Weekly Roundup -
May 13, 2026
Smart. Strategic. Essential.
Unmatched Healthcare Insights from 红领巾瓜报,
Leavitt Partners & Wakely.
Featured:
The New Uninsured: State Policy Options for Californians Losing Medi-Cal Coverage
READ BRIEFValue-Based Payment Readiness Assessment Tool
READ MORETrending: In Focus
Turning Insight into Action: The New Operating Reality in Behavioral Health
Thousands听of behavioral health leaders, clinicians, advocates, and industry partners听convened听during听NatCon听2026,听April 27鈥29 in Denver,听CO鈥攐ne听of the sector鈥檚 largest annual gatherings.听This year,听the听event听was听more focused and pragmatic听than in听recent years.听Although听behavioral health听providers still face significant pressure, there was also a听noticeable shift toward how organizations can move听toward sustainable models for growth, technology adoption, and integrated care delivery.听
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.听
Behavioral health organizations听continue to respond to听constrained听funding conditions,听evolving听reimbursement dynamics, and the need to diversify revenue beyond unstable听and uncertain听grant support听and rate reimbursement volatility.听
Operational visibility听was closely tied听to听financial resilience.听
Leaders听discussed the need for听a clearer, more real-time听understanding of their performance. Performance was considered broadly to include听financial indicators, clinical outcomes, and workforce capacity.听Data and听measurement听have moved from a 鈥渘ice to have鈥 to听鈥渆ssential鈥 for听effective听engagement听with payers.听
Innovation听conversations are shifting toward听implementation.听
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).听
This year鈥檚 conference听highlighted听enduring听opportunities and challenges听for the field,听including:听
- 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听
Behavioral Health Industry Trends听
The industry trends听emerging听from听NatCon听2026 suggest that behavioral health听organizations听are entering a more disciplined operating environment听to maximize efficiencies and ensure long-term sustainability in听what seems听sometimes听to听be a听chaotic environment. Organizations are placing greater emphasis on听their听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听supports. Rather than treating mental health and substance use services as isolated programs, providers are increasingly building coordinated systems that听address whole-person needs across settings.听
Another notable trend is that technology is becoming a clearer differentiator.听Some听organizations are piloting or scaling technology,听while others are taking a more cautious approach.听Discussions surrounding AI in particular appeared to听have听matured听significantly, with attention moving from abstract concerns toward change management, sequencing of use cases, return on investment, governance, and clinician trust.听In that sense, technology is听moving from being听a side initiative听to听a strategic differentiator.听
Transformation in the Behavioral Health Field听
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听need to manage uncertainty while continuing to meet听the听growing demand for services听and听more intentional use of data, infrastructure, and听outcomes听measurement.听
More broadly, the conversations throughout the conference pointed to a field that is moving toward greater pragmatism. There is still a clear need for听additional听resources, but there is also growing recognition that adaptability听will听serve an equally听important role.听
How听We听Can听Help听
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.听
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.听
For questions about the听market dynamics听or听approaches to strengthen your听organization鈥檚听adaptability,听contact one of our 红领巾瓜报 experts.听
Federal Policy News
Fueled By Weekly Health Intelligence
Hantavirus Response Raises Questions About U.S. Public Health Readiness
On May 8, the听Centers for Disease Control and Prevention (CDC)听听a statement on the U.S. government鈥檚 response to the recent hantavirus outbreak on the M/V听Hondius听cruise ship, in which three people听died听and five others were known to be infected at the time. On May 10,听the U.S. Department of Health and Human Services (HHS)听听a subsequent statement that it is working to support the U.S. Department of State in the repatriation of American citizens from the M/V听Hondius听cruise ship affected by the Andes variant of hantavirus, in addition to CDC鈥檚 efforts to provide public health guidance and risk assessment.听
In the statements, HHS states that the risk posed by the hantavirus to the American public is 鈥渆xtremely low,鈥 as 鈥渢ransmission is rare and limited to close-contact settings.鈥听
Since CDC and HHS鈥檚 formal statements, on May 11, HHS provided an听听on social media stating that 17 Americans who were on the ship have since been transported to the University of Nebraska Medical Center/Nebraska Medicine鈥疪egional Emerging Special Pathogen Treatment Center (RESPTC) on a U.S. government medical repatriation flight, and then later听听that an 18th听passenger, a dual U.S.-British citizen, had been transported to the Center. HHS听听that two of the passengers travelled in the plane鈥檚 biocontainment units out of an abundance of caution, as one passenger 鈥渃urrently has mild symptoms and another passenger tested mildly PCR positive for the Andes virus.鈥 CDC also announced that two of the passengers have since been transported to Emory University鈥檚 RESPTC in Atlanta.听
In the May 8 statement, and in several posts on social media, CDC notes additional actions taken to address the outbreak, including the development of health guidance for impacted American passengers and state health departments, as well as a 听to inform clinicians and health departments about the cluster. The agency has also deployed epidemiologists to the Canary Islands where the ship will dock to conduct a risk assessment.听
Public health experts have expressed听听regarding听the CDC鈥檚 timeliness in issuing official statements and guidance, as well as the ability of the U.S. government to respond to the outbreak, following the reductions in force听impacting听CDC and the听 of U.S. membership in the World Health Organization (WHO). Upon听terminating听the membership, the Trump Administration听indicated听it would continue to collaborate with other countries and selected health institutions through 鈥渄irect, bilateral and results-driven partnerships鈥 to advance global health security. In the statement听regarding听the hantavirus outbreak, CDC states that it is 鈥渃ontinuing to work closely with international partners to develop consistent monitoring guidance,鈥 but does not provide further details on which international partners the agency has communicated with. In an with CNN on May 9, Acting CDC Director听Dr. Jay Bhattacharya stated that CDC has been 鈥渋n touch with the WHO鈥 and other international health organizations.听
The agencies are also navigating the situation without permanent leadership. Since Dr. Susan Monarez was fired in August 2025 and several senior career officials also left, the CDC has been led by acting directors. The career officials that left when Dr. Monarez was fired were among the remaining senior leaders who had been involved in the agency鈥檚 response to COVID-19, including the repatriation and quarantine efforts. The Assistant Secretary for Preparedness and Response position is also still vacant. The White House nominated individuals for these positions in recent weeks, but Senate HELP Committee hearings have not yet been announced.听
Administration Tests New Approach to Employer Fertility Coverage
On May 10, the Departments of Labor, HHS, and Treasury听听a proposed rule that would create a new category of limited excepted benefits, allowing employers to offer fertility benefits to employees outside the framework of ACA market reforms and certain other federal health coverage laws.听The proposal, issued by the Department of Labor’s Employee Benefits Security Administration (EBSA), follows the February 2025 Executive Order, 鈥,鈥 which directed the Assistant to the President for Domestic Policy to submit to the President policy recommendations 鈥渙n protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment.鈥 The proposed rule would allow employers to offer fertility benefits as a鈥渓imited excepted benefit,鈥 to employees outside of non-excepted group health plans, similarly to coverage for vision and dental. The Administration states that the proposed benefit can include 鈥渘ot just IVF, but also diagnostics, counseling, medications, surgical treatments, and services addressing underlying causes of infertility,鈥 so long as the benefits meet three requirements:听
- Substantially all听of the benefits must be for the diagnosis, mitigation, or treatment of infertility or related reproductive health conditions;听
- Benefits would be capped at a combined lifetime maximum of up to $120,000 for the participant and their beneficiaries, indexed for inflation for plan years starting after 2028; and听
- Employers would听be required听to provide a notice clearly describing the coverage and meeting other specified requirements.听
The departments note that most workers of reproductive age receive health coverage through their employers, but the majority do not have 鈥渞obust鈥 fertility coverage. Acting Secretary of Labor Keith Sonderling and HHS Secretary Robert F. Kennedy, Jr.听characterized听the proposal as expanding access to fertility care and supporting family formation. Comments on the proposed rule are due听60 days听after publication in the Federal Register.听
The Administration highlighted the proposed rule, as well as several other initiatives, during a Mother鈥檚 Day event on May 10, which also included the听听of Moms.gov, a new government website intended to provide resources on fertility, pregnancy, and infant health for mothers.听
FDA Finalizes Guidance on Postapproval Pregnancy Safety Studies
On May 8, FDA issued a听听for industry,鈥,鈥 aimed at improving the collection of safety data on already-approved drugs and biological products when used during pregnancy. This guidance听finalizes听FDA鈥檚 draft issued in听May 2019, and听provides recommendations for听postapproval听study designs to better assess product safety and pregnancy-related risks. It describes pregnancy-safe data collection methods, complementary studies, descriptive studies, and pregnancy registries, with the goal of generating information that can be incorporated into product labeling to support informed decision-making by patients and clinicians.鈥听
FDA Expands Internal AI Capabilities with Launch of ELSA 4.0
On May 6, FDA听听the launch of ELSA 4.0, an upgrade to the agency鈥檚 internal AI tool available to FDA staff and the completion of a data platform consolidation that integrates more than 40 application and submission data sources, systems, and portals across all FDA centers into a new platform called HALO (Harmonized AI & Lifecycle Operations for Data). According to the agency, Elsa is built within a FedRAMP High secure Google Cloud Platform environment, does not train on input data or any data submitted by regulated industry, and is not connected to the internet, though its enhanced search capability allows it to access refreshed secured data web; FDA also states that staff remain involved at every stage of the AI work process, with human subject matter experts verifying all inputs, analytic processes, and output implementation. FDA Commissioner Marty Makary and Chief AI Officer Jeremy Walsh characterized the announcement as a step to streamline agency operations and accelerate regulatory science, with Walsh noting that Elsa will become 鈥渢he main entr茅e into the FDA’s systems and data.鈥 FDA launched Elsa 1.0 in June 2025.听
Ready to talk about your organization's challenges?
Schedule a ConsultationState Policy News
Arkansas Submits 1115 ARHOME Renewal Request with Work Requirements
The Arkansas Department of Human Services (DHS)鈥鈥痮n April 30, 2026, a request to renew its Section 1115 Arkansas Health and Opportunity for Me (ARHOME) demonstration through December 31, 2031, continuing Medicaid expansion coverage through Qualified Health Plans (QHPs) while adding several major policy changes. The renewal would add community engagement and work requirements for most non-exempt enrollees, requiring听80 hours听per month of qualifying activity at application and redetermination. It also would expand Life360 HOMEs to Federally Qualified Health Centers (FQHCs) and other approved providers, raise the Medical Loss Ratio (MLR) to 85 percent, require QHPs to remit pharmacy rebates to the state, tax Advanced Cost Sharing Reduction payments as premiums, and update cost-sharing rules under federal law. Arkansas听estimates enrollment could decline by about 20 percent. Public comments will be accepted through June 10.
Colorado Governor Signs Fiscal 2027 Budget with Medicaid Reductions to Close Deficit
Colorado Senate Democrats鈥鈥痮n May 11, 2026, that Governor Jared Polis signed Colorado鈥檚听$46.8 billion听fiscal 2027 budget. The enacted budget includes a $270 million reduction to some Medicaid reimbursement rates and services to help the state close a听$1.2 billion听deficit. The budget limits reimbursements for family members that are caregivers for Medicaid recipients to听56 hours per week and reduces the Cover All Coloradans program. The budget keeps core Medicaid services, and the overall Medicaid budget increased by $468 million.
Georgia Releases Medicaid Fraud, Waste, and Abuse Solution RFI
The听Georgia Department of Community Health (DCH)鈥鈥痮n May 11, 2026, a Request for Information (RFI) for a Medicaid fraud, waste, and abuse (FWA) detection and prevention solution across fee-for-service (FFS) and managed care. The state is seeking input on tools that use artificial intelligence, cloud-based analytics, and program integrity听expertise听to听identify aberrant billing, support payment reviews, verify member residency and eligibility, strengthen pharmacy lock-in monitoring, and support investigations. The RFI may inform a future procurement and could include staff augmentation as Georgia prepares to expand managed care to aged, blind, and disabled (ABD) populations by 2028. Responses are due May 20.
Nevada Releases Medicaid PBM RFI
The Nevada Health Authority鈥鈥痮n May 8, 2026, a request for information (RFI) seeking feedback on an upcoming procurement of a single pharmacy benefit manager (PBM) for Nevada Medicaid. The RFI aims to align the state with a bill enacted during the 2025 legislative session requiring the state to听consolidate pharmacy benefit administration across fee-for-service (FFS) and managed care. The state is seeking responses on the requirements and expectations it should set for procurement and with future contactors. Responses are due May 29, 2026. The current FFS vendor is Magellan.
States Release RHTP Funding Opportunities
The Arkansas Department of Finance and Administration鈥鈥痮n May 11, 2026, a notice of funding opportunity (NOFO) for the Telehealth, Health鈥慚onitoring, and Response Innovation for Vital Expansion (THRIVE) initiative of the state鈥檚 Rural Health Transformation Program (RHTP).听The state is seeking qualified applicants to help modernize rural healthcare delivery by expanding access to telehealth services, strengthening emergency response听systems听and reducing response times, improving chronic disease and behavioral health outcomes, strengthening interoperability, and supporting data-driven care coordination. The state will issue awards based off four sub-initiatives, with up to $28.1 million available in year one for Linking Infrastructure for Emergency Lifesaving and Integrated Network Expansion; nearly $18.6 million for Health Outcomes through Monitoring & Engagement; $2 million for Virtual Innovation for Rural Telehealth, Utilization, Access, and Longevity; and $7 million for the TECH Fund (Telehealth, Equipment, and Connectivity Hub). Applications are due June 12, 2026.听Meanwhile, the Nevada Health Authority鈥听two requests for applications (RFAs) for funding opportunities to support initiatives of听RHTP.听The first opportunity is for the Rural Health Outcomes Accelerator Program initiative. Nevada is seeking qualified organizations to propose programs and initiatives that will improve chronic disease, primary care, behavioral health, and maternal and infant health, as well as reward providers for improved health outcomes. The second opportunity is for the Rural Health Innovation and Technology (RHIT) initiative. The state is seeking qualified applicants that have investment ideas that will enable providers to implement practical technology solutions that strengthen care delivery, matching providers鈥 actual needs and capacity, minimizing unnecessary complexity, and ensuring accountability. Applications for the RHOAP initiative are due June 26, 2026, and applications for RHIT funding are due July 6, 2026. Both RFAs will result in multiple awards totaling approximately $27 million for one year of funding in each initiative.听
Private Market News
Fueled By
Oscar Health's Profit Hits $679M, Membership Rises in Q1
听posted听$4.6 billion听in revenue in the first quarter of the year, up from the听$3 billion听revenue听it reported in Q1 2025.听Oscar posted听a very strong听first quarter, with profit and membership both rising sharply, suggesting its ACA-focused growth strategy is still working at scale.听
Our Insights
Fueled By Experts Across Our 红领巾瓜报 Companies
红领巾瓜报
The New Uninsured: State Policy Options for Californians Losing Medi-Cal Coverage
红领巾瓜报鈥檚 new report for the California Health Care Foundation explains how recent federal and state policy changes could cause up to two million Californians to lose Medi-Cal coverage. The report outlines practical short-term program paths California could use to preserve access to care while full-scope coverage is restored. It summarizes the policy and fiscal context, describes stakeholder-informed design goals, and presents two illustrative coverage alternatives with modeled cost ranges and key trade-offs in benefits, provider payment rates, cost sharing, and bridge-period design.
ACA Enrollment Declines: Implications and Options for State and Federal Policymakers
Recent and future policy changes are reshaping the鈥疉ffordable Care鈥疉ct (ACA)鈥痬arket. A recent Wakely report finds that only 86% of ACA enrollees nationwide paid their first premium at the start of the year, raising important questions about affordability, access, and market stability. Additionally, the 2027 Notice of Benefits and Payment Parameters (NBPP) is expected to be鈥痜inalized鈥痶his鈥疭pring鈥痺hich will have additional implications for consumers, issuers, and other stakeholders. On May 20, join 红领巾瓜报鈥檚 ACA team for a policy-focused conversation on what these projected changes mean for marketplace dynamics, including impacts to risk pools, premiums, and issuer participation. The session will explore emerging federal and鈥痵tate鈥痯olicy responses and offer insight into how today鈥檚 decisions may shape 2027 rates, plan offerings, and long-term market sustainability.听
Webinar Replay: Saving Lives with Compassion: Overdose Response Training with RiVive庐
This webinar presented findings from the 2025 RiVive Community Engagement Report and best practices in compassionate overdose response鈩, with a focus on the community use of RiVive naloxone nasal spray 3 mg. A panel of expert speakers presented their protocols for effective overdose intervention, guidance on the training of others, and strategies for integrating trauma-informed approaches into post-overdose care.
The webinar covered why compassionate dosing is important, how to integrate this concept into trainings for community members, and communication strategies for teaching titration, rescue breathing, and overdose prevention.
2026 Maryland State of Reform Health Policy Conference | May 21, 2026
The 2026 Maryland State of Reform Health Policy Conference will be taking place in-person on May 21st, 2026 at the Baltimore Marriott Waterfront! Managing constant change in healthcare takes more than just hard work. It takes a solid understanding of the legislative process and knowledge about intricacies of the healthcare system. That鈥檚 where State of Reform comes in.
Wakely
To LEAD or Not: Accountable Care Organizations Have A Decision To Make By May 17
LEAD (the Long-term Enhanced ACO Design) Model is the Centers for Medicare & Medicaid Innovation Center鈥檚 newest鈥鈥痯ayment model, running for 10 years from January 1, 2027, through December 31, 2036. ACOs have until May 17,听2026听to apply at鈥鈥痠f they want to听participate听in the model.听If听测辞耻鈥檇听like to learn more about how LEAD will听impact听your organization, or have already applied, and want to learn how to best mitigate your risk profile in LEAD, contact one of our authors below and request a consultation听and get more information here:听鈥.
Upcoming Webinar
ACA Enrollment Declines: Implications and Options for State and Federal Policymakers
Register HereRFP Calendar
RFP Calendar
| Date | State/Program | Event | Beneficiaries |
|---|---|---|---|
| Date: February 2026 - DELAYED | State/Program: Illinois | Event: Awards | Beneficiaries: 2,400,000 |
| Date: May 1, 2026 | State/Program: Nevada Children's Specialty | Event: Proposals Due | Beneficiaries: NA |
| Date: May 12, 2026 | State/Program: Nevada CO D-SNP | Event: Awards | Beneficiaries: 88,000 |
| Date: June 24, 2026 | State/Program: Wisconsin LTC GSR 3 | Event: Awards | Beneficiaries: 56,000 (all GSR) |
| Date: Summer 2026 | State/Program: Illinois Foster Care | Event: RFP Release | Beneficiaries: 33,000 |
| Date: July 1, 2026 | State/Program: Hawaii Community Care Services | Event: Implementation | Beneficiaries: 5,500 |
| Date: July 28, 2026 | State/Program: Nevada Children's Specialty | Event: Awards | Beneficiaries: NA |
| Date: August 2026 | State/Program: Indiana | Event: RFP Release | Beneficiaries: 1,400,000 |
| Date: January 1, 2027 | State/Program: Illinois | Event: Implementation | Beneficiaries: 2,400,000 |
| Date: January 1, 2027 | State/Program: Nevada CO D-SNP | Event: Implementation | Beneficiaries: 88,000 |
| Date: January 1, 2027 | State/Program: Wisconsin LTC GSR 3 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: January 1, 2027 | State/Program: Illinois Tailored Care Management Program | Event: Implementation | Beneficiaries: 22,400 |
| Date: July 1, 2027 | State/Program: Nevada Children's Specialty | Event: Implementation | Beneficiaries: NA |
| Date: January 1, 2028 | State/Program: Wisconsin LTC GSR 4,6 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: Fall 2027 | State/Program: Oregon | Event: RFP Release | Beneficiaries: 1,200,000 |
| Date: 2028 | State/Program: North Carolina | Event: RFP Release | Beneficiaries: 2,200,000 |
| Date: 2029 | State/Program: California | Event: RFP Release | Beneficiaries: NA |