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What听you missed in 2025鈥攁nd why you should join us in 2026听

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Last year鈥檚 红领巾瓜报 conference brought together healthcare leaders to confront a changing landscape across Medicare, Medicaid, and the Marketplace. The agenda reflected the issues shaping the industry in real time: public policy in motion, the future of value-based care, behavioral health innovation, digital transformation, population health, and the partnerships needed to turn strategy into results. From keynote and plenary conversations to focused workshops and collaborative small-group sessions, attendees were immersed in practical discussions about what comes next. 

Want a quick look at what made the 2025 conference so valuable?  

Those conversations matter even more now. Join 红领巾瓜报鈥檚 annual conference, US Healthcare 2026: Signals, Signs & Flashing Lights, October 5鈥�7 in New Orleans. This year鈥檚 event is designed for executives and leaders across providers, payers, government, and the organizations that enable care delivery, with a clear focus on helping attendees navigate financial pressure, performance demands, and AI-driven change. Early registration is already underway, with early-bird pricing available through August 7. 

If you look back at last year鈥檚 agenda, you can see how well it anticipated this moment. In three fast-moving days, this year鈥檚 conference will help attendees read policy and market signals earlier and translate them into decisions, manage risk and costs while protecting outcomes and access, learn what is working to sustain systems of care amid uncertainty, how to apply AI and emerging technology through real operational and clinical use cases, and build relationships through structured networking across sectors. These priorities come to life across four central themes: managing risk and costs, sustaining systems of care, AI and innovation, and partnerships and collaboration. Together, they reflect exactly what healthcare leaders need now: practical strategies for a more complex environment, clearer paths to stability, measurable approaches to innovation, and stronger models for delivery and community impact. 

The 2026 conference is not just another industry event. It is an opportunity to step away from day-to-day demands and engage with peers facing the same questions about cost, risk, performance, access, and technology adoption. Whether you lead strategy, operations, policy, clinical transformation, product development, or partnerships, you will leave with practical insights you can put to work right away. The value is not only in hearing what is next, but in understanding what to do now. 

Attendees this year can expect the same cross-sector depth that stood out last year, paired with even greater urgency. The forces affecting Medicare, Medicaid, Marketplace, and adjacent programs are not moving in isolation. Payment reform connects to access. Digital transformation connects to quality and workforce realities. Behavioral health connects to community capacity, and long-term sustainability, and governmental policy changes drive all of the above. The organizations that succeed will be the ones that can see these connections early and act on them thoughtfully. 

Last year鈥檚 conference showed the value of bringing more than 350 policymakers, providers, payers, advisors, innovators, and community leaders into the same conversation. This year offers the chance to continue that conversation at exactly the right time. If you want insight that is strategic, grounded, and immediately relevant to the decisions in front of you, come join us in New Orleans this October. 

 to take advantage of Early Bird pricing, which ends August 7. 

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Michigan Health Policy Conference 2026: Medicaid, OBBBA, and State Budget Impacts

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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,  (SOR), an 红领巾瓜报 Company, hosted its annual , 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鈥檚 budget outlook, and the Rural Health Transformation Program (RHTP). 

Michigan DHHS鈥檚 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鈥檚 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鈥檚 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鈥攊ncluding Danielle Devine, Market President at McLaren Health Plan, and Jen Flood, Budget Director for the State of Michigan鈥攈ighlighted how OBBBA is already reshaping Michigan鈥檚 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鈥檚 $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鈥檚 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  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, 红领巾瓜报 experts are available to help navigate these complex changes and identify practical paths forward. 

红领巾瓜报 (红领巾瓜报),  brings together state leaders, providers, plans, and community organizations to surface real-world strategies for navigating federal change. Join us in  on May 21, 2026, or visit the  to view the full conference schedule and register for an upcoming event. 

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 organizers, providers, payers, and more. 

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National Collaborative Launched to Strengthen US Behavioral Health Crisis System

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National Alliance on Mental Illness (NAMI) and 红领巾瓜报 (红领巾瓜报) 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 红领巾瓜报 (红领巾瓜报) 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听
  • Limited access to community-based behavioral health听services听
  • Fragmentation across crisis responses systems听
  • Overreliance on emergency departments and law enforcement听

Experts increasingly agree that 988 is only one component of a comprehensive crisis system. Effective systems must also include: 

  • Mobile crisis response teams听
  • Crisis stabilization facilities听
  • Ongoing care coordination and follow-up services听

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听hub for coordination, learning, and action听
  • Bring together public and private stakeholders听across sectors听
  • Support听states and communities in building coordinated, person-centered crisis response systems听
  • Advance innovation and shared solutions to improve outcomes听

The launch of this collaborative also reflects a broader shift in national focus鈥攆rom 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听
  • Access emerging policy and implementation insights听
  • Align local strategies with national priorities in crisis care听

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 红领巾瓜报 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 . 

For more information on 红领巾瓜报鈥檚 work in Crisis services, contact鈥�Monica Johnson, Managing Director, 红领巾瓜报. 

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Special Alert: CMS Proposes Major Medicaid Payment Reform to Cap State-Directed Payments and Align Rates with Medicare

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On May 20, the Centers for Medicare and Medicaid Services (CMS)听听a proposed rule aimed at curbing state Medicaid payment practices that federal regulators 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,听CMS听projects the听rule will听result听in听significant听federal听savings over time and听will听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.听红领巾瓜报听(红领巾瓜报)听experts are听continuing to听review听the proposed Medicaid payment reform听and will provide听additional听analysis in听future听newsletters and communications to听interest-holders.听听

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Turning Insight into Action: The New Operating Reality in Behavioral Health

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Thousands of behavioral health leaders, clinicians, advocates, and industry partners convened during NatCon 2026, April 27鈥�29 in Denver, CO鈥攐ne of the sector鈥檚 largest annual gatherings. This year, the event was more focused and pragmatic than in recent years. Although behavioral health providers still face significant pressure, there was also a noticeable shift toward how organizations can move toward sustainable models for growth, technology adoption, and integrated care delivery.

红领巾瓜报 (红领巾瓜报) colleagues attended the event to listen, connect, and contribute to the meaningful conversations. Many of the themes and industry trends we have been tracking emerged consistently throughout the conference. In this article, our behavioral health experts discuss their collective insights and the road ahead for behavioral health interest-holders.

Key Themes from听NatCon听2026听

Financial resilience听remained at the forefront.

Behavioral health organizations continue to respond to constrained funding conditions, evolving reimbursement dynamics, and the need to diversify revenue beyond unstable and uncertain grant support and rate reimbursement volatility.

Operational visibility was closely tied听to听financial resilience.

Leaders discussed the need for a clearer, more real-time understanding of their performance. Performance was considered broadly to include financial indicators, clinical outcomes, and workforce capacity. Data and measurement have moved from a 鈥渘ice to have鈥� to 鈥渆ssential鈥� for effective engagement with payers.

Innovation听conversations are shifting toward听implementation.

Artificial intelligence (AI) and digital tools were still hot topics, but the discussion has moved toward implementation and effective deployment. Conversations centered on practical use cases such as clinical documentation support, measurement-based care linked to improved health outcomes, and better integration with electronic health records (EHR).

This year鈥檚 conference highlighted enduring opportunities and challenges for the field, including:

  • Core service priorities,听such as听crisis response,听suicide prevention, collaborative care听and听increased opportunities around听Certified Community Behavioral Health Clinics听(CCHBCs), and value-based payment strategies听for financial resilience听
  • Workforce sustainability, with organizations looking听to reduce administrative burden, strengthen recruitment and retention, and support staff well-being while demand for services continues to rise

Behavioral Health Industry Trends

The industry trends emerging from NatCon 2026 suggest that behavioral health organizations are entering a more disciplined operating environment to maximize efficiencies and ensure long-term sustainability in what seems sometimes to be a chaotic environment. Organizations are placing greater emphasis on their Medicaid strategy, managed care contracting, and value-based arrangements that reward outcomes and continuity of care. There is also continued momentum behind integrated models that connect behavioral health with primary care, public health, and community-based supports. Rather than treating mental health and substance use services as isolated programs, providers are increasingly building coordinated systems that address whole-person needs across settings.

Another notable trend is that technology is becoming a clearer differentiator. Some organizations are piloting or scaling technology, while others are taking a more cautious approach. Discussions surrounding AI in particular appeared to have matured significantly, with attention moving from abstract concerns toward change management, sequencing of use cases, return on investment, governance, and clinician trust. In that sense, technology is moving from being a side initiative to a strategic differentiator.

Transformation in the Behavioral Health Field

We were struck by the level of alignment across different parts of the field. Many of the themes we heard reinforced what providers experience daily鈥攖he need to manage uncertainty while continuing to meet the growing demand for services and more intentional use of data, infrastructure, and outcomes measurement.

More broadly, the conversations throughout the conference pointed to a field that is moving toward greater pragmatism. There is still a clear need for additional resources, but there is also growing recognition that adaptability will serve an equally important role.

贬辞飞听奥别听颁补苍听贬别濒辫

One of the most valuable aspects of NatCon is the opportunity to compare experiences across organizations and regions. The themes emerging from this year’s conference reflect broader shifts happening across the behavioral health landscape. 

A key role of our team is to connect what we hear in different settings and share it in a way that is useful for others in the field鈥攈ighlighting emerging approaches, surfacing common challenges, and creating opportunities for peer exchange.

For questions about the market dynamics or approaches to strengthen your organization鈥檚 adaptability,  contact one of our 红领巾瓜报 experts.

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Why Children鈥檚 Behavioral Health Demands Action Now

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Practical Strategies for Medicaid, Schools, Hospitals, and Communities

During Children鈥檚 Mental Health Awareness Week, May 3鈥�9, and Mental Health Awareness Month, we are spotlighting actionable solutions across the US children鈥檚 behavioral health system. This post is intended for children鈥檚 behavioral health providers, state Medicaid agencies, school-based health centers, hospitals, local government agencies, local education agencies (LEAs), child welfare agencies, and philanthropic organizations that are working to strengthen prevention, crisis response, care coordination, and community-based continuums of care. 红领巾瓜报 has a robust and growing team of behavioral health experts who support this work and have developed a series of case studies showcasing practical strategies implemented with clients鈥攆rom crisis system design and referral pathway improvements to financing and implementation roadmaps.

Children鈥檚 Mental Health Awareness Week is a reminder that children鈥檚 behavioral health and youth mental health are not niche issues. They are systemic issues that require coordinated action across Medicaid, education, public health, hospitals and health systems, child welfare, and local government鈥攅specially where schools and community partners are on the front line.

The need remains substantial. The Centers for Disease Control and Prevention鈥檚 results, released in 2024, showed that 40% of high school students reported persistent feelings of sadness or hopelessness, even as some measures improved from 2021 levels. CDC also highlighted how bullying, safety concerns at school, racism, unfair discipline, and frequent social media use are tied to youth mental health risks.

The Substance Abuse and Mental Health Services Administration鈥檚 (SAMHSA鈥檚) , released in 2025, adds another important dimension. Among adolescents ages 12鈥�17, the 2024 survey found that:

  • 15.4% experienced a major depressive episode within the past year
  • 10.1% had serious thoughts of suicide
  • About 40% who had a major depressive episode in the past year did not receive mental health treatment

The data show that progress is possible when systems respond with real capacity, access, and support. That is why this moment calls for more than awareness. It calls for action that is operational, financeable, and grounded in what works.

At 红领巾瓜报, we work with child-serving systems that are trying to solve real problems, including how to strengthen crisis response, improve referral pathways, build a more coherent continuum of care, and connect strategy with implementation.

Over the coming weeks, we will feature three examples that reflect different parts of the children鈥檚 behavioral health landscape.

1. Children鈥檚 hospital mental health strategy and crisis response

This case study will highlight work to help a children鈥檚 hospital strengthen its mental health approach and support next-stage crisis system design.

In this engagement, 红领巾瓜报 partnered with Rady Children鈥檚 Hospital Orange County to move pediatric behavioral health from strategy to implementation鈥攁ligning emergency department (ED) mental health workflows, clarifying pediatric crisis pathways, building an investment-ready fiscal pro forma, and advancing priority programs to strengthen access and care coordination. This work can inform hospitals and health systems, Medicaid agencies, and community partners seeking to reduce ED boarding and improve pediatric crisis response.

2. County-level ecosystem and referral system improvement

This case study will show how local systems can bring multiple stakeholders together to improve referral pathways and make behavioral health more accessible for children, youth, and families.

红领巾瓜报 supported a county-led effort to strengthen cross-system referral pathways by aligning agencies around shared intake and triage practices, clearer roles and accountability, and more navigable access points for families. This approach is relevant for local government agencies, LEAs, school-based health centers, child welfare agencies, and community providers working to reduce fragmentation and speed connection to the right level of care.

3. Building a stronger children鈥檚 behavioral health continuum in New Orleans

This case study will focus on assessing gaps, identifying opportunities, and supporting a more coherent community-based continuum for children鈥檚 behavioral health.

红领巾瓜报 helped deliver the first integrated view of pediatric behavioral health in New Orleans, LA, aligning schools, healthcare, philanthropy, and government around a shared understanding of unmet needs and critical system gaps, as well as charting a prioritized roadmap to strengthen and better coordinate the continuum of care.

What It Means for Key Child-Serving Audiences

  • Children鈥檚 behavioral health providers: Prepare for stronger care coordination expectations (warm handoffs, follow-up after crisis, shared care plans) and increased demand for community-based alternatives to the ED
  • State Medicaid agencies: Focus on financeable crisis continuums (including pediatric crisis response), payment and contracting approaches that support access and continuity, and data/reporting that demonstrates outcomes
  • School-based health centers and LEAs: Strengthen referral pathways, clarify roles between schools and providers, and build protocols that support early identification while keeping students connected to safe learning environments
  • Hospitals and health systems: Improve pediatric ED mental health workflows, create clearer crisis pathways, and develop investment-ready business cases for behavioral health capacity and partnerships
  • Local government agencies: Convene cross-system partners, establish shared intake/triage and accountability, and use implementation roadmaps to move from planning to operational change
  • Child welfare agencies: Align behavioral health access for children and youth involved with child welfare, reduce handoff failures, and integrate crisis planning into placement stability and permanency strategies
  • Philanthropy: Target catalytic investments that fill continuum gaps, build capacity for implementation (not just planning), and support cross-system governance and measurement

The common thread among these examples is a simple belief: Children鈥檚 behavioral health improvement does not happen through aspiration alone. It happens when organizations and public systems translate urgency into design, partnerships, financing strategies, and implementation steps.

That is also why children鈥檚 behavioral health is so relevant. National data still point to high levels of distress and suicide risk among adolescents, despite recent improvements. CDC鈥檚 findings show how strongly youth mental health is shaped by the environments in which they live, learn, and play鈥攅specially their schools and communities.

For leaders in Medicaid, behavioral health, child welfare, education, county government, hospitals, and provider organizations, the question is not whether children鈥檚 behavioral health deserves attention, but rather is how to build systems that respond earlier, coordinate better, and support children and families more effectively.

We hope this series contributes to that conversation by sharing practical examples of work that can inform future action.

Other Resources on Children鈥檚 Behavioral Health and Youth Mental Health

Contact us to discuss how 红领巾瓜报 can support your children鈥檚 behavioral health strategy鈥攚hether you work for a Medicaid agency, hospital/health system, school-based health partner, LEA, local government agency, child welfare agency, provider organization, or philanthropic funder. We can help with crisis continuum planning, care coordination design, referral pathway improvement, financing and pro forma development, and implementation support.

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Join us at 红领巾瓜报鈥檚 2026 National Conference: Signals, Signs & Flashing Lights

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Registration is now open for the 红领巾瓜报 (红领巾瓜报) 2026 National Conference, , October 5鈥�7 in New Orleans, LA. 

 is intentionally structured to bring together leaders who are shaping decisions across sectors鈥攖hose setting policy, managing risk, leading clinical operations, and innovating approaches to improve outcomes鈥攖o engage in candid conversations about what is working, what is not, and what is changing in  and adjacent programs. In an environment defined by new challenges and 鈥渇lashing lights,鈥� even the most seasoned healthcare leaders will find value in stepping out of their day鈥憈o鈥慸ay roles to compare strategies, test assumptions, and learn from peers facing similar pressures. 

This year鈥檚 conference is designed to reflect the environment healthcare leaders are navigating today鈥攐ne defined less by policy certainty and more by shifting expectations and competing pressures on cost, access, and performance. Our experts are crafting discussions to address how organizations are approaching policy engagement in this environment, including new strategies for interpreting signals from federal and state policymakers and negotiating policy frameworks that directly shape market dynamics. 

Across plenary sessions, breakout discussions, and 红领巾瓜报鈥檚 signature coffee conversations, the conference will focus on how organizations are interpreting these signals and translating them into practical strategies. 

Programming will center on four cross-cutting themes shaping healthcare decision-making: 

  • Managing听risk and cost amid continued financial pressure. Discussions will examine听the drivers of听utilization听and affordability trends across Medicare, Medicaid, and commercial markets and which听strategies are听demonstrating听measurable impact.听
  • Sustaining access and system stability. The agenda also will focus on how providers, health systems, and state programs are maintaining access amid workforce challenges, coverage transitions, and ongoing financial strain.
  • Turning innovation into impact.听Sessions will explore where artificial intelligence听(AI)听and digital health tools are delivering measurable operational or clinical impact听and听what it takes to implement them effectively.听
  • Building partnerships听that last.听Conversation听will highlight how stakeholders are听aligning incentives,听funding,听and strategy to move from short-term听responses to long-term, sustainable听solutions.听

As in prior years, the 红领巾瓜报 National Conference is structured to support candid dialogue, actionable takeaways, and meaningful connections. Attendees consistently highlight the opportunity to move beyond high-level trends and engage in practical discussions that inform decision-making in their organizations. 

 is now available for a limited time. The  includes new opportunities for your organization. Additional agenda details, featured speakers, and interactive programming announcements will be released in the coming weeks. 

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Outlook 2026: A Conversation on Medicare Draft Payment Rules

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As the Centers for Medicare & Medicaid Services (CMS)听advances through the 2027 Medicare payment rule cycle, stakeholders across Medicare Advantage (MA) and the provider community are assessing how proposed changes could affect payment, utilization, and longer-term revenue. To better understand what to watch as draft rules move toward finalization,听Jen Colamonico, Vice President, Strategy and Communications at 红领巾瓜报 (红领巾瓜报), caught up with Senior Consulting Actuary with Wakley, an 红领巾瓜报 Company. Of particular interest was CMS鈥檚 decision to eliminate the Inpatient Only List (IPO) over a three- year period.

Q: As CMS begins releasing draft payment rules for 2027, what stands out most to you from a budgetary perspective?
Rachel: Timing and uncertainty really stand out. These policies don鈥檛 operate in isolation. Changes to Medicare fee-for-service (FFS) payment ultimately affect Medicare Advantage benchmarks, provider contracting, and long-term revenue expectations. Because bids, budgets, and contracts are set before rules are finalized, modeling different scenarios becomes essential. 

Q: One issue that has garnered significant interest is CMS鈥檚 decision to phase out Medicare鈥檚 Inpatient Only (IPO) policy, which is a list of procedures and services that must be provided on an inpatient basis. In 2026, CMS eliminated nearly 300 services, mostly musculoskeletal services, from the IPO list. How are Medicare Advantage plans thinking about the Inpatient Only list specifically? 

Rachel: Historically, many MA plans have followed the IPO policy even though they weren鈥檛 required to do so, largely because it simplified operations and aligned with Medicare fee-for-service payment systems. Plans do have flexibility in how they contract with providers, and we see a wide range of approaches in the market. Some contracts closely mirror FFS, while others incorporate more customized arrangements or risk sharing. Because of that, the direct impact of IPO changes will vary significantly across plans and provider relationships. 

Q: Where do you see the biggest potential impact for Medicare Advantage?
Rachel: I think the bigger impact may be indirect rather than tied to individual contract changes. Medicare Advantage benchmarks are driven by underlying fee-for-service spending trends. If CMS anticipates lower overall inpatient spending as procedures move to outpatient or ambulatory surgical center settings, that expectation could show up in benchmark growth rates. Even relatively small changes in benchmark growth can affect plan revenue, rebates, and benefit flexibility. 

Q: Are you already seeing signs of that in the data?
Rachel: We do see lower inpatient trends reflected in the 2027 and 2028 US per capita cost projections. It鈥檚 still unclear what鈥檚 driving those trends鈥攚hether its assumptions related to the IPO list removal or other factors. We鈥檝e asked CMS for more clarity. From an actuarial standpoint, understanding what鈥檚 baked into those projections is critical, because so many MA financial decisions flow from them. 

Q: How does this uncertainty affect provider planning, especially for hospitals?
Rachel: Providers are understandably concerned about potential revenue shifts if cases move out of the inpatient setting. But in Medicare Advantage, the picture is more nuanced than in fee-for-service. Many MA arrangements include risk sharing, medical loss ratio targets, and quality incentive payments. If overall costs decline, providers may share in savings through those mechanisms. So, while there may be pressure on inpatient revenue, it鈥檚 not necessarily a one directional loss. 

Q: Does that mean the overall impact may be less dramatic than it appears?
Rachel: Potentially, yes鈥攅specially for organizations already participating in value-based arrangements. A reduction in unit costs doesn’t automatically mean a reduction in total provider revenue in MA. The redistribution of dollars through shared savings and quality bonuses can offset some of that pressure. That鈥檚 why understanding contract structure is just as important as understanding the policy itself. 

Q: What about quality and patient safety as procedures move to lower cost settings?
Rachel: Quality is always central in Medicare Advantage, and plans are already managing a lot of complexity related to Star ratings and quality measurement. We haven鈥檛 yet seen specific quality safeguards tied to the IPO list changes, but I would expect more discussion in the forthcoming proposed rules. From the MA side, contracting remains a key lever. Plans still have flexibility to ensure procedures are performed in appropriate settings and to align incentives with quality outcomes. 

Q: What steps do you recommend to stakeholders to prepare for the final rule and for 2027?
Rachel: Modeling helps organizations understand the range of possible outcomes rather than betting on a single assumption. We鈥檙e looking at different utilization scenarios, site of care shifts, and benchmark growth trajectories. For providers, modeling can inform contract negotiations and capital planning. For plans, it helps assess revenue risk and benefit design flexibility. It doesn鈥檛 eliminate uncertainty, but it helps organizations make informed decisions. 

Q: If you could change one thing about how these policies are rolled out, what would it be?
Rachel: Transparency. The more clarity CMS can provide around cost projections and assumptions鈥攅specially those affecting benchmarks鈥攖he better positioned actuaries, plans, and providers will be to respond. So much of Medicare Advantage pricing relies on understanding how fee-for-service is expected to evolve. Greater transparency helps everyone plan more responsibly. 

红领巾瓜报鈥檚 Medicare Practice Group Can Help 

As CMS moves closer to finalizing the 2027 payment rules, actuarial modeling will continue to be an important tool for translating policy direction into financial strategy. For MA plans and providers alike, early analysis and scenario planning can help mitigate risk and identify opportunity as Medicare鈥檚 payment landscape continues to evolve. 

For additional insights, listen to Rachel Stewart and Zach Gaumer on 红领巾瓜报鈥檚 Vital Viewpoints podcast. Learn more about our Medicare services and solutions. 

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Early Signals from a Pivotal ACA Enrollment Year

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On April 15, 2026, Wakely Consulting Group, an 红领巾瓜报 company, published 鈥�,鈥� the first comprehensive nationwide look at 2026 enrollment trends in the Affordable Care Act (ACA) market. While the Centers for Medicare & Medicaid Services (CMS) has released 2026 plan selection , the Wakely report addresses who retained coverage and who did not, what we still don鈥檛 know, and what we should be watching for throughout the rest of the 2026 plan year.

This article highlights key findings in the report, related state-level data, impacts and takeaways, and actions states and other interest-holders should consider as they look to mitigate further coverage losses and address market stability in& plan year 2027 and beyond.

Key Findings from the ACA Marketplace Early Enrollment Trends Report 

The report is based on analysis of data from the Wakely National Risk Adjustment Reporting (WNRAR) project, which includes summary data from participating ACA-compliant individual market plans. WNRAR includes data from over 75 issuers representing nearly 80 percent of enrollment the individual market. Key national findings in the report include:

  • Only 86% of enrollees paid their January 2026 premium.听
  • State variation is significant, ranging from as low as鈥�63%鈥痯aid鈥痠n January to as high as鈥�99%.听
  • The overall听average听enrollment鈥痙ecrease鈥痠s鈥痚stimated听to be between听17% and听26%鈥痩ower than 2025,听with morbidity projected to worsen听by听2.9鈥�6.5%.听

The report highlights shifts in plan choice activity driven by affordability pressures, which resulted in considerable migration away from richer benefit plans to plans with lower premiums and higher out-of-pocket maximums. Examples include:

  • Silver plan enrollment fell听approximately听17% from 2025.听
  • Bronze enrollment increased by more than 10%.听
  • More than听13% of听2025听Gold plan enrollees听selected a lower听priced,听Bronze听tier plan听in 2026.听

The report also demonstrated the importance and value of outreach, operational excellence, and state-level affordability mitigation strategies. Examples include: 

  • Enrollment decreases are lower in听states with听state-based marketplaces听(SBMs)听and expected to stay lower than Healthcare.gov states, largely听because of听proactive outreach and marketing initiatives,听lower net premium increases,听and state听affordability听programs.听
  • States with premium alignment and silver-loading as a policy lever for improving gold plan affordability are seeing results. Gold plan enrollment increased by 10 percentage points in states where gold plans cost less than silver plans, whereas gold enrollment did not materially change in states where silver plans cost less. For states, this provides a lever to assist consumers seeking to shift into plans with lower cost-sharing without increasing premiums.

State-Reported Early Enrollment Results 

Many states warned of coverage losses as a result of changing federal policies and the expiration of enhanced premium tax credits (ePTCs). State-specific reporting for 2026 validates the findings in the Wakely report. The recently released state-level data from SBMs affirms that the drop-off in enrollment through cancellations and dis-enrollments is significant. It also illustrates that state efforts to mitigate and address affordability gaps have worked to some extent but have not been enough on their own to head off coverage losses in 2026. Examples are as follows: 

  • In听骋别辞谤驳颈补鈥攖he听only SBM without Medicaid expansion鈥攅nrollment听听27% from an estimated听1.3听million in听April听2025 to approximately听950,000听in听April 2026.听
  • 滨苍听狈别飞听闯别谤蝉别测鈥攁听state听with state-funded premium subsidies,听a reinsurance program, and a mandate听that听residents have health听insurance鈥攅nrollment has听听by more than 11%听since听April 2025.听
  • 滨苍听California鈥攁nother state with premium subsidies,听facilitated听enrollment,听and an individual mandate鈥攅ffectuated听enrollment听听by 7%听from February 2025 to February 2026.听
  • Overall, SBMs are听听that coverage drops听were听24% higher from January to March 2026 than听during听the same period in 2025 and that听the rate of plan shifting from Silver to Bronze听increased听significantly,听quadrupling听in six states.听

Downstream Impact on Healthcare Access and Uncompensated Care 

While not yet apparent in the early enrollment data, the downstream impact of 1) coverage losses, 2) increased enrollment in plans with higher cost-sharing, and 3) a worsening risk pool on the health of consumers, as well as the healthcare system, will be significant. Consumers may decide to postpone or forgo necessary care, which could lead to avoidable and more costly healthcare conditions. Increases in the number of people who uninsured and underinsured will have a direct and negative economic impact on provider finances, which are already strained, and uncompensated care and demands on patient assistance programs will increase accordingly. 

Looking Ahead 

The individual market will continue to evolve and change in the coming years as a result of future regulatory and operational changes. A shortened Open Enrollment Period, increased Medicaid redetermination requirements, and new pre-enrollment verification requirements are notable initiatives that are expected to roll out in the coming years.

Healthcare organizations and government agencies should consider the effect of these changes, including further coverage losses and instability in the individual market driven by the administrative complexity of these changes.

In addition, there are potential federal changes such as expanded availability of catastrophic plans, the introduction of non-network plans, and additional eligibility changes, which could put further strain on ACA Marketplace operations and the individual market.

Getting ahead of these changes will be critical to mitigating coverage losses and ensuring the long-term stability and viability of the individual market. In a federal policy environment that has largely deferred acting on ACA affordability, we expect policymakers, issuers, and other interest-holders to increasingly look to governors and state legislatures for decisive action. State subsidy and reinsurance programs are established affordability mechanisms that can provide consumers with affordability relief quickly, assuming state funding is available.

These investments can pay off for consumers from an economic perspective as well. For every additional dollar spent on state subsidies or reinsurance to maintain or increase coverage, states can expect to see reductions in uncompensated care, less reliance on patient assistance programs, and decreases in the number of consumers who forgo or delay care. In addition, investments in enrollment operations and assistance, outreach, and education will be critical to ensuring consumers are aware of the changes ahead and the actions they need to take to access and stay covered.

Connect with Us 

红领巾瓜报, Inc. (红领巾瓜报), and Wakely colleagues are closely tracking federal policy activity and state actions to address these challenges. Our experts support states, issuers, consumer groups, and other interest-holders to achieve success in the operation of and participation in the marketplaces. Our team has broad historical knowledge of the challenges and opportunities in this market and can support every step of the planning and execution processes to improve affordability and stability as it evolves in the coming months and years. 

Contact听our experts below with questions about the report and听to discuss opportunities to address the trends and forthcoming changes in the market.听

To read more about the changes ahead, see the following reports: 

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CMS Proposes Modest Hospital Payment Updates and Signals Expanded Use of Mandatory Value-Based Models

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On April 10, 2026, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the . The proposal combines a modest net increase in hospital payments with policy signals around quality reporting and mandatory episode-based payment models鈥攎ost notably a proposed nationwide expansion of the Comprehensive Care for Joint Replacement (CJR) model. 

These proposed updates underscore CMS鈥檚 continued emphasis on value-based purchasing, episode accountability, and alignment across quality programs. In addition, CMS resurfaces ongoing debates with hospital stakeholders about the adequacy of Medicare payment updates amid rising costs and coverage disruptions. 

This article reviews several key provisions in the FY 2027 proposed rule. 

Hospital Payment Updates: Headline Increase Masks Net Impact 

Under the proposed rule, CMS would increase base IPPS and LTCH PPS payment rates by 2.4 percent in FY 2027. However, after accounting for proposed reductions to uncompensated care payments for disproportionate share hospitals (DSH) and changes in outlier payments for extraordinarily high-cost cases, CMS estimates the effective payment increase would be closer to 1.2 percent. 

In aggregate, CMS projects the proposed update would translate to approximately $1.4 billion in additional payments to acute care hospitals next year. Hospital industry groups鈥攊ncluding the American Hospital Association (AHA) and the Federation of American Hospitals (FAH)鈥攈ave pushed back, arguing that the proposed update does not sufficiently reflect medical inflation, workforce pressures, or anticipated growth in the uninsured population. 

These concerns reflect a long-standing dynamic in annual hospital payment rules: CMS seeking to balance statutory updates and budget neutrality constraints against the hospital industry鈥檚 concern that Medicare payments are lagging behind underlying costs. 

Quality Reporting and Program Alignment 

The proposed rule would also make notable updates to the Hospital Inpatient Quality Reporting (IQR) Program. CMS proposes adding three new quality measures to be phased in during 2029 and 2030, while modifying eight existing measures to include Medicare Advantage patients. CMS also proposes shortening the performance period for certain measures from three years to two鈥攁 change designed to accelerate feedback and better align measures across programs. 

These changes continue CMS鈥檚 broader effort to harmonize quality measurement across Medicare payment and value-based programs, reduce reporting lag, and incorporate a more comprehensive view of patient populations. 

Updates to Mandatory TEAM Model 

CMS also proposes several updates to the Transforming Episode Accountability Model (TEAM), the mandatory episode-based payment model finalized last year. Key proposals include: 

  • Expanding the list of听MS-DRGs听included in the spinal fusion episode听
  • Aligning TEAM quality measurement performance periods with the IQR Program听
  • Making targeted technical refinements to payment听methodology听

In addition, CMS is seeking stakeholder feedback on whether ambulatory surgery centers (ASCs) should participate in TEAM and whether participation should be voluntary for physician-owned hospitals, signaling potential future expansion or recalibration of the model. 

Proposed Expansion of Joint Replacement Bundles 

CMS proposes to expand the existing Comprehensive Care for Joint Replacement Expanded (CJR-X) Model nationwide beginning October 1, 2027. The agency also plans to make participation mandatory for most IPPS hospitals. 

CMS tested the original CJR model in 34 metropolitan areas between 2016 and 2024, generating improved patient outcomes and net Medicare savings, according to agency evaluations. CJR-X would become the fifth Center for Medicare and Medicaid Innovation model to meet the statutory criteria for nationwide expansion. 

Under CJR-X, hospitals performing lower extremity joint replacements would be accountable for the cost and quality of care for the initial procedure and most related spending during the subsequent 90 days. Although the overall structure mirrors the original CJR model, CMS proposes several important updates: 

  • Expansion of episodes to include ankle replacements, in addition to hip and knee procedures听
  • Adoption of a more robust risk adjustment听methodology听with significantly more variables, aligning closely with the TEAM model听
  • Introduction of a 5 percent stop-loss policy for hospitals听that听serve听higher proportions of dually eligible beneficiaries and certain smaller hospitals听

Participation would be mandatory for most IPPS hospitals, with exceptions for hospitals already participating in TEAM, which includes a lower extremity joint replacement episode; Maryland hospitals operating under global budgets; and hospitals not paid under both IPPS and the Outpatient Prospective Payment System, such as Critical Access Hospitals. 

Why It Matters 

The 2027 IPPS and LTCH PPS proposed rule reinforces several clear policy signals: 

  • Pressure on hospital margins is likely to persist, as payment updates continue to trail hospital-reported cost growth.听
  • Mandatory episode-based models听remain听central to CMS鈥檚听value-based strategy, with CJR-X听representing听a significant escalation in scope and scale.听
  • Program alignment and MA inclusion are accelerating, with implications for hospital data systems, care coordination strategies, and reporting infrastructure.听

Hospitals and health systems will need to assess not only the near-term financial impact of the proposed payment updates, but also their readiness to accept expanded episode accountability and meet evolving quality measurement requirements. 

Comments on the proposed rule will shape final decisions regarding payment levels, quality program changes, and the scope of mandatory participation in CJR-X. Stakeholders will be watching closely to see whether CMS moderates its approach to mandatory models or doubles down on episode-based accountability as a cornerstone of Medicare payment reform. 

In parallel, CMS has released several other proposed payment rules this month, including those that would affect skilled nursing facilities, hospice providers, inpatient rehabilitation facilities, and inpatient psychiatric facilities. For these entities, CMS generally proposes payment updates of approximately 2.4 percent and 2.3 percent for inpatient psychiatric facilities. As part of its broader program integrity focus, CMS also has proposed new transparency measures for hospice providers; this follows recent enforcement actions related to fraudulent enrollment. 

Connect with Us 

红领巾瓜报, Inc. (红领巾瓜报), monitors federal regulatory and legislative developments in the inpatient setting and assesses the impact on hospitals, life science companies, and other stakeholders. Our experts interpret and model hospital payment policies and assist clients in developing CMS comment letters and long-term strategic plans. Our team replicates CMS payment methodologies and model alternative policies using the most recent Medicare fee-for-service and Medicare Advantage (100%) claims data. We also support clients with DRG reassignment requests, New Technology Add-on Payment (NTAP) applications, and analyses of Innovation Center alternative payment models. 

For more information about the proposed policies, contact one of our Medicare experts. 

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Medicaid Managed Care Enrollment: Q4 2025 Trends and Early Signals Ahead of New Eligibility Policies

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This week 红领巾瓜报 (红领巾瓜报), draws on its database of monthly Medicaid managed care enrollment to present its latest quarterly analysis, offering a snapshot of enrollment trends across 37 states. 

The analysis comes at a critical time. As states prepare for Medicaid eligibility policy changes that take effect in 2027鈥攊ncluding more frequent eligibility determinations and expanded work and community engagement requirements鈥攃urrent enrollment trends provide an early signal of how policy decisions and administrative practices are already influencing coverage levels. 

The 红领巾瓜报 Information Services (红领巾瓜报IS) analysis shows that Medicaid managed care accounted for 85.6 percent of total Medicaid enrollment in December 2025. This analysis, available to 红领巾瓜报IS subscribers, uses data from nearly 300 health plans in 41 states.鈥疶he report provides by-plan enrollment plus corporate ownership, program inclusion, and for-profit versus not-for-profit status, with breakout tabs for publicly traded plans. 

Key Insights from Q4 2025 Data 

The 37 states included in this review have released monthly Medicaid managed care enrollment data through public websites or in response to a public records request from 红领巾瓜报. The report includes the most recent data obtained and illustrates the effect of state-level choices around eligibility and administration. Key findings include: 

  • As of听December听2025,听Medicaid managed care enrollment across the 37 states declined by听2.2 million members听year over year, falling to 62.5 million鈥攁听3.4 percent decrease.听
  • Of the 37 states,听eight鈥擟olorado, Delaware, Mississippi, Missouri, New Jersey, North Carolina, North Dakota, and Oregon鈥攄id听not听experience year-over-year听managed care enrollment听declines,听and听instead showed听flat enrollment or modest gains.听With the exception of Mississippi, these听are听all听Medicaid expansion states.听
  • Arizona听and Indiana听experienced听double-digit听percentage听declines. Notably,听Indiana began requiring听enrollees听to actively respond to renewal mailers,听which aligns with听enrollment declines that began in March 2025.听
  • Among the听expansion states in the analysis,听enrollment听declined听by听1.7听million (-3.3%) to听50.8听million.听The听seven non-expansion states听experienced听a听similar听decline (-3.6%),听bringing听enrollment to听11.7听million enrollees.听

Data Considerations. The data have some important limitations. States report enrollment figures at different points during the month, with some data reflecting beginning of the month totals and others capturing end of the month enrollment. In addition, some state datasets encompass all Medicaid programs offering managed care plans, whereas others reflect only a subset of the managed Medicaid population. As a result, the findings should be viewed as indicative of broader trends rather than a comprehensive state-by-state comparison.鈥�&苍产蝉辫;

Market Share and Plan Dynamics 

Using our data repository for 300 health plans across 41 states, 红领巾瓜报IS analyzes corporate ownership, program participation, and tax status among Medicaid managed care plans. As of December 2025, Centene maintained the largest share of the national Medicaid managed care market at 17.8 percent, followed by Elevance (10.4%), United (8.5%), and Molina (6.0%) (see Figure 1).鈥疶hese figures highlight continued concentration among large national plans, even as overall enrollment declines. 

Figure 1. National Medicaid Managed Care Market Share by Number of Beneficiaries for a Sample of Publicly Traded Plans, December 2025鈥� 

What to Watch鈥� 

Enrollment trends observed in the fourth quarter (Q4) of 2025 and continuing into 2026 indicate increasing state attention to eligibility policy and program integrity. State legislative activity, budget pressures, and federal regulatory developments are prompting many states to assess and strengthen certain aspects of their programs related to eligibility, particularly as they prepare to implement redetermination and work and community engagement requirements. 

Several states are already moving toward implementation. Nebraska is scheduled to launch Medicaid work requirements on May 1,听2026,听while Montana plans to begin implementation on July 1, 2026. With听additional听federal guidance still听emerging, most other states are working toward compliance ahead of January 2027 deadlines.听滨苍听expansion听states,听policymakers听retain听authority to tighten administrative processes, alter optional benefits, or adjust provider payment levels鈥攁ctions that听may听materially affect enrollment.听

These developments underscore why Medicaid managed care enrollment trends deserve close attention. Declines in enrollment are often an early indicator of broader system impacts, including rising uncompensated care for providers, shifts in payer mix, and increased financial pressure on safety鈥憂et systems. For managed care organizations, even modest enrollment changes can mask more significant shifts in risk profiles, geographic concentration, or service needs. 

Connect with Us鈥� 

红领巾瓜报 is home to experts who know the Medicaid managed care landscape听and how it is evolving. 红领巾瓜报IS鈥檚听Medicaid听enrollment data, financials,听procurement听tracking, and a robust library of public documents鈥痚quips stakeholders with听timely, actionable intelligence.听

For more information about the 红领巾瓜报IS subscription, contact鈥�Andrea Maresca鈥痑苍诲鈥�Alona Nenko.鈥�&苍产蝉辫;

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红领巾瓜报 Resource Provides Key Insights about the Evolving Medicare-Medicaid Integration Landscape

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People who are dually eligible for Medicare and Medicaid remain a central focus for policymakers and healthcare organizations, given their complex care needs, disproportionate share of spending, and the long-standing challenge of coordinating coverage across two programs. One of the primary vehicles for advancing integration has been Dual Eligible Special Needs Plans (D-SNPs), which continue to play an increasingly prominent role as federal and state policymakers encourage tighter Medicare-Medicaid alignment.

As states play a more active role in shaping enrollment rules, Medicaid contracting, and procurement strategies, the duals market is becoming more structured and more explicitly guided by state policy decisions. 红领巾瓜报 (红领巾瓜报鈥檚) 2026 Duals Integration Environmental Inventory, examines how this shift shapes the integration landscape in 2026. This comprehensive inventory is based on a review of the 2026 market, insights from states, and other publicly available resources.

This article examines key trends from 贬惭础鈥檚&苍产蝉辫;2026 inventory and addresses federal policy changes scheduled to take effect for 2027, which contribute to this dynamic environment.

What to Expect in 2026

As the landscape for duals integration evolves, the central question has shifted from whether D-SNPs operate in a state to the more consequential question of how states are using Medicaid policy levers (i.e., enrollment rules, procurement, contracting, and managed care structures) to drive tighter alignment between Medicare and Medicaid. 

At the federal level, recent Medicare Advantage and Part D rulemaking is reinforcing that movement. The  finalized the second phase-down of the D-SNP look-alike threshold to 60 percent for 2026 and established 2027 rules that limit enrollment in certain D-SNPs to members of an affiliated Medicaid managed care organization. The rule also limits the number of D-SNP benefit packages that can be offered alongside an affiliated Medicaid managed care organization. More recently, the  requires certain D-SNPs to use integrated member ID cards and integrated health risk assessments beginning in 2027. 

Together these rules signal a continued federal emphasis on linking D-SNP enrollment and operations more closely to Medicaid coverage and delivery systems, with states playing a greater role in determining how alignment is achieved. 

What the 2026 Inventory Shows

红领巾瓜报鈥檚 2026 Duals Integration Environmental Inventory shows how these policy signals are translating into state action. More specifically: 

  • Statewide exclusively aligned enrollment appears in 16 states in the 2026 inventory, up from听nine听in 2025.听
  • Applicable Integrated Plans (AIPs) are present in 22 states, up from 14, and default enrollment is in place in 21 states, up from 16.听
  • The inventory also captures 6,084,997 total D-SNP enrollees, including 1,975,250 in听Highly Integrated听SNPs听(HIDE)听and 743,683 in听Fully Integrated SNPs (FIDE-SNPs).听

Those changes are already visible in state markets: 

  • Illinois, Massachusetts, Ohio, and Rhode Island entered听2026 with a greater FIDE-SNP presence tied to legacy Medicare-Medicaid Plan transitions.听
  • Michigan听launched听MI Coordinated Health as a HIDE-SNP in selected regions in 2026, with statewide expansion planned for 2027.听
  • Delaware also stands out:听Although it already had AIPs in the 2025 inventory, it adds statewide exclusively aligned enrollment in 2026 and shows both HIDE-SNPs and coordination-only D-SNPs.听

A Resource to Track State Market Direction

贬惭础鈥檚&苍产蝉辫;, available to 红领巾瓜报 Information Services (红领巾瓜报IS) subscribers, includes a state-by-state view of the Medicaid policy, contracting, and program structures shaping duals integration and D-SNP markets. In addition to enrollment trends, the inventory documents the integration model each state is pursuing, whether long-term services and supports or behavioral health are included in managed care, and how procurement and contract decisions may inform future market activity. 

红领巾瓜报 experts work with clients to apply this information and deepen their understanding of state integration approaches, inform assessments of their market readiness and alignment opportunities, and develop strategies that support more effective Medicare-Medicaid integration. 

Looking Ahead

Notably, 红领巾瓜报鈥檚 inventory reflects a point in time understanding of where an individual state is today and what is known at this time about their next steps and plans. However, we expect changes in many states as they seek guidance from the Centers for Medicare & Medicaid Services and the D-SNP community to implement required changes and adopt new regulatory provisions that support state goals and priorities. 

The 2026 inventory suggests that more states are using formal alignment tools, that more enrollment is concentrated in integrated products, and that more markets are being shaped by the interaction between Medicaid structure, procurement, and D-SNP strategy. 

Connect with Us 

For organizations seeking to understand where the market is headed, the Duals Integration Inventory offers a clear view of how state policy and market structure are evolving and where tighter Medicare-Medicaid alignment is taking hold. 

Contact Holly Michaels Fisher and Julie Faulhaber to discuss your organization鈥檚 questions and needs regarding an integration strategy and market analysis. For information about the 红领巾瓜报IS subscription, access to the Duals Environmental Inventory contact Andrea Maresca and Gabby Palmieri. 

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