September 3, 2025
This week's roundup:
- In Focus: States Begin to Engage with the Rural Health Transformation Program
- 红领巾瓜报 National Conference: Catalyst for Collaboration, Innovation, and Impact
- Colorado Governor to Reverse Medicaid Rate Increases Amid Budget Deficit
- Hawaii Issues Community Care Services Behavioral Health RFI
- Massachusetts To Receive $12.25 Million Settlement from CVS over Medicaid Drug Pricing
- New York Faces $10 Billion Deficit Increase Over Two Years as Federal Cuts Threaten Medicaid Coverage
- Tennessee Medicaid Program Now Covers Obesity Management Medication
- Texas Medicaid Joins Cell and Gene Therapy Access Model
- CMS AHEAD Model Extended to 2035 with New Requirements for States
- Cigna鈥檚 Evernorth Health Invests $3.5 Billion in Shields Health Solutions
In Focus
States Begin to Engage with the Rural Health Transformation Program
The Rural Health Transformation Program (RHTP) established in H.R. 1 represents one of the most significant federal investments in rural healthcare in decades. With $50 billion allocated between fiscal years 2026 and 2030, the program is designed to stabilize and transform rural health systems nationwide by supporting infrastructure, workforce development, and innovative care delivery models.
Administered by the Centers for Medicare & Medicaid Services (CMS), the RHTP requires each state to submit a one-time application detailing a comprehensive rural health transformation plan. These plans must address eight core priorities, including improving access and outcomes, leveraging technology, fostering regional partnerships, and ensuring long-term financial solvency for rural entities. The Centers for Medicare & Medicaid Services (CMS) has posted the , with application materials expected to become available in mid-September and state submissions due in late fall 2025.
The experts at 红领巾瓜报, including our Information Services team (红领巾瓜报IS), are tracking several state-level indicators and actions, including lead state agency points of contact, regulatory and public comment deadlines, and links to official notices. Following are the key takeaways from 红领巾瓜报IS State Action Tracker鈥攁 living resource for 红领巾瓜报IS subscribers, which will be updated with federal and state-level details such as state-selected RHTP categories and award amounts.
Initiative Alignment and Partner Engagement: Common Themes Across States
As of early September 2025, at least 15 states have begun structured intake to inform initiatives and uses of the RHTP funding鈥攔equests for information (RFIs), surveys, town halls, webinars鈥攚ith others maintaining a planning posture pending release of CMS鈥檚 application template.
Common themes and approaches emerging from these activities include:
- Category-aligned input. States are encouraging stakeholders to align proposals with the statute鈥檚 eligible activities (e.g., access, outcomes, technology/prevention, partnerships, workforce, data/IT, solvency). Examples include:
- requires submissions to identify which of the nine categories are addressed and to discuss outcomes and sustainability.
- Delaware and use structured prompts to sort feedback by activity type.
- Pre-guidance tools. States like and are using RFIs and statewide surveys to gather ideas and identify viable projects before CMS guidance is finalized.
- Tech-enabled care. New and expanded uses of technology are topics of interest to states that are seeking ideas on how to maximize investments in remote monitoring, artificial intelligence (AI)/robotics, data/analytics, and IT/cybersecurity as eligible investments for improving access to services, healthcare delivery, and workforce support. For example:
- explicitly references technology-enabled care models.
- and highlight health IT/cybersecurity and value-based purchasing.
- Local coordination. States are encouraging regional partnerships/community hubs and rebalancing or right sizing service lines to match local demand. and emphasize right sizing service lines and coordinated care across the continuum of pre-hospital, emergency, acute inpatient, outpatient, and post-acute services. solicitation prioritizes regionally coordinated partnerships and explicitly calls out right sizing the care continuum as a focus area. highlights strengthening partnerships between rural hospitals and other providers as a required component of the state plan.
- Sustainability and value-based readiness. States are asking how projects will be sustained after federal funding ends and how these can support and sustain alternative payment models. and request implementation details and financial durability plans. prompts discussion of how proposals enable care coordination and payment reform.
Looking Ahead
The emerging national landscape for RHTP initiatives is mixed. Early state movers and their engaged partners are building momentum and reducing execution risk, while others are preserving flexibility until additional federal guidance arrives. States waiting on CMS鈥檚 template may face challenges in coordinating stakeholders and finalizing priorities before the application deadline.
For providers and community-based organizations (CBOs), now is a critical time to engage. These organizations are uniquely positioned to shape state applications by sharing on-the-ground insights, identifying unmet needs, and proposing scalable, sustainable solutions. Participating in state RFIs, surveys, and town halls allow providers and CBOs to inform how funding is prioritized and deployed.
To prepare for the RHTP resources and support, healthcare organizations should:
- Monitor state-level engagement opportunities and respond to RFIs or surveys with clear, category-aligned proposals
- Build or strengthen partnerships with other local organizations to demonstrate regional coordination
- Assess internal capacity to implement and sustain projects beyond the federal funding window
- Document outcomes and financial models that support long-term viability and alignment with value-based care
Connect with Us
To support transparency during this fast-moving period, 红领巾瓜报IS has launched the RHTP State Action Tracker, a centralized resource for curating each state鈥檚 actions, agency leads, deadlines, and links to official notices. The tracker will be updated as CMS guidance is released and as states fill in details, such as selected categories and award amounts. For details about the RHTP, including the 红领巾瓜报IS State Action Tracker, contact 红领巾瓜报 experts Alessandra Campbell, Andrea Maresca, Gabby Palmieri, and Greg Uszak.
红领巾瓜报 National Conference: Catalyst for Collaboration, Innovation, and Impact
Amid the rapid changes in health policy, 红领巾瓜报 (红领巾瓜报), is convening its Eighth National Conference, , October 14鈥�16, 2025, in New Orleans, LA. This year鈥檚 event promises to be a dynamic forum for policy leaders, providers, payers, and innovators to shape the future of publicly financed healthcare.
Why Moderators Are Excited
红领巾瓜报鈥檚 conference moderators are energized by the opportunity to foster meaningful dialogue and share actionable insights. Warren Brodine, Managing Director, 红领巾瓜报 Delivery Systems Practice, expressed these sentiments:
鈥淚鈥檓 looking forward to the chance for people to tackle the toughest problems in healthcare today. I love that the conference isn鈥檛 just speeches. The environment allows everyone to think differently and explore creative solutions鈥�
Warren also emphasized the unique structure of his main stage session, From Gridlock to Growth: Advancing Population Health Through Resilient System Design:
鈥淲e have the regulator, the plan, and the provider. Together, we鈥檒l explore the interplay of all three and how they can learn from each other to maximize outcomes鈥攁nd maximize financial benefits for all parties.鈥�
Teresa Garate, Managing Director, 红领巾瓜报鈥檚 Behavioral Health Practice, who will moderate a session on October 16, shared her enthusiasm for the diversity of perspectives that will be presented, noting:
鈥淵ou鈥檒l hear from a large commercial insurance payer, a for-profit psychiatric hospital system CEO, and a state commissioner鈥攁ll responding to potential changes in regulations, eligibility, and coverage. Each plays a distinct role in ensuring behavioral health remains accessible to all.鈥�
Loren Anthes, a member of the team affiliated with 红领巾瓜报鈥檚 Ohio office is hosting a conversation over coffee, Connecting Plans and People: Building Sustainable MCO-CBO Collaborations. In his preparations for the event, he highlighted the spirit of shared purpose that defines the 红领巾瓜报 conference:
鈥淐ollaboration and communication bring seemingly disconnected partners together鈥攅specially in times of uncertainty. Kelly [O鈥橰eilly, CEO of the Ohio Association of Health Plans] leads with kindness and ensures diverse perspectives find common ground.鈥�
Loren also highlighted the spirit of shared purpose that defines the 红领巾瓜报 conference, saying, 鈥淚f you鈥檝e seen one state鈥檚 Medicaid program, you鈥檝e seen one state鈥檚 Medicaid program鈥攂ut if you鈥檝e seen any American in need of healthcare, then you understand the responsibility we all share to serve them. Being around people who embrace that common cause with energy and creativity is what makes this conference special.鈥�
What to Expect
The conference will feature a robust agenda of plenary sessions and workshops, including:
- When the Ground Shifts: Publicly Financed Health Coverage and Policy in Motion
- Making Medicaid Work Requirements Work
- From Gridlock to Growth: Advancing Population Health Through Resilient System Design
- Maintaining Behavioral Health Innovation Momentum in a Complex Environment
Confirmed speakers include senior leaders from the Centers for Medicare & Medicaid Services (CMS), state Medicaid and Health and Human Services agencies, health plans, and community-based organizations.
Join the Conversation
The 红领巾瓜报 National Conference is more than a gathering鈥攊t’s a catalyst for collaboration, innovation, and impact. Whether you’re shaping policy, delivering care, or designing systems, this is your opportunity to engage with peers who share your commitment to improving publicly financed healthcare.
Join us and be part of the conversation that鈥檚 driving change across Medicare, Medicaid, and Marketplaces. For more information about the event, contact Andrea Maresca, Managing Director, 红领巾瓜报 Information Services.
红领巾瓜报 Roundup
Colorado
Colorado Governor to Reverse Medicaid Rate Increases Amid Budget Deficit. The Colorado Sun听听on August 28, 2025, that Colorado Governor Jared Polis will be reversing the state鈥檚 plan to increase reimbursement rates for Medicaid providers in an effort to address the approximate $750 million state budget deficit. Without the 1.6 percent rate hike, Colorado will save approximately $38 million. Governor Polis will present the planned cut to the legislature鈥檚 Joint Budget Committee. The announcement comes after the Colorado legislature passed a bill during the special session that cedes budget cutting to the governor鈥檚 office.
Hawaii
Hawaii Issues Community Care Services Behavioral Health RFI. The Hawaii Department of Human Services听听on September 2, 2025, a Request for Information (RFI) to prepare for the re-procurement of the Community Care Services (CCS) program, which provides intensive behavioral health services for Medicaid members with serious mental illness. The state is seeking feedback on topics such as standardization, integration with physical health, strengthening the behavioral health continuum, reimbursement approaches, and telehealth. Responses are due September 15, 2025. The current incumbent is Centene/Ohana Health Plan.
Massachusetts
Massachusetts To Receive $12.25 Million Settlement from CVS over Medicaid Drug Pricing. The Massachusetts Attorney General Andrea Joy Campbell听听on August 27, 2025, a $12.25 million settlement with CVS Pharmacy to resolve allegations that the company overcharged MassHealth by not applying its lowest available drug prices. The settlement stems from claims that CVS offered lower rates through a discount program run by ScriptSave but failed to extend those prices to MassHealth, violating the state鈥檚 鈥淢ost Favored Nation鈥� drug pricing rule. In addition to paying MassHealth, CVS will implement an annual reconciliation process to prevent future overcharges. The case was part of a multistate action.
New York
New York Faces $10 Billion Deficit Increase Over Two Years as Federal Cuts Threaten Medicaid Coverage. Crain鈥檚 New York Business听听on August 29, 2025, that New York State Comptroller Thomas DiNapoli warned that federal health care cuts could deepen the state鈥檚 $34 billion deficit by another $10 billion over the next two years. The reductions, tied to President Trump鈥檚 new budget bill, target Medicaid, food stamps, and the state鈥檚 Essential Plan potentially leaving over 2 million New Yorkers at risk of losing coverage, including 1.5 million becoming uninsured. Governor Kathy Hochul has said the cuts could drain nearly $13 billion annually from New York鈥檚 health care system, but she has ruled out tax hikes.
Tennessee
Tennessee Medicaid Program Now Covers Obesity Management Medication. The Tennessee Division of TennCare听听on August 26, 2025, that TennCare, the state鈥檚 Medicaid program, will cover obesity management medications for both adults and children, with drugs subject to interim prior authorization (PA) and quantity limits, effective August 1, 2025. Several agents, including phentermine, orlistat, and phentermine/topiramate, will be preferred without PA, while Wegovy and Zepbound will be preferred with PA. Others, such as Saxenda, Imcivree, and Evekeo, will be non-preferred.
Texas
Texas Medicaid Joins Cell and Gene Therapy Access Model. The Texas Department of Health and Human Services听听on August 25, 2025, that its Medicaid program will join the federal Cell and Gene Therapy (CGT) Access Model, giving eligible enrollees access to treatments for sickle cell disease, starting September 1, 2025. The model covers two therapies, Lyfgenia (bluebird bio) and Casgevy (Vertex Pharmaceuticals) and uniquely provides fertility preservation services at no cost, paid for by drug manufacturers. Providers must register with the Center for International Blood and Marrow Transplant Research (CIBMTR) and follow billing rules. The initiative aims to expand access to lifesaving one-time gene therapies while ensuring continuity of care across Medicaid managed care and fee-for-service programs.
National
CMS AHEAD Model Extended to 2035 with New Requirements for States. The Centers for Medicare & Medicaid Services (CMS)听听policy and operational changes to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model, extending its end date to December 31, 2035. Beginning in January 2026, all participating states will gain new tools to manage Medicare costs, improve quality, and advance preventive care through a Population Health Accountability Plan. States will also be required to implement at least two policies that promote choice and competition. The updates introduce payment reforms, transparency requirements, and for the first time, total cost of care (TCOC) accountability for all Original Medicare beneficiaries in AHEAD regions, aiming to strengthen competition, prevention, and population health while lowering costs.
Industry News
Cigna鈥檚 Evernorth Health Invests $3.5 Billion in Shields Health Solutions. Evernorth Health Services, a subsidiary of the Cigna Group,听听on September 2, 2025, a $3.5 billion investment in Shields Health Solutions, a specialty pharmacy management company that recently became a standalone business after Walgreens Boots Alliance鈥檚 acquisition by private equity firm Sycamore Partners. Shields, which partners with more than 80 health systems and 1,000 hospitals nationwide, helps providers develop and manage specialty pharmacies. Evernorth said the investment, structured as preferred stock, will not affect Cigna鈥檚 2025 earnings guidance.
RFP Calendar
Actuaries Corner
.听MA pays 10% to 15% less than what is paid by the government in original Medicare, report says. Editor’s Note:听Since 2016, Medicare reimbursement rates for outpatient procedures have decreased yearly. This has led to an overall decline of about 10%, while inflation has been continuously increasing.
Discover other developments in the Wakely Wire .
红领巾瓜报 News & Events
红领巾瓜报 Webinar
Navigating Medicaid Managed Care Shifts: Financial Pressures, Federal Policy, and Medicaid MCO Implications. Wednesday, September 17, 2025, 12 PM ET. Medicaid managed care organizations face mounting pressure as enrollment patterns shift, federal policy evolves, and state budgets tighten. In this timely webinar, experts from 红领巾瓜报, Wakely, an 红领巾瓜报 Company, and 红领巾瓜报鈥檚 Information Services team will share exclusive analysis of Medicaid Managed Care Organization (MCO) financial performance, explore the implications of HR 1 and other federal policies, and offer State and MCO perspectives. This webinar is for Medicaid managed care leaders, state officials, vendors, budget officers, and investors navigating financial pressures and policy shifts.
红领巾瓜报 Podcast
What Should Quality in Healthcare Really Mean Today? Quality is a word we all use in healthcare, but what does it truly mean for patients, clinicians, and systems striving to improve care? In this episode of Vital Viewpoints on Healthcare, , principal at Leavitt Partners, an 红领巾瓜报 company, and a nationally recognized expert in healthcare quality unpacks how quality has been defined and measured over the years, why measurement sometimes gets in the way of improvement, and how digital interoperability will more accurately capture true drivers of quality. Sarah also shares why engaging patients in defining their goals and outcomes is essential to creating measures that reflect what really matters in people鈥檚 lives.
NEW THIS WEEK ON 红领巾瓜报 INFORMATION SERVICES
(Exclusive Access for 红领巾瓜报IS Subscribers):
红领巾瓜报IS Medicaid Market Overviews, Reports, and Data
- New H.R. 1 Rural Health Transformation Program State Tracker
- Updated 红领巾瓜报 Federal Health Policy Snapshot
- New Medicaid enrollment, RFP documents, and other market intelligence resources for dozens of states
A subscription to 红领巾瓜报 Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services.
If you鈥檙e interested in becoming an 红领巾瓜报IS subscriber, contact Andrea Maresca at听[email protected].