far to support various rural facilities. 

Medicaid managed care 

Community HealthChoices (CHC), Pennsylvania鈥檚 Medicaid managed long-term services and supports (MLTSS) program, has been at the forefront of the healthcare conversation in the state as a result of the cancellation of its 2024 contract awards for the program. In June 2026, DHS a request for information seeking responses on several topics that could shape a new CHC re-procurement, including the number of Medicaid managed care organizations (MCOs) within CHC, regional versus statewide coverage, length of contract terms, strategies to align coordination of Medicare and Medicaid, artificial intelligence (AI), and other program recommendations. 

During the managed care discussion, Sally Kozak, Deputy Secretary of the Office of Medical Assistance Programs, and Emily Katz, Executive Director of Pennsylvania Medicaid MCOs, joined health plan leaders in assessing how well the physical health managed care program is improving access, quality, and cost management. 

The conversation centered on persistent challenges involving provider participation, care coordination, the complexity of administering the programs, and the variation in performance by region. There are opportunities to reform or refine managed care to better align incentives with patient needs and system sustainability. 

Workforce shortages 

Like all states, Pennsylvania is facing a health professional shortage across all sectors. Jennifer Hale, Director of the Bureau of Policy and Regulatory Management in the Office of Long-Term Living, and Garry Pezzano, President and Chief Executive Officer of LeadingAge PA, highlighted how this issue is affecting people who need long-term care. Speakers emphasized that Pennsylvania鈥檚 ability to meet the needs of an aging population will depend largely on strengthening the workforce that delivers these services. They explained several of the strategies underway and being discussed to achieve this goal, for example by improving wages and benefits for direct care workers, strengthening education and training pipelines, expanding loan repayment programs, prioritizing recruitment, and investing in technology for telehealth services and AI-assisted workflows. 

Advancing Change: Upstream Interventions and Collaboration 

Paying for care continues to be a chief concern. While many of the financial pressures come from within the healthcare system as the result of policy and budgetary challenges, throughout the conference speakers emphasized that many of Pennsylvania鈥檚 most pressing healthcare challenges begin outside the healthcare system. Food insecurity, unstable housing, transportation barriers, limited caregiver support, and lack of social and community supports worsen health outcomes and lead to increased healthcare expenditures. 

Panelists called for greater investment in upstream prevention services that help people remain healthy and independent before their needs become more acute to contain costs over time. Speakers recommended approaches such as expanding housing supports, food as medicine initiatives, community health worker investments, caregiver supports, reentry services, and technology that allows people to receive care at home, as well as other initiatives to ensure people can remain healthy and independent. 

Pennsylvania has already begun investing in several of these areas. The fiscal 2027 budget allocated $1.9 million to the Investments in Health pilot program for housing stability services and reentry supports for incarcerated individuals. Federal matching dollars for the first year of this program total $5.2 million. Another tool, connects people with CBOs, state agencies, and providers that can help people access basic necessities. 

Speakers also stressed that these efforts will have limited reach if organizations operate separately. Better coordination among healthcare providers, MCOs, CBOs, hospital systems, and state agencies can reduce the fragmentation, make services easier to navigate, and help funding and data systems support common goals. That message was consistently expressed throughout the conference: Pennsylvania鈥檚 healthcare challenges cannot be addressed by one sector alone, and progress will depend on sustained collaboration among the organizations that serve individuals and communities. 

Looking Ahead 

If you are looking for strategies and solutions to address urgent healthcare policy and operational challenges, 红领巾瓜报 (红领巾瓜报) experts are available to help you navigate these complex changes and identify practical paths forward. 

Through the , partnership events, and other 红领巾瓜报 meetings across the country, we connect state leaders, providers, health plans, and community stakeholders to share insights, elevate lessons, and advance solutions. Join us at an upcoming event鈥攊ncluding our next 红领巾瓜报 National Conference in New Orleans, LA, October 5鈥�7, 2026鈥攐r explore additional opportunities to engage with 红领巾瓜报 and access the full schedule of conferences and resources. 

State of Reform develops its conference agendas through collaboration with 红领巾瓜报 subject matter experts/market leads and stakeholders across the public and private sectors, including state officials, community-based organizations, providers, payers, and more.

Blog

Medicaid Managed Care Enrollment Declines in Q2 2026: 红领巾瓜报 Analysis of State Trends and Market Share

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红领巾瓜报 (红领巾瓜报) analyzed monthly Medicaid managed care鈥痚nrollment鈥痙ata reported by 34 states in the second quarter of 2026. Enrollment totaled 59.2 million members in June 2026鈥攁 decline of 3.5 million members (5.5%) from June 2025. The broader Medicaid and CHIP population has declined at approximately the same pace as managed care, with the Centers for Medicare & Medicaid Services (CMS) showing a 5.9% decrease from May 2025 to May 2026. 

The findings establish a timely baseline before new eligibility policies take effect. Under the 2025 budget reconciliation act (P.L. 119-21), now known as the Working Families Tax Cut (WFTC) Act, most states must implement Medicaid community engagement requirements for certain adults beginning January 1, 2027, conduct eligibility redeterminations every six months for this population, and implement other policies that will narrow Medicaid eligibility. 

Medicaid Managed Care Enrollment Trends in Q2鈥�2026 

红领巾瓜报 Information Services (红领巾瓜报IS) tracks monthly Medicaid enrollment for all states, including managed care enrollment in the subset of states with managed care programs. Among the 34 states with managed care programs that reported enrollment data in the second quarter of 2026: 

  • Enrollment changes varied across states, reflecting a combination of state-specific demographic, administrative, operational, and policy factors.聽
  • Only three states鈥擬ississippi, Nevada, and South Carolina鈥攔eported modest gains in Medicaid managed care enrollment since June 2025.聽
  • Arizona, Indiana, and Louisiana鈥痚ach reported double-digit declines, ranging from 10.1% to 21.1%.聽
  • The鈥痵even non-expansion states in this analysis鈥擣lorida, Georgia, Mississippi, South Carolina, Tennessee, Texas, and Wisconsin鈥攅xperienced a鈥痙ecline of 455,000 (3.8%),鈥痓ringing鈥痚nrollment to鈥�11.6鈥痬illion enrollees.聽

Among the鈥痚xpansion states in the analysis,鈥痚nrollment鈥痙ecreased鈥痓y鈥�3鈥痬illion (5.9%) to鈥�47.6鈥痬illion.鈥疶he larger decline among expansion states is particularly relevant because adults in expansion states will be most directly affected by the new community engagement and six-month redetermination policies. Details are illustrated in Figure 1. 

Figure 1. States Included in the Medicaid Managed Care Enrollment Analysis, June 2026

Note: States colored as blue shown on the map above are included in the 红领巾瓜报 Enrollment Analysis. 

National Medicaid Managed Care Market Share 

红领巾瓜报IS also tracks Medicaid managed care ownership, program participation, and tax status for nearly 300 plans. In this June 2026 snapshot, Centene covered 17.9% of enrollees, followed by Elevance at 10.7%, UnitedHealth Group at 8%, and Molina at 6% (see Figure 2). These four organizations represented 42.6% of enrollment in the 红领巾瓜报IS dataset, underscoring continued concentration among large, national Medicaid managed care organizations. (Note: The number and mix of plans changed over the past 12 months, and several state enrollment reports reflect different reporting months. Other limitations are discussed in the Data Considerations section of this article.) 

The enrollment declines as well as pressure from acuity, utilization, and payment rates are compelling Medicaid managed care organizations (MCOs) to reassess where they participate, including whether individual markets can support sustainable performance. For example, one national Medicaid MCO has publicly discussed exiting unprofitable Medicaid markets and left one state market in August 2026 with plans to exit another at the end of the year. These decisions illustrate how enrollment contraction can interact with rate adequacy, acuity, utilization, and state-specific contract performance to influence plan participation. 

Figure 2. National Medicaid Managed Care Enrollment Share by Parent Organization, June 2026 

How Medicaid Work Requirements and Eligibility Policies Could Affect Enrollment in 2027 

In , approximately 20.4 million people were enrolled in Affordable Care Act Medicaid expansion plans鈥�5 million of whom reside in California, and nearly 2 million live in New York. The WFTC Act applies requirements to Affordable Care Act (ACA) expansion adults and certain Medicaid Section 1115 demonstration populations in 44 states beginning January 2027. 

In September 2026, CMS published an that outlines an optional framework that states may use to identify and verify individuals who qualify for the medical frailty exclusion. Although the framework gives states options for consideration, they still must determine which health conditions to cover and data sources to use when additional documentation is requested and how to notify members of their determinations. Many states have already made decisions about these issues, which could materially affect administrative workload, the consistency of determinations, and whether eligible individuals maintain coverage as well as the number of people who retain coverage and the composition of the population that remains enrolled. 

In addition, a few states have already started implementing the new eligibility policies. For example, Nebraska launched Medicaid work/community engagement requirements on May 1,鈥�2026. Montana began implementation on July 1, 2026, while Arkansas began a soft launch in July 2026 before enforcement begins in January 2027. Iowa intends to begin early implementation December 1, 2026. Although Montana and Arkansas are not managed care states, they, along with Nebraska, can offer directional insights on beneficiary response, exclusion determinations, procedural losses, appeals, and administrative workload before nationwide implementation. 

Notably, the second quarter鈥痚nrollment decline predates full implementation of the new federal eligibility policy changes and community engagement requirement, which means future enrollment changes may not be entirely attributable to the WFTCA requirements. 

Organizations should continue to monitor total enrollment, churn, eligibility category, risk mix, and transitions to Marketplace or uninsured status. 

Data Considerations. 红领巾瓜报 Information Services (红领巾瓜报IS) tracks monthly Medicaid managed care enrollment, ownership, program participation, and tax status for approximately 300 plans. The data in this analysis have some important limitations. States report enrollment figures at different points throughout the month, with鈥痵ome data鈥痳eflecting鈥痓eginning of the month totals鈥痑nd鈥痮thers capturing鈥痚nd of month鈥痚nrollment.鈥疘n addition,鈥痵ome鈥痵tate datasets encompass all Medicaid programs that offer managed care plans, whereas others reflect only a subset of the managed Medicaid population. As a result, the analysis can be used to identify direction, magnitude, and market signals rather than as a comprehensive state-by-state comparison. 

The 红领巾瓜报IS enrollment reports and analyses, available through subscription, use鈥痙ata from鈥痭early 300鈥痟ealth plans in 39 states, DC, and Puerto Rico. 红领巾瓜报IS鈥檚鈥疢edicaid鈥痚nrollment data, financials,鈥痯rocurement鈥痶racking, and a robust library of public documents鈥痚quips stakeholders with鈥痶imely, actionable intelligence. Subscribe here. 

Preparing for Enrollment Shifts

WFTC Act implementation will require state-specific policy decisions, eligibility system changes, new data-matching processes, staff training, beneficiary outreach, and workable approaches to identifying people who qualify for exemptions for medical frailty and other conditions. Differences in data availability, verification pathways, documentation requirements, and review processes could produce materially different effects on enrollment, continuity of coverage, beneficiary experience, and the risk profile of the population that remains enrolled. 

Healthcare executives and state Medicaid leaders should establish a baseline, monitor emerging implementation signals, and model the operational and financial implications. Priority measures include enrollment and churn, procedural terminations, exclusion determinations, appeals, transitions to other coverage, changes in acuity and utilization, payer mix, and geographic variation. These insights can inform decisions about eligibility operations, beneficiary support, capitation and rate development, network strategy, provider reimbursement, revenue forecasting, and uncompensated care exposure. 

MCOs are unable to help states with determining eligibility determination or compliance, cannot receive capitation rate bumps for non-medical activities, or use their own work programs to help beneficiaries meet the community engagement requirements but may be able to provide support through outreach and education. CMS has indicated it expects to provide additional guidance on what activities are appropriate. MCOs can potentially use their existing relationships with beneficiaries, care managers, providers, and community organizations to help members understand and navigate the new requirements. 

红领巾瓜报IS provides the market intelligence needed to track these shifts, including state-reported enrollment, plan ownership, financial performance, procurement activity, and related public documents. 红领巾瓜报 consultants extend that intelligence through state- and market-specific scenario modeling, policy and operational analysis, and implementation support鈥攈elping clients forecast enrollment and revenue, assess payer mix and utilization effects, strengthen eligibility and beneficiary support workflows, evaluate competitive positioning, and prepare for changes in program financing and oversight. 

Contact 红领巾瓜报 to translate evolving enrollment and implementation signals into an actionable strategy for your state, market, or organization.

Solutions

Medicaid Funding Changes, Eligibility Requirements, and the Safety Net: What Community Leaders Need to Know

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红领巾瓜报 Solutions

Medicaid Funding Changes, Eligibility Requirements, and the Safety Net: What Community Leaders Need to Know

Federal policy and funding changes are reshaping Medicaid, healthcare delivery, human services, and the local safety net. 红领巾瓜报 helps healthcare, Medicaid, human services, and community leaders assess the impact of federal funding changes, protect access to care, strengthen local safety-net systems, and develop practical implementation strategies.

Communities Face Converging Fiscal and Service Pressures

Changes to Medicaid financing, eligibility, and community engagement requirements will not remain contained within state Medicaid agencies. The effects can move across health systems, local government, human services programs, community-based organizations, and households. When coverage becomes harder to maintain, people still need care and support. The costs and responsibilities often surface elsewhere in the community.

Hospitals and healthcare providers may face greater uncompensated care and pressure on already vulnerable service lines. Counties and municipalities may encounter increased demand for behavioral health, public health, housing, emergency response, and other locally supported services. Human services agencies may need to implement more complex processes without additional workforce capacity. Community-based organizations may be asked to help people navigate new requirements while also managing reductions or instability in their own funding.

These pressures will not be distributed evenly. Children and families, people with disabilities, older adults, rural residents, people experiencing homelessness, low-income working adults, pregnant and postpartum people, individuals with behavioral health needs, and people involved with child welfare systems may face heightened risk when administrative complexity and service constraints increase.

Supporting the Leaders Closest to Community Impact

红领巾瓜报 works with the organizations responsible for financing, administering, delivering, and sustaining healthcare and community supports.

State Medicaid agencies, health and human services departments, and executive and legislative leaders

Counties, municipalities, public health agencies, and local human services systems

Hospitals, rural health organizations, safety-net providers, health plans, and provider associations

Behavioral health organizations, child welfare agencies, housing and homelessness systems, and family-serving organizations

Community-based organizations, coalitions, foundations, associations, and cross-sector partnerships

Our multidisciplinary teams connect Medicaid and healthcare expertise with human services, community systems, organizational strategy, operations, financing, analytics, and implementation support. That breadth allows 红领巾瓜报 to help clients understand not only what a policy change requires, but also how the change will affect people, providers, partners, workflows, budgets, and outcomes.

红领巾瓜报 Can Help Leaders Move from Uncertainty to Action

红领巾瓜报 can tailor support to a single organization, local community, statewide system, or cross-sector coalition. Engagements may include rapid analysis, operational planning, stakeholder engagement, implementation support, and performance monitoring.

Assess Policy and Fiscal Impact

Translate federal and state changes into clear implications for coverage, enrollment, provider reimbursement, service utilization, administrative cost, workforce demand, and local government exposure.

How 红领巾瓜报 helps: Policy analysis, fiscal-impact assessment, coverage and enrollment scenario planning, provider vulnerability analysis, local cost-shift analysis, and executive briefings.

Prepare Medicaid and Eligibility Operations

Help agencies and partners prepare for eligibility, verification, reporting, data-matching, communication, and coverage-retention challenges while reducing avoidable administrative burden.

How 红领巾瓜报 helps: Operational readiness assessments, workflow mapping, data-gap analysis, implementation roadmaps, community communications, and performance measures.

Evaluate Safety-Net and Provider Vulnerability

Identify where reductions in coverage or reimbursement may threaten access, critical service lines, rural providers, behavioral health capacity, maternity care, specialty services, and community-based care.

How 红领巾瓜报 helps: Provider and service-line vulnerability assessments, market and network analysis, rural access review, scenario modeling, mitigation planning, and monitoring dashboards.

Strengthen Community Infrastructure

Assess whether community-based organizations and local partners have the capacity, funding, data, referral relationships, and operating infrastructure needed to absorb new responsibilities.

How 红领巾瓜报 helps: CBO capacity and sustainability assessments, referral-network mapping, partnership strategy, reimbursement opportunity analysis, sustainability planning, and technical assistance.

Build Cross-Sector Response Plans

Bring healthcare, Medicaid, human services, public health, housing, workforce, philanthropy, and community partners together around shared risks, priorities, roles, resources, and accountability.

How 红领巾瓜报 helps: Stakeholder engagement, facilitated convenings, governance design, shared implementation planning, resource mapping, and accountability frameworks.

Redesign Human Services and Community Systems

Help agencies align policy, funding, operations, workforce, technology, community voice, and performance expectations so systems can function more effectively under constraint.

How 红领巾瓜报 helps: Current-state assessments, operating-model redesign, workforce strategy, change management, implementation tools, and continuous quality improvement structures.

Develop Sustainable Financing Strategies

Help clients move beyond reliance on a single funding source by identifying opportunities to maximize, blend, braid, and sequence public and private resources.

How 红领巾瓜报 helps: Funding opportunity scans, Medicaid optimization, financing and reimbursement strategy, financial modeling, grant and partnership strategy, and sustainability roadmaps.

Use Data to Target Resources and Track Results

Combine policy, fiscal, enrollment, utilization, geographic, provider, and community information to identify hotspots, prioritize resources, and monitor whether implementation is protecting access.

How 红领巾瓜报 helps: Data inventory and gap assessments, community indicator mapping, geographic hotspot analysis, dashboards, performance measures, and evaluation plans.

Questions Leaders Should Be Asking Now

  • Who is most likely to lose coverage or encounter barriers maintaining eligibility?
  • Where will the effects appear first across emergency care, behavioral health, maternity care, rural access, housing, public health, and human services?
  • Which providers and community organizations have the least capacity to absorb additional uncompensated work?
  • How could federal and state decisions shift costs to counties, municipalities, providers, and families?
  • What data will show where risks are concentrated and whether the response is working?
  • What can be protected, redesigned, financed differently, or delivered through stronger regional and cross-sector partnerships?

红领巾瓜报 Has the Right Team

红领巾瓜报 brings deep Medicaid, healthcare, human services, financing, implementation, and community-system expertise to help clients translate policy change into operational readiness, protect access to care, strengthen safety-net infrastructure, and coordinate action across providers, agencies, local governments, and community partners.

Connect with 红领巾瓜报 to discuss what the changing fiscal landscape means for your state, community, organization, providers, and residents.

Podcasts

Why Is Medicaid Program Integrity More Than Fighting Fraud?

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In this episode of Vital Viewpoints on Healthcare, Clint Eisenhower, regional director at 红领巾瓜报, discusses the critical role of Medicaid program integrity and why it is about much more than preventing fraud. Drawing on his experience leading state and federal Medicaid program integrity organizations, Clint explains how protecting taxpayer dollars, managing enterprise risk, and ensuring the right people and processes are in place all contribute to stronger healthcare programs. He also explores common misconceptions about program integrity and shares why this work is essential to maintaining trust, accountability, and the long-term sustainability of Medicaid.

Blog

2027 Maternity Care Coding Changes: How Providers, Health Plans, and States Can Prepare for Service-Level Reimbursement

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What the shift away from global obstetric billing may mean for care delivery, coding and documentation, reimbursement, quality measurement, and more.

AT A GLANCE: Beginning January 1, 2027, maternity care reimbursement will change from bundled global obstetric codes toward more granular, service-level reporting for antepartum care, labor management, delivery, and postpartum care. The new approach is intended to more accurately capture how maternity care is delivered today across multiple clinicians, settings, modalities, and risk profiles. Organizations should begin assessing operational, financial, contracting, and data implications now.

What Is Changing?

Under the new approach, maternity services will be recognized and reported at the service level rather than through a single global obstetric payment. The impacts will unfold over time and will depend on final policy, coding guidance, fee schedules, contracts, and implementation decisions specific to payers, providers, and local markets.

What This Will Mean?

This change is more than a coding update. It will affect payment policy, claims systems, documentation workflows, actuarial assumptions, provider contracts, quality and access monitoring, data reporting, and patient care models. For Medicaid agencies, health plans, federally qualified health centers (FQHCs), hospitals, physician and midwifery practices, and professional associations, the transition creates implementation risks and uncertainties as well as opportunities to modernize maternity care financing around person-centered perinatal care, social needs screening and management, telemedicine, home monitoring, and postpartum support. Early preparation can reduce disruption and enable increased visibility into access, quality, equity, outcomes, and total cost.

New Questions Stakeholders Will Need to Answer

  • How will payment rates, fee schedules, and contracts change when maternity care is no longer paid as a single global payment?
  • What documentation, coding, and billing workflows will providers need to update before the new codes (and/or potential interim codes, depending on the Centers for Medicare & Medicaid Services (CMS) decision-making) take effect in order to ensure that care is correctly reimbursed?
  • What systems changes and staff training will be needed?
  • What claims edits, utilization management rules, encounter data processes, and reporting systems will need to be revised?
  • How will payers distinguish routine care, higher-risk care, care coordination, social needs services, telehealth, and home monitoring?
  • How can stakeholders use new data to assess access, quality, equity, outcomes, and total cost of maternity care?

Supporting Next Steps

红领巾瓜报 can help stakeholders understand the implications of the new coding structure, evaluate policy and operational options, create a practical path forward, and operationalize that plan across programs, systems, contracts, and care delivery models.

StakeholderHow 红领巾瓜报 Can Help红领巾瓜报 Services Include
StatesAssess Medicaid policy impacts, update provider guidance, model budget and rate implications, align managed care contracts, and design monitoring strategies for access, quality, equity, and outcomesRevenue Cycle Management

Actuarial Analysis

Market Analysis and Strategic Planning

Financial Modeling

Operational Planning and Implementation Support

Research and Evaluation

Contract Review and Negotiation Support

Business Analytics

Clinical and Health-Related Social Needs Service Model Development

Quality Measurement and Accreditation Support

Information Technology Advisory Services    
Providers: FQHCs, hospitals, physician practices, and midwifery groupsHelp organizations prepare for coding, documentation, billing, revenue cycle, and clinical workflow changes; identify training needs; and evaluate how new payment rules affect service delivery and financial sustainability
Health plansRevise payment policies, claims logic, provider communications, contract terms, encounter data processes, and network oversight approaches to support a smooth transition
Associations and coalitionsTranslate the changes for members, develop implementation roadmaps, convene stakeholders, identify advocacy priorities, and support coordinated action across the maternity care environment

Frequently Asked Questions

What is changing in maternity care reimbursement in 2027?

Maternity care reimbursement is shifting from bundled global obstetric billing toward more granular, service-level reporting for antepartum care, labor management, delivery, and postpartum care.

Who will be affected by the maternity care coding changes?

OB/GYN practices, hospitals, FQHCs, midwifery groups, health plans, Medicaid agencies, professional associations, and other organizations involved in maternity care financing, delivery, claims, contracting, or oversight will be affected by these significant changes.

What should organizations do first?

Start with an impact assessment: inventory current payment arrangements, map services and documentation, identify systems changes and training needs, model financial effects, review contracts, and develop implementation roadmaps.

Blog

MESC 2026 Highlights: Medicaid Modernization, AI, Eligibility, and Program Integrity

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Key Insights from the 2026 MESC Conference and What They Mean for Your Organization 

State Medicaid agencies and partner organizations are facing one of the most consequential periods of operational change in more than a decade. Those challenges were a central focus of the , August 17-20, 2026, in Portland, OR, where state, federal, and industry leaders discussed how technology, data, and operational modernization are becoming essential tools for implementing policy change. 

During the conference, leaders of 红领巾瓜报 (红领巾瓜报) and HealthTech Solutions, an 红领巾瓜报 company, reinforced a consistent theme: We have moved beyond the era when Medicaid enterprise systems modernization simply meant replacing aging technology. Instead, states are building the infrastructure needed to manage continuous policy evolution, support more sophisticated program integrity efforts, adapt to changing eligibility requirements, and provide the financial and operational visibility necessary to navigate an increasingly complex Medicaid environment. That direction is also reflected in recent  that the Centers for Medicare & Medicaid Services (CMS) issued to gather stakeholder input on how to advance a more standardized, interoperable, and cost-effective MES ecosystem. 

What We Learned at MESC 

Modernization Is Becoming an Ongoing Operating Capability 

Medicaid modernization is moving beyond the replacement of legacy systems. States are building the capabilities needed to manage continuous change. That work includes stronger governance through better data and more disciplined implementation practices; clearer ownership for decisions, risks, dependencies, and outcomes; and the development of cross-functional teams. Policy, operations, technology, finance, communications, and program leadership must work together from the beginning. 

What it means for states and partners
Modernization programs need a clear operating model that defines decision rights, measures of success, implementation responsibilities, and long-term support. Partners should help build state capability instead of focusing only on system delivery. 

Modularity Now Means Managing the Connections Between Systems 

Modularity can give states more flexibility, support specialized solutions, and reduce dependence on one large platform. Modularity, however, also creates more connections and business relationships that must be managed. A modular environment involves multiple vendors, systems, interfaces, data flows, release schedules, and support models. Because difficulties can arise when these elements are disconnected, MESC sessions emphasized the need for enterprise integration and coordination. States must manage testing, release planning, architecture, data contracts, vendor handoffs, and incident resolution. 

What it means for states and partners
Modularity requires more than modular procurement. States need an enterprise layer that manages the relationships between components. Partners should understand how their work affects the broader Medicaid ecosystem. 

Federal Requirements Are Shaping the Modernization Agenda 

CMS and other federal requirements continue to influence state priorities. Certification remains important, along with federal reporting, data quality, security, interoperability, and program integrity. The conference also reflected growing pressure to prevent fraud, waste, and abuse earlier in the Medicaid life cycle. States are strengthening provider enrollment, referral intake, payment controls, analytics, and audit preparation. These efforts move program integrity closer to the front door. The goal is to identify risk before it becomes a payment error or an investigation. 

What it means for states and partners
Compliance and program integrity should be part of solution design from the beginning. States and partners should build evidence, controls, testing, and monitoring into normal operations. These activities should not be postponed until certification or an audit is approaching. 

Eligibility Changes Require New Data and Operational Models 

Changes to Medicaid eligibility are creating new demands for states. Workforce and community engagement requirements are one example. States may also need enhanced verification, new exemption processes, shorter response timelines, and stronger outreach. 

These changes extend beyond eligibility systems. They shape how states communicate with members, support contact centers and caseworkers, manage appeals, connect data sources, and help people understand what they need to do to maintain coverage. MESC sessions underscored the value of listening to stakeholders and explored how health information exchange data and other sources could support exemption decisions and reduce preventable coverage loss. 

What this means for states and partners
Eligibility modernization must connect policy to daily operations. States need reliable data and clear workflows. They also need ways to explain changes and track outreach. Partners can translate policy into decision logic, test cases, notices, training, and operational procedures. 

AI Means Governed Support for Real Medicaid Work 

AI was a major topic of discussion at MESC. The strongest examples involved practical work rather than general experimentation. States are exploring AI for policy questions, quality assurance, document review, contact center support, knowledge management, and program integrity. These use cases can reduce administrative burden and help staff manage complex workloads. Conference speakers clarified that AI is no substitute for reliable governance structures. States need reliable content, security controls, privacy protections, human review, workforce training, and performance monitoring. 

What this means for states and partners
AI adoption should begin with a specific business problem. States should define who is accountable for the outcome and how the tool will be monitored. Partners can support use case selection, governance, procurement, testing, implementation, and workforce adoption. 

How 红领巾瓜报 Can Help 

MESC 2026 reinforced the argument that Medicaid modernization is no longer a discrete technology project. States and their partners are responding to federal requirements, modular system complexity, eligibility changes, AI adoption, and heightened program integrity expectations at the same time. 

红领巾瓜报 and HealthTech Solutions help organizations turn that complexity into an actionable modernization strategy. Our teams bring together Medicaid policy expertise, operational experience, technology strategy, procurement support, compliance knowledge, and implementation discipline so clients can make better decisions and execute with confidence. 

We support organizations in assessing current systems and capability gaps, prioritizing technology investments, translating policy into operational and technical requirements, managing vendor selection and procurement, strengthening compliance and program integrity, and adopting AI in ways that are effectively governed, practical, and aligned with Medicaid business needs. 

Contact 红领巾瓜报 experts to get your questions answered. 

Blog

Federal and State Medicaid Leaders and VA Assistant Secretary to Discuss Public Healthcare Transformation at 红领巾瓜报 Conference

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红领巾瓜报 (红领巾瓜报) is pleased to announce that , Principal Deputy for the Center for Medicaid & CHIP Services, will participate in two sessions at , October 5-7, 2026. in New Orleans, LA. As states, plans, providers, and community partners prepare for a new era in Medicaid and other public healthcare programs, these conversations will focus on practical solutions, implementation realities, and the partnerships needed to move from policy change to sustainable results. 

State Medicaid and CHIP Strategies for Applied Behavior Analysis and Autism Services 

As the prevalence of autism has increased, state investments in Applied Behavior Analysis (ABA) and related services have grown substantially. This preconference session will examine federal guidance and state strategies for supporting appropriate, high-quality care for children with autism while helping programs strengthen oversight, access, and service delivery. 

Medicaid Policy Changes and Their Ripple Effects Across Healthcare 

Changes in Medicaid policy and financing will not stay confined to Medicaid. Coverage churn across Medicaid, the Affordable Care Act (ACA) Marketplace, and employer-sponsored insurance can reshape risk pools, influence plan participation, increase provider financial exposure, and leave more people uninsured. This session will bring federal and state leaders together to discuss how Medicaid agencies and their partners are responding, where collaboration is most needed, and what strategies will be needed to navigate the next phase of public healthcare transformation. 

The following current and former Medicaid directors will join Dr. Knapp: 

  • , Administrator, Nevada Medicaid Nevada Health Authority聽
  • 聽Senior Advisor; Former Medicaid Director, Virginia Department of Medical Assistance Services聽
  • 聽Medicaid Director & Assistant Secretary for MassHealth, Massachusetts Executive Office of Health & Human Services聽
  • Director, Ohio Department of Medicaid聽

VA Community Care and NextGen Healthcare Innovation for Veterans 

As the nation鈥檚 largest integrated health system serving聽military聽veterans, the VA is聽working聽with health plans, providers, health systems, technology firms, and other innovators to bring聽effective聽solutions from across the healthcare marketplace to聽people聽who have served our nation.聽Approximately聽42 percent of the healthcare services that veterans receive聽today聽is聽delivered聽through the contracted Community Care program,聽and that share is expected to grow.聽聽will聽discuss聽the VA鈥檚 vision for the future of Community Care,聽the critical role industry partners will play,聽and how the VA聽intends聽to learn from聽the field, adopt proven practices, leverage emerging technologies, and foster innovation that improves access, quality, and outcomes for聽veterans.

As Medicaid, VA Community Care, and other public healthcare programs enter a period of significant change, 红领巾瓜报鈥檚 conference will focus on the partnerships, operational strategies, and solutions needed to move from policy to implementation.

to join leaders working through the decisions that will shape the next phase of public healthcare. 

Brief & Report

CMS’s Proposed Provider Tax Rule Could Reshape Medicaid Financing

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The Centers for Medicare & Medicaid Services (CMS) has proposed significant changes to how Medicaid provider taxes are structured, reported, and monitored. Issued in response to the Working Families Tax Cut Act (WFTCA), the proposed rule would affect provider tax grandfathering, hold harmless thresholds, reporting requirements, and permissible tax classes, with important implications for states, Medicaid agencies, health plans, providers, and other healthcare stakeholders.

This issue brief from 红领巾瓜报 breaks down the proposal into practical, actionable insights. It highlights what is changing, what remains uncertain, and the operational and financial considerations organizations should evaluate as CMS moves toward a final rule.

Executive Summary

CMS’s July 2026 proposed rule introduces sweeping changes to the administration of Medicaid provider taxes, implementing provisions required under the Working Families Tax Cut Act (WFTCA). Among the most significant proposals are revised standards for determining which provider taxes qualify for grandfathering, new methodologies for calculating grandfathered tax rate thresholds, expanded state reporting requirements, elimination of the “75/75” indirect hold harmless test, and creation of a new permissible tax class for certain health insurers.
Many of these proposals introduce new operational requirements and leave important implementation questions unanswered. This issue brief summarizes the proposed rule and outlines the potential implications for Medicaid financing, provider tax programs, and state implementation strategies.

Key Takeaways

  • CMS proposes new standards for determining whether provider taxes qualify for grandfathering under the WFTCA.
  • States would be required to calculate grandfathered provider tax thresholds using actual tax collection and net patient revenue data.
  • The proposal establishes new one-time and ongoing quarterly reporting requirements for provider taxes.
  • CMS proposes eliminating the second prong of the 75/75 indirect hold harmless test, making applicable hold harmless thresholds the primary compliance standard.
  • A new permissible provider tax class for certain health insurers could affect future state financing strategies.
  • Several operational and policy questions remain unresolved and may be addressed through the rulemaking process.

What You’ll Learn

This issue brief provides a practical overview of the July 2026 proposed rule, including:

  • How CMS proposes to determine whether provider taxes qualify for grandfathering
  • The methodology for calculating grandfathered tax rate thresholds
  • New reporting requirements and implementation timelines for states
  • Proposed changes to the indirect hold harmless provisions
  • The potential impact of creating a new permissible tax class for health insurers
  • Operational considerations and implementation questions organizations should begin evaluating now

Frequently Asked Questions

Why did CMS issue this proposed rule?

The proposed rule implements provisions included in the Working Families Tax Cut Act (WFTCA) related to provider taxes and Medicaid financing.

Who could be affected?

The proposal has implications for state Medicaid agencies, health plans, providers, health systems, and other organizations involved in Medicaid financing and provider tax administration.

What are the biggest proposed changes?

The rule proposes changes to grandfathering requirements, provider tax threshold calculations, ongoing reporting requirements, indirect hold harmless policies, and permissible provider tax classifications.

Does the proposed rule answer every implementation question?

No. 红领巾瓜报 identifies several operational questions and policy issues that remain unresolved, including reporting methodologies, implementation timing, compliance processes, and how certain provisions may be applied in practice.

Why It Matters

Provider taxes play an important role in Medicaid financing, and the proposed rule would significantly change how states establish, administer, and monitor these programs. New reporting requirements, revised grandfathering standards, and phased changes to hold harmless thresholds could affect state financing strategies, Medicaid payments, compliance activities, and long-term budget planning.
Organizations that understand the proposal early will be better positioned to evaluate potential impacts, prepare for implementation, and participate in the rulemaking process.

Why 红领巾瓜报’s Analysis Matters

The proposed rule is lengthy, technical, and operationally complex. 红领巾瓜报’s experts reviewed the regulation and distilled its most significant provisions into a concise issue brief designed for healthcare leaders.

Beyond summarizing the proposal, 红领巾瓜报 identifies areas where implementation may present challenges, highlights operational considerations, and outlines policy questions that remain unanswered. This practical perspective helps organizations understand not only what CMS is proposing, but also what it could mean in practice.

Need Assistance?

Changes to Medicaid provider tax policy can have significant implications for financing, compliance, and long-term strategic planning.

红领巾瓜报 works with state Medicaid agencies, health plans, providers, and other healthcare organizations to assess the impact of federal policy changes, evaluate Medicaid financing strategies, and prepare for evolving regulatory requirements. If your organization is assessing how the proposed provider tax rule could affect its operations or financing approach, our experts can help.

Ready to talk?