This retrospective examines the Early and Periodic Screening, Diagnostic, and Treatment benefit's comprehensive care standards for Medicaid enrollees under 21, including how it guarantees preventive and medically necessary services beyond typical adult coverage. The analysis addresses current operational challenges for managed care plans, including eligibility disruptions, provider network adequacy for pediatric specialty care, and MCO performance measurement around EPSDT compliance. It positions EPSDT's expansive benefit design as a foundational compliance requirement for Medicaid MCOs serving children and CHIP populations.

HHS has revised its interpretation of the 1996 welfare reform law to broaden what constitutes a "federal public benefit," immediately making non-citizens who don't meet qualified alien status ineligible for a wider array of HHS programs. For Medicaid managed care organizations, this policy shift will likely affect enrollment, eligibility verification processes, and member populations, particularly in states with significant immigrant communities. MCOs and state Medicaid agencies will need to understand which programs are newly restricted and prepare operational changes before the August 13 comment period closes.

Children in the child welfare system face fragmented care across multiple systems—Medicaid, foster care, behavioral health, education—with frequent placement changes disrupting medical homes and treatment continuity. Health plans can bridge these gaps through integrated care models, specialized provider networks for trauma-informed and behavioral health services, and improved data sharing with child welfare agencies. The piece argues MCOs are uniquely positioned to coordinate across agencies and address the severe shortage of child-focused behavioral health providers serving this high-need population.

Sellers Dorsey marks Medicaid's 60th anniversary by highlighting key policy expansions including 12-month continuous eligibility for children, extended postpartum coverage, and the shift toward value-based care models. The firm acknowledges that while these milestones have expanded access and improved outcomes, the program now faces "major policy changes" following passage of H.R. 1, creating uncertainty for state programs and managed care organizations navigating the budget reconciliation landscape.

The piece argues that fragmented behavioral health delivery—especially in states where mild-to-moderate and serious mental illness care are split between entities—creates dangerous gaps that push people into crisis and homelessness. It calls for a paradigm shift toward community-based early intervention, integration with physical health, and culturally responsive care models that prevent decompensation rather than only responding to acute episodes. For Medicaid MCO compliance teams and state directors, this frames core challenges in behavioral health carve-in versus carve-out models and the case for upstream investment in social supports.

Sellers Dorsey explores how federally qualified health centers can serve children and families in the child welfare system through comprehensive medical, behavioral health, and substance use services. The discussion covers partnership opportunities including referral agreements and care coordination protocols between child welfare agencies and FQHCs. This matters for Medicaid managed care because many children in child welfare are Medicaid-enrolled and coordination between these systems affects utilization, outcomes, and network adequacy for vulnerable populations.

Sellers Dorsey has released a comprehensive playbook guiding states, managed care organizations, and vendors through the design and implementation of Medicaid work and community engagement requirements. Drawing on insights from former state Medicaid directors, the framework addresses operational considerations, compliance strategies, and lessons from previous work requirement initiatives. This resource is directly relevant to MCO compliance teams and state officials preparing for potential federal policy shifts around beneficiary eligibility conditions.

Sellers Dorsey has released an interactive map providing child welfare agency leadership contacts, program structures, and resources across all states to help managed care organizations and providers identify partnership opportunities. The tool is designed to streamline business development and collaboration efforts for MCOs seeking to work with child welfare systems, including potential pilot programs and subcontracting arrangements. This resource addresses a common challenge for Medicaid MCOs navigating the complex landscape of state child welfare agencies, particularly as more states integrate health and welfare services.

This report compiles governor-proposed budgets for fiscal year 2026 with focused attention on Medicaid spending plans across states. The compilation provides state-by-state intelligence on how Medicaid programs are being funded and prioritized in the upcoming budget cycle, along with related spending on social determinants like housing and workforce development. For MCO executives and state Medicaid directors, this offers strategic insight into upcoming rate-setting cycles, program expansions or contractions, and budget pressures that will shape contract negotiations and program design.

CMS has issued a proposed rule that would prohibit states from imposing higher provider tax rates on Medicaid managed care services compared to commercial services, addressing concerns that current tax structures undermine redistributive goals. The rule would require states seeking waivers from broad-based or uniform tax requirements to meet both existing statistical tests and new redistributive standards that prevent targeting Medicaid revenue. This proposal directly impacts state Medicaid financing strategies and MCO tax obligations, with transition periods for existing waiver arrangements.

Sellers Dorsey compiles state-specific impact analyses from nine states examining how potential federal Medicaid funding cuts could affect healthcare systems, coverage, and state economies. The resource aggregates recent state reports and links to supplementary analysis from KFF on enrollment and Commonwealth Fund on related SNAP funding impacts. This compilation serves as a centralized reference for managed care organizations and state officials navigating potential federal policy changes and their fiscal consequences.

This policy tracker monitors five significant federal Medicaid reform proposals currently under consideration: limitations on provider taxes, restrictions on state-directed payments, per capita cap proposals, FMAP reductions, and work requirement expansions. Each represents a potential structural change to Medicaid financing or coverage that would directly affect how states fund programs and how MCOs operate, with implications for rate-setting, provider networks, enrollment, and revenue streams.

This piece outlines practical strategies for aligning Medicaid managed care operations with state child welfare systems to serve foster children more effectively. It advocates for integrated care models using Section 1115 waivers, specialized care coordination roles, cross-agency data sharing agreements, and MCO contracting requirements that address the unique needs of children in foster care. The recommendations are directly actionable for state Medicaid directors and MCO executives managing populations with complex behavioral health and coordination needs.

This panel discussion examines the role managed care organizations can play in improving outcomes for children involved in the child welfare system, a population predominantly covered by Medicaid. The webinar explores strategies for MCOs to better coordinate care and address the complex health needs of this vulnerable population. Given the high Medicaid enrollment among foster children and families involved with child welfare services, this content directly addresses managed care plans' responsibilities for a key member population.

This piece argues that technology innovations—particularly predictive analytics, AI-driven risk stratification, and telehealth expansion—offer critical pathways for Medicaid programs to improve care coordination, address social determinants of health, and reach underserved populations more effectively. It emphasizes how data integration between MCOs, state agencies, and providers can reduce administrative burden while enabling proactive interventions for high-risk enrollees. The analysis is directly relevant to MCO compliance teams implementing these technologies and state Medicaid directors setting policy frameworks for their adoption.

California's decade of child welfare reforms—including priority placement with families over institutions and expanded kinship care support—requires coordination across healthcare, education, and social services systems. For Medicaid managed care organizations, these shifts affect care for foster children and families receiving behavioral health services, though the piece focuses primarily on child welfare policy rather than Medicaid program specifics. The discussion of trauma-informed care, social determinants, and post-system support touches on areas where MCOs interface with child welfare agencies.

HHS has rescinded the Richardson Waiver, eliminating its longstanding commitment to seek public input before changing Medicaid policies. Because Medicaid is classified as a grant program under the Administrative Procedures Act, CMS may now adopt or revise managed care regulations without formal notice-and-comment periods unless other specific laws require it. This shift could significantly accelerate regulatory changes affecting MCOs and state Medicaid programs, though the extent to which CMS will use this authority remains unclear.

Healthcare providers serving children in foster care face significant challenges including incomplete medical records, behavioral health access barriers, and care disruptions from placement changes. The piece outlines specific strategies for MCOs and providers to leverage Medicaid EPSDT benefits, coordinate with child welfare agencies, and establish medical homes to address gaps—particularly critical given that 30% of foster children don't receive required screenings and 80% have mental health needs. It positions managed care organizations as key partners in creating specialized care models and reimbursement structures to support this vulnerable population.

A consulting firm helped Drexel University identify and access public funding mechanisms—likely including Medicaid supplemental payment programs and provider reimbursement strategies—to maintain operations at St. Christopher's Hospital for Children, a safety-net pediatric facility serving a medically underserved Philadelphia community. The case illustrates how Medicaid financing tools can be leveraged to sustain critical pediatric infrastructure serving vulnerable populations, though the piece is primarily a client testimonial rather than substantive policy analysis.

Sellers Dorsey has published a strategic guide based on California's approach to integrating health and social services within its Medicaid safety-net system, aimed at improving outcomes for underserved populations. The playbook provides actionable frameworks for safety-net leaders to implement similar transformation strategies in their own Medicaid programs. This is particularly relevant as states increasingly look to California's innovations—including CalAIM and whole-person care models—as templates for managed care delivery system reform.