Weekly Roundup -
May 13, 2026
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Unmatched Healthcare Insights from ºìÁì½í¹Ï±¨,
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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
ThousandsÌýof behavioral health leaders, clinicians, advocates, and industry partnersÌýconvenedÌýduringÌýNatConÌý2026,ÌýApril 27–29 in Denver,ÌýCO—oneÌýof the sector’s largest annual gatherings.ÌýThis year,ÌýtheÌýeventÌýwasÌýmore focused and pragmaticÌýthan inÌýrecent years.ÌýAlthoughÌýbehavioral healthÌýproviders still face significant pressure, there was also aÌýnoticeable shift toward how organizations can moveÌýtoward sustainable models for growth, technology adoption, and integrated care delivery.Ìý
ºìÁì½í¹Ï±¨ (ºìÁì½í¹Ï±¨) 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 fromÌýNatConÌý2026Ìý
Financial resilienceÌýremained at the forefront.Ìý
Behavioral health organizationsÌýcontinue to respond toÌýconstrainedÌýfunding conditions,ÌýevolvingÌýreimbursement dynamics, and the need to diversify revenue beyond unstableÌýand uncertainÌýgrant supportÌýand rate reimbursement volatility.Ìý
Operational visibilityÌýwas closely tiedÌýtoÌýfinancial resilience.Ìý
LeadersÌýdiscussed the need forÌýa clearer, more real-timeÌýunderstanding of their performance. Performance was considered broadly to includeÌýfinancial indicators, clinical outcomes, and workforce capacity.ÌýData andÌýmeasurementÌýhave moved from a “nice to have†toÌý“essential†forÌýeffectiveÌýengagementÌýwith payers.Ìý
InnovationÌýconversations are shifting towardÌýimplementation.Ìý
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).Ìý
This year’s conferenceÌýhighlightedÌýenduringÌýopportunities and challengesÌýfor the field,Ìýincluding:Ìý
- Core service priorities,Ìýsuch asÌýcrisis response,Ìýsuicide prevention, collaborative careÌýandÌýincreased opportunities aroundÌýCertified Community Behavioral Health ClinicsÌý(CCHBCs), and value-based payment strategiesÌýfor financial resilienceÌýÌý
- Workforce sustainability, with organizations lookingÌýto reduce administrative burden, strengthen recruitment and retention, and support staff well-being while demand for services continues to riseÌý
Behavioral Health Industry TrendsÌý
The industry trendsÌýemergingÌýfromÌýNatConÌý2026 suggest that behavioral healthÌýorganizationsÌýare entering a more disciplined operating environmentÌýto maximize efficiencies and ensure long-term sustainability inÌýwhat seemsÌýsometimesÌýtoÌýbe aÌýchaotic environment. Organizations are placing greater emphasis onÌýtheirÌýMedicaid 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-basedÌýsupports. Rather than treating mental health and substance use services as isolated programs, providers are increasingly building coordinated systems thatÌýaddress whole-person needs across settings.Ìý
Another notable trend is that technology is becoming a clearer differentiator.ÌýSomeÌýorganizations are piloting or scaling technology,Ìýwhile others are taking a more cautious approach.ÌýDiscussions surrounding AI in particular appeared toÌýhaveÌýmaturedÌýsignificantly, with attention moving from abstract concerns toward change management, sequencing of use cases, return on investment, governance, and clinician trust.ÌýIn that sense, technology isÌýmoving from beingÌýa side initiativeÌýtoÌýa strategic differentiator.Ìý
Transformation in the Behavioral Health FieldÌý
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—theÌýneed to manage uncertainty while continuing to meetÌýtheÌýgrowing demand for servicesÌýandÌýmore intentional use of data, infrastructure, andÌýoutcomesÌýmeasurement.Ìý
More broadly, the conversations throughout the conference pointed to a field that is moving toward greater pragmatism. There is still a clear need forÌýadditionalÌýresources, but there is also growing recognition that adaptabilityÌýwillÌýserve an equallyÌýimportant role.Ìý
HowÌýWeÌýCanÌýHelpÌý
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.Ìý
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—highlighting emerging approaches, surfacing common challenges, and creating opportunities for peer exchange.Ìý
For questions about theÌýmarket dynamicsÌýorÌýapproaches to strengthen yourÌýorganization’sÌýadaptability,Ìýcontact one of our ºìÁì½í¹Ï±¨ experts.Ìý
Federal Policy News
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Hantavirus Response Raises Questions About U.S. Public Health Readiness
On May 8, theÌýCenters for Disease Control and Prevention (CDC)ÌýÌýa statement on the U.S. government’s response to the recent hantavirus outbreak on the M/VÌýHondiusÌýcruise ship, in which three peopleÌýdiedÌýand five others were known to be infected at the time. On May 10,Ìýthe U.S. Department of Health and Human Services (HHS)ÌýÌýa subsequent statement that it is working to support the U.S. Department of State in the repatriation of American citizens from the M/VÌýHondiusÌýcruise ship affected by the Andes variant of hantavirus, in addition to CDC’s efforts to provide public health guidance and risk assessment.Ìý
In the statements, HHS states that the risk posed by the hantavirus to the American public is “extremely low,†as “transmission is rare and limited to close-contact settings.â€Ìý
Since CDC and HHS’s formal statements, on May 11, HHS provided anÌýÌýon social media stating that 17 Americans who were on the ship have since been transported to the University of Nebraska Medical Center/Nebraska Medicine Regional Emerging Special Pathogen Treatment Center (RESPTC) on a U.S. government medical repatriation flight, and then laterÌýÌýthat an 18thÌýpassenger, a dual U.S.-British citizen, had been transported to the Center. HHSÌýÌýthat two of the passengers travelled in the plane’s biocontainment units out of an abundance of caution, as one passenger “currently has mild symptoms and another passenger tested mildly PCR positive for the Andes virus.†CDC also announced that two of the passengers have since been transported to Emory University’s RESPTC in Atlanta.Ìý
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 Ìýto 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.Ìý
Public health experts have expressedÌýÌýregardingÌýthe CDC’s 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 forceÌýimpactingÌýCDC and theÌý of U.S. membership in the World Health Organization (WHO). UponÌýterminatingÌýthe membership, the Trump AdministrationÌýindicatedÌýit would continue to collaborate with other countries and selected health institutions through “direct, bilateral and results-driven partnerships†to advance global health security. In the statementÌýregardingÌýthe hantavirus outbreak, CDC states that it is “continuing to work closely with international partners to develop consistent monitoring guidance,†but does not provide further details on which international partners the agency has communicated with. In an with CNN on May 9, Acting CDC DirectorÌýDr. Jay Bhattacharya stated that CDC has been “in touch with the WHO†and other international health organizations.Ìý
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’s 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.Ìý
Administration Tests New Approach to Employer Fertility Coverage
On May 10, the Departments of Labor, HHS, and TreasuryÌýÌýa 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.ÌýThe proposal, issued by the Department of Labor’s Employee Benefits Security Administration (EBSA), follows the February 2025 Executive Order, “,†which directed the Assistant to the President for Domestic Policy to submit to the President policy recommendations “on protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment.†The proposed rule would allow employers to offer fertility benefits as a “limited excepted benefit,†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 “not just IVF, but also diagnostics, counseling, medications, surgical treatments, and services addressing underlying causes of infertility,†so long as the benefits meet three requirements:Ìý
- Substantially allÌýof the benefits must be for the diagnosis, mitigation, or treatment of infertility or related reproductive health conditions;Ìý
- 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; andÌý
- Employers wouldÌýbe requiredÌýto provide a notice clearly describing the coverage and meeting other specified requirements.Ìý
The departments note that most workers of reproductive age receive health coverage through their employers, but the majority do not have “robust†fertility coverage. Acting Secretary of Labor Keith Sonderling and HHS Secretary Robert F. Kennedy, Jr.ÌýcharacterizedÌýthe proposal as expanding access to fertility care and supporting family formation. Comments on the proposed rule are dueÌý60 daysÌýafter publication in the Federal Register.Ìý
The Administration highlighted the proposed rule, as well as several other initiatives, during a Mother’s Day event on May 10, which also included theÌýÌýof Moms.gov, a new government website intended to provide resources on fertility, pregnancy, and infant health for mothers.Ìý
FDA Finalizes Guidance on Postapproval Pregnancy Safety Studies
On May 8, FDA issued aÌýÌýfor industry,“,†aimed at improving the collection of safety data on already-approved drugs and biological products when used during pregnancy. This guidanceÌýfinalizesÌýFDA’s draft issued inÌýMay 2019, andÌýprovides recommendations forÌýpostapprovalÌýstudy 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. Ìý
FDA Expands Internal AI Capabilities with Launch of ELSA 4.0
On May 6, FDAÌýÌýthe launch of ELSA 4.0, an upgrade to the agency’s 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 “the main entrée into the FDA’s systems and data.†FDA launched Elsa 1.0 in June 2025.Ìý
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Schedule a ConsultationState Policy News
Arkansas Submits 1115 ARHOME Renewal Request with Work Requirements
The Arkansas Department of Human Services (DHS)  on 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, requiringÌý80 hoursÌýper 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. ArkansasÌýestimates 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  on May 11, 2026, that Governor Jared Polis signed Colorado’sÌý$46.8 billionÌýfiscal 2027 budget. The enacted budget includes a $270 million reduction to some Medicaid reimbursement rates and services to help the state close aÌý$1.2 billionÌýdeficit. The budget limits reimbursements for family members that are caregivers for Medicaid recipients toÌý56 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
TheÌýGeorgia Department of Community Health (DCH)  on 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 integrityÌýexpertiseÌýtoÌýidentify 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  on 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 toÌýconsolidate 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  on May 11, 2026, a notice of funding opportunity (NOFO) for the Telehealth, Health‑Monitoring, and Response Innovation for Vital Expansion (THRIVE) initiative of the state’s Rural Health Transformation Program (RHTP).ÌýThe state is seeking qualified applicants to help modernize rural healthcare delivery by expanding access to telehealth services, strengthening emergency responseÌýsystemsÌýand 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.ÌýMeanwhile, the Nevada Health Authority Ìýtwo requests for applications (RFAs) for funding opportunities to support initiatives ofÌýRHTP.ÌýThe 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’ 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.Ìý
Private Market News
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Oscar Health's Profit Hits $679M, Membership Rises in Q1
ÌýpostedÌý$4.6 billionÌýin revenue in the first quarter of the year, up from theÌý$3 billionÌýrevenueÌýit reported in Q1 2025.ÌýOscar postedÌýa very strongÌýfirst quarter, with profit and membership both rising sharply, suggesting its ACA-focused growth strategy is still working at scale.Ìý
Our Insights
Fueled By Experts Across Our ºìÁì½í¹Ï±¨ Companies
ºìÁì½í¹Ï±¨
The New Uninsured: State Policy Options for Californians Losing Medi-Cal Coverage
ºìÁì½í¹Ï±¨â€™s 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 Affordable Care Act (ACA) market. 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 finalized this Spring which will have additional implications for consumers, issuers, and other stakeholders. On May 20, join ºìÁì½í¹Ï±¨â€™s 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 state policy responses and offer insight into how today’s decisions may shape 2027 rates, plan offerings, and long-term market sustainability.Ìý
Webinar Replay: Saving Lives with Compassion: Overdose Response Training with RiVive®
This webinar presented findings from the 2025 RiVive Community Engagement Report and best practices in compassionate overdose responseâ„¢, 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’s 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’s newest  payment model, running for 10 years from January 1, 2027, through December 31, 2036. ACOs have until May 17,Ìý2026Ìýto apply at  if they want toÌýparticipateÌýin the model.ÌýIfÌý²â´Ç³Ü’dÌýlike to learn more about how LEAD willÌýimpactÌýyour 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 consultationÌýand get more information here:Ìý .
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 |