Weekly Roundup -
September 2, 2026
Smart. Strategic. Essential.
Unmatched Healthcare Insights from 红领巾瓜报,
Leavitt Partners & Wakely.
Featured:
Webinar Replay – Modernizing and Streamlining Health Plan Prior Authorization
ACCESS WEBINAR
Closing the Care Continuity Gap in Substance Use Disorder
READ BRIEF
Trending: In Focus
Federal and State Medicaid Leaders and VA Assistant Secretary to Discuss Public Healthcare Transformation at 红领巾瓜报 Conference
红领巾瓜报听(红领巾瓜报) is听pleased to announce that听, Principal Deputy for the Center for Medicaid & CHIP Services, will participate in two sessions at听,听October 5-7, 2026.听in听New Orleans, LA.听As states, plans, providers, and community partners prepare for a new era in听Medicaid听and other public healthcare programs, these conversations will focus on practical solutions, implementation realities, and听the听partnerships needed听to听move from policy change to sustainable results.听
State Medicaid听and CHIP Strategies for听Applied Behavior Analysis听and Autism Services听
As the prevalence of autism has increased, state investments in Applied Behavior Analysis (ABA) and related services have grown substantially. This preconference session will examine federal guidance and听state strategies听for supporting听appropriate, high-quality听care for children with autism听while helping programs strengthen oversight, access, and service delivery.听
Medicaid听Policy Changes and Their听Ripple Effects Across Healthcare听
Changes in Medicaid policy and financing will not stay confined to Medicaid. Coverage churn across Medicaid, the Affordable Care Act (ACA) Marketplace, and employer-sponsored insurance can reshape risk pools, influence plan participation, increase provider financial exposure, and leave more people uninsured. This session will bring federal and state leaders together to discuss how Medicaid agencies and their partners are responding, where collaboration is most needed, and what strategies will be needed to navigate the next phase of public healthcare transformation.听
The following听current and former Medicaid directors听will join听Dr. Knapp:听
- , Administrator, Nevada Medicaid Nevada Health Authority听
- 听Senior Advisor; Former Medicaid Director, Virginia Department of Medical Assistance Services听
- 听Medicaid Director & Assistant Secretary for MassHealth, Massachusetts Executive Office of Health & Human Services听
- Director, Ohio Department of Medicaid听
VA Community Care and NextGen Healthcare Innovation for Veterans听
As the nation鈥檚 largest integrated health system serving听military听veterans, the VA is听working听with health plans, providers, health systems, technology firms, and other innovators to bring听effective听solutions from across the healthcare marketplace to听people听who have served our nation.听Approximately听42 percent of听the听healthcare听services that veterans receive听today听is听delivered听through the contracted Community Care program,听and that share is expected to grow.听听will听discuss听the VA鈥檚 vision for the future of Community Care,听the critical role industry partners will play,听and how the VA听intends听to learn from听the field, adopt proven practices, leverage emerging technologies, and foster innovation that improves access, quality, and outcomes for听veterans.
As Medicaid, VA Community Care, and other public healthcare programs enter a period of significant change, 红领巾瓜报鈥檚 conference will focus on the partnerships, operational strategies, and solutions needed to move from policy to implementation.
to join leaders working through the decisions that will shape the next phase of public healthcare.听
MESC 2026 Highlights: Medicaid Modernization, AI, Eligibility, and Program Integrity
Key Insights from the 2026听MESC听Conference and What They Mean for Your Organization听
State Medicaid听agencies and partner organizations听are听facing听one of the most consequential periods of operational change in more than a decade. Those challenges were a central focus of the听, August 17-20, 2026, in Portland, OR, where state, federal, and industry leaders discussed how technology, data, and operational modernization are becoming essential tools for implementing policy change.听
During the conference, leaders of 红领巾瓜报 (红领巾瓜报) and HealthTech Solutions, an 红领巾瓜报 company, reinforced a consistent theme: We have moved beyond the era when Medicaid enterprise systems modernization simply meant replacing aging technology. Instead, states are building the infrastructure needed to manage continuous policy evolution, support more sophisticated program integrity efforts, adapt to changing eligibility requirements, and provide the financial and operational visibility necessary to navigate an increasingly complex Medicaid environment. That direction is also reflected in recent that the Centers for Medicare & Medicaid Services (CMS) issued to gather stakeholder input on how to advance a more standardized, interoperable, and cost-effective MES ecosystem.听
What We听Learned听at听MESC听
Modernization Is Becoming an Ongoing Operating Capability听
Medicaid modernization is moving beyond the replacement of legacy systems. States are building the capabilities needed to manage continuous change. That work includes stronger governance听through听better data and more disciplined implementation practices;听clearer听ownership for decisions, risks, dependencies, and outcomes;听and听the development of听cross-functional teams. Policy, operations, technology, finance, communications, and program leadership must work together from the beginning.听
What听it听means for states and partners
Modernization programs听need听a clear operating model听that听defines听decision rights, measures of success, implementation responsibilities, and long-term support.听Partners should help build state capability instead of focusing only on system delivery.听
Modularity Now Means Managing the Connections Between Systems听
Modularity can give states more flexibility, support specialized solutions, and reduce dependence on one large platform. Modularity, however, also creates more connections and business relationships that must be managed. A modular environment involves multiple vendors, systems, interfaces, data flows, release schedules, and support models. Because difficulties can arise when these elements are disconnected, MESC sessions emphasized the need for enterprise integration and coordination. States must manage testing, release planning, architecture, data contracts, vendor handoffs, and incident resolution.听
What听it听means for states and partners
Modularity听requires听more than modular procurement. States need an enterprise layer that manages the relationships between components. Partners should understand how their work affects the broader Medicaid ecosystem.听
Federal Requirements Are Shaping the Modernization Agenda听
CMS and other federal requirements continue to influence state priorities. Certification听remains听important,听along听with听federal reporting, data quality, security, interoperability, and program integrity. The conference also reflected growing pressure to prevent fraud, waste, and abuse earlier in the Medicaid life听cycle. States are strengthening provider enrollment, referral intake, payment controls, analytics, and audit preparation. These efforts move program integrity closer to the front door. The goal is to听identify听risk before it becomes a payment error or an investigation.听
What听it听means for states and partners
Compliance and program integrity should be part of solution design from the beginning. States and partners should build evidence, controls, testing, and monitoring into normal operations. These activities should not听be听postponed听until certification or an audit is approaching.听
Eligibility Changes Require New Data and Operational Models听
Changes to Medicaid eligibility are creating new demands for states. Workforce and community engagement requirements are one example. States may also need enhanced verification, new exemption processes, shorter response timelines, and stronger outreach.听
These changes extend beyond eligibility systems. They shape how states communicate with members, support contact centers and caseworkers, manage appeals, connect data sources, and help people understand what they need to do to maintain coverage. MESC sessions underscored the value of listening to stakeholders and explored how health information exchange data and other sources听could听support exemption decisions and reduce preventable coverage loss.听
What this means for states and partners
Eligibility modernization must connect policy to daily operations. States need reliable data and clear workflows. They also need ways to explain changes and track outreach. Partners can translate policy into decision logic, test cases, notices, training, and operational procedures.听
AI Means Governed Support for Real Medicaid Work听
AI was a major topic of discussion at MESC. The strongest examples involved practical work rather than general experimentation. States are exploring AI for policy questions, quality assurance, document review, contact center support, knowledge management, and program integrity. These use cases can reduce administrative burden and help staff manage complex workloads. Conference speakers clarified that AI is no substitute for reliable governance structures. States need reliable content, security controls, privacy protections, human review, workforce training, and performance monitoring.听
What this means for states and partners
AI adoption should begin with a specific business problem. States should define who is accountable for the outcome and how the tool will be听monitored. Partners can support听use听case听selection, governance, procurement, testing, implementation, and workforce adoption.听
How 红领巾瓜报 Can Help听
MESC 2026 reinforced the argument that Medicaid modernization is no longer a discrete technology project. States and their partners are responding to federal requirements, modular听system complexity,听eligibility听changes,听AI听adoption,听and听heightened听program integrity听expectations at the same time.听
红领巾瓜报 and HealthTech Solutions help organizations turn that complexity into an actionable modernization strategy.听Our teams bring together Medicaid policy expertise, operational experience, technology strategy, procurement support, compliance knowledge, and implementation discipline听so听clients听can听make better decisions and execute with confidence.听
We support organizations in assessing current systems and capability gaps, prioritizing technology investments, translating policy into operational and technical requirements, managing vendor selection and procurement, strengthening compliance and program integrity, and adopting AI in ways that are听effectively听governed, practical, and aligned with Medicaid business needs.听
Contact听红领巾瓜报 experts to get your questions answered.听
Federal Policy News
Fueled By Weekly Health Intelligence
The House Returns With a Funding Deadline Front and Center
On September 1, the House of Representatives passed a short-term continuing resolution (CR), the鈥�,鈥痶o fund the federal government through December 11, 2026.鈥�The鈥痩egislation, which already passed the Senate,鈥痑lso included a provision鈥�that temporarily prevents鈥痶he Office of Management and Budget (OMB)鈥痜rom听finalizing听its鈥�鈥痯roposed rule that would鈥痳equire senior political appointee review of discretionary awards. The short-term funding bill sets up the need for Congress to vote again this year, after the November mid-term election but before the new Congress is鈥痵worn in, to provide听additional听funding to keep the government open.听听
Autism Research Roadmap Approved After Divided Vote
On August 27, the Interagency Autism Coordinating Committee (IACC)听听its full committee meeting and officially adopted the draft strategic plan. The听, approved by a vote of 26鈥�1, with 13 abstentions, plans to increase federal autism research funding from $390 million to $747 million and shift priorities beyond the traditional genetics–focused approach to include research on diet, inflammation, metabolic stress, folate, and other environmental and biological factors. While some researchers and advocates welcomed the plan鈥檚 focus on co-occurring conditions, such as epilepsy and sleep disorders, others raised concerns about its emphasis on areas with limited supporting evidence, including folate-based therapies, such as leucovorin. Stakeholders also noted that the plan does not address听important issues affecting autistic adults, such as employment and independent living. A number of听autism and disability organizations cited concerns that the more than 5,000 comments on the plan could not have been adequately considered prior to the vote. The meeting further drew attention because committee members discussed vaccines as a potential cause of autism, despite the scientific evidence debunking causation. The strategic plan will serve as a roadmap for future federal autism research investments and recommendations to Congress and federal agencies, making its implementation and influence on research funding priorities important to听monitor.
HHS Tests New Strategies for School Nutrition
On听August 26, HHS听听the Developing Evidence for Programs to Ensure Nutrition for Development (DEPEND) initiative, a new $32.5 million effort to support schools in replacing highly processed foods with more nutritious options. The initiative will provide grants ranging from $75,000 to $2.5 million to schools, school districts, and School Food Authorities to test innovative approaches related to food purchasing and supply, workforce and food production, student demand and meal participation, and operational and infrastructure improvements. HHS said听DEPEND听is intended to address longstanding barriers schools face in providing healthier meals, including procurement, staffing, infrastructure, and financial challenges, while building evidence around which strategies are most effective, scalable, sustainable, and economically听viable. Grant applications are expected to be available in mid-September, and HHS has听indicated听it may expand funding in FY 2027 if the program proves successful.
FDA Clears New Treatment for Pancreatic Cancer
On August 26, FDA听听Rasonque听(daraxonrasib), a treatment shown to dramatically extend survival for patients with the most听common form听of pancreatic cancer. FDA highlighted that the approval was granted 鈥�6.5 months before the user fee deadline.鈥� It received a number of designations intended to expedite FDA鈥檚 review, including being granted听听and听, and Priority Review. FDA also听states听that the application was reviewed under the听, which provides accelerated review to certain manufacturers for efforts听deemed听by FDA to be in the national interest,听established听under听former Commissioner Marty Makary.听Rasonque听is manufactured by Revolution Medicines, Inc.
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State Policy News
Indiana Releases Medicaid Managed Care RFP Covering 1.5 Million Beneficiaries
The Indiana Family and Social Services Administration (FSSA)鈥�鈥痑 request for proposals听on August 27, 2026,听to听reprocure contracts for all four of the听state鈥檚听managed care programs, covering approximately 1.5听million听beneficiaries.听The procurement includes听Hoosier Healthwise (HHW), Healthy Indiana Plan (HIP), Hoosier Care Connect (HCC), and Indiana听PathWays听for Aging, making it one of the most significant Medicaid managed care procurements currently underway.听
Indiana is seeking managed care organizations (MCOs) that can support the state鈥檚 Make Indiana Healthy Again initiative while advancing quality improvement, member engagement, provider collaboration, and fiscal accountability. The RFP also encourages plans to offer targeted enhanced benefits, implement member and provider incentive programs, and expand value-based purchasing arrangements.听
The state intends to award contracts for all four Medicaid programs to the same participating health plans. In addition, successful bidders will听be required听to听operate听a Dual Eligible Special Needs Plan (D-SNP) beginning January 1, 2029, and throughout the contract term to support integration of care for Medicare-Medicaid beneficiaries enrolled in听PathWays听for Aging.听
Contracts are expected to begin January 1, 2029, and run for four years, with two optional one-year extensions. Current incumbents include Elevance/Anthem, CareSource, Centene/Managed Health Services (MHS), UnitedHealthcare, Humana, and other participating plans across the four programs. Proposals are due November 6, 2026, and Indiana expects to announce award recommendations in July 2027.听
For Medicaid health plans, providers, and healthcare investors, the procurement听represents听a major opportunity to compete for membership across Indiana鈥檚 Medicaid market while positioning for the state鈥檚 continued focus on quality performance, integrated care, and value-based delivery models.听
Elevance鈥檚 Healthy Blue to Exit Louisiana Medicaid Managed Care Program
The Louisiana Department of Health (LDH)鈥�鈥痮n September 1, 2026,听that听Elevance/Healthy Blue will exit the state鈥檚 Medicaid managed care program听effective听after听December 31, 2026. The departure听will affect approximately 290,000听Louisiana听Medicaid beneficiaries, who will need to select coverage through one of the other four plans鈥擜meriHealth Caritas, CVS/Aetna, Centene/LA Healthcare Connections, or Humana. Members who do not select a new plan will be automatically assigned. LDH is听coordinating听with Healthy听Blue听and the听remaining听managed care plans听on听the transition.听The Louisiana exit is part of a broader strategy by Elevance Health to reduce participation in Medicaid markets it has identified as financially unsustainable.听听
Michigan Releases RFP for Medicaid Non-Emergency Medical Transportation Broker
The Michigan Department of Health and Human Services (MDHHS)鈥�鈥痮n August 27, 2026, a request for proposals (RFP)听to select听a non-emergency medical transportation (NEMT) broker for fee-for-service Medicaid beneficiaries in Wayne, Oakland, and Macomb counties, with听the potential听to expand broker听services statewide.听The procurement is important for transportation vendors, Medicaid contractors, and healthcare organizations that support access to care, particularly because the selected contractor will manage beneficiary calls, verify eligibility, schedule medically necessary transportation, recruit and oversee a driver network, and determine NEMT reimbursement rates. Bidders must submit separate responses and cost proposals for two geographic regions: one covering Wayne, Oakland, and Macomb counties, and one covering the full state, including both the Upper and Lower Peninsulas. MDHHS currently serves听as the听fee-for-service听NEMT broker in all other counties. The听new听contract will run from August 1, 2027, through July 31, 2030, with up to five听additional听one-year extensions. Proposals are due October 30, 2026.听ModivCare听is the听incumbent NEMT broker in听Wayne, Oakland, and Macomb counties.
New Mexico Awards $750,000 in Emergency Contracts for Medicaid Outreach
The听听(HCA)听approved听on August 25, 2026, two 90-day emergency contracts totaling $750,000 to support rapid Medicaid member communications tied to new federal community engagement requirements and eligibility changes. HCA awarded up to $500,000 to听Windlark听Studios for multilingual, plain-language materials explaining work requirements, the revised medical-frailty exemption, reporting obligations, and the October 1 transition of certain noncitizens from federal Medicaid to a new state-funded coverage program. HCA also awarded up to $250,000 to听XOMAD听for digital outreach through New Mexico-based trusted messengers and local creators to reach members who may not engage with traditional government communications. The agency is using听the emergency听contracts as a bridge while it completes competitive procurements for any continuing communications services.听
CMS Approves Oklahoma SoonerCare Section 1115 Waiver Renewal Through 2031
The Centers for Medicare & Medicaid Services (CMS)听听a five-year renewal of Oklahoma鈥檚 Section 1115听SoonerCare听demonstration on August 28, 2026, extending the program from January 1, 2027, through December 31, 2031.听The renewal allows Oklahoma to continue several longstanding Medicaid initiatives, including the听Insure Oklahoma Employer-Sponsored Insurance premium assistance program, Health Access Networks, and the Health Management Program, which provides care coordination and disease management services for beneficiaries with complex or chronic health conditions. The renewed demonstration also reflects Oklahoma鈥檚 transition to the听SoonerSelect听managed care program, phases out the听Insure听Oklahoma Individual Plan, and incorporates updated federal requirements related to budget neutrality, monitoring, and program evaluation.
Private Market News
Fueled By
Wakely Wire: Medicare Advantage and ACA Markets Take Diverging Paths as Cost Pressures Persist
Moody鈥檚 reports that health insurers are taking increasingly different approaches to managing margin pressure across Medicare Advantage and ACA Marketplace businesses. While Medicare Advantage plans are relying on pricing and benefit changes to improve performance, ACA carriers are reevaluating market participation amid enrollment and risk pool challenges. Read the latest听听for actuarial insights into the trends shaping payer strategy and financial performance.听
Our Insights
Fueled By Experts Across Our 红领巾瓜报 Companies
红领巾瓜报
Webinar: Modernizing and Streamlining Health Plan Prior Authorization (Sept. 9)
During听this webinar,听leaders听from 红领巾瓜报 and NTT DATA will explore the common sources of friction and inefficiency in prior authorization (PA) processes and discuss how modern technology, including artificial intelligence (AI), can help streamline PA operations, improve compliance, and enhance the experiences for health plans, providers, and members. Attendees will gain insights into the evolving regulatory landscape, the root causes of PA administrative burden, and practical strategies for听leveraging听IT modernization to create more efficient, transparent, and effective prior authorization workflows.
Webinar Replay 鈥� Advancing Community Health Through CHWs: Research, Recommendations, and Action
Community Health Workers (CHWs) play a critical role in connecting communities to trusted health information, services, and resources. In this webinar, 红领巾瓜报 (红领巾瓜报) presented findings from its research examining how health-related information reaches, is interpreted by, and flows through Community Health Workers in Cook County, Illinois. Participants learned about 红领巾瓜报鈥檚 key findings and recommendations for strengthening health information systems, elevating the value of the CHW workforce, and advancing partnerships that support equitable, community-centered care.
Wakely
Quantifying the Care Continuity Gap: A $569M Analysis of ACA Marketplace SUD Spending
A听new joint analysis from Sober Sidekick and Wakely Consulting Group, an 红领巾瓜报 Company,听shows that health plans spend $3.64 on acute stabilization and short-cycle services for every $1 spent on services that support sustained recovery in SUD.听听The analysis found that 51.5% of spending went to acute stabilization and short-cycle services, while 14.1% went to sustained recovery services. ED care represented the largest single concentration of spending at $127.9 million.听The brief estimates听the听opportunity if spending shifts toward recovery sustaining services.
红领巾瓜报 Conference 2026
Signals, Signs & Flashing Lights | October 5-7 | New Orleans
RFP Calendar
RFP Calendar
| Date | State/Program | Event | Beneficiaries |
|---|---|---|---|
| Date: Summer 2026 | State/Program: Illinois Foster Care | Event: RFP Release | Beneficiaries: 33,000 |
| Date: July 28, 2026 (Delayed) | State/Program: Nevada Children's Specialty | Event: Awards | Beneficiaries: NA |
| Date: November 6, 2026 | State/Program: Indiana | Event: Proposals Due | 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 2027 | State/Program: Indiana | Event: Awards | Beneficiaries: 1,400,000 |
| Date: July 1, 2027 | State/Program: Nevada Children's Specialty | Event: Implementation | Beneficiaries: NA |
| Date: September 2, 2026 | State/Program: Missouri | Event: Proposals Due | Beneficiaries: 1,000,000 |
| Date: Fall 2027 | State/Program: Oregon | Event: RFP Release | Beneficiaries: 1,200,000 |
| Date: January 1, 2028 | State/Program: Wisconsin LTC GSR 4,6 | Event: Implementation | Beneficiaries: 56,000 (all GSR) |
| Date: 2028 | State/Program: North Carolina | Event: RFP Release | Beneficiaries: 2,200,000 |
| Date: 2029 | State/Program: California | Event: RFP Release | Beneficiaries: NA |
| Date: January 1, 2029 | State/Program: Indiana | Event: Implementation | Beneficiaries: 1,400,000 |