Manatt Health outlines strategic approaches for states to deploy Rural Health Transformation Program funding—a five-year, $50 billion federal investment distributing roughly $1 billion per state—with emphasis on creating infrastructure that outlasts the program itself. The piece advocates for hub-and-spoke telehealth networks, workforce pipeline investments, and value-based payment models as mechanisms to address rural access gaps while generating sustainable Medicaid reimbursement. For Medicaid MCOs and state directors, this represents both a capital infusion into struggling rural networks and an opportunity to restructure how Medicaid beneficiaries access specialty and hospital care in underserved areas.

Sellers Dorsey analyzes nearly 200 stakeholder comments submitted to CMS regarding the CRUSH Request for Information, which proposes sweeping changes to Medicaid program integrity oversight including restrictions on intergovernmental transfers, supplemental payments, state-directed payments, provider enrollment screening, and eligibility verification. The firm's summary provides Medicaid officials and MCO compliance teams insight into how various stakeholders are responding to proposed federal oversight expansions that could fundamentally reshape Medicaid financing mechanisms and regulatory requirements for states and health plans.

Sellers Dorsey has released a practical guide addressing why most Dual Eligible Special Needs Plans still struggle to achieve full coordination between Medicare and Medicaid benefits, despite that being their core design intent. The playbook identifies specific operational barriers health plans face and provides concrete implementation strategies to overcome coordination gaps, directly relevant to MCOs managing dual-eligible populations and state Medicaid agencies overseeing D-SNP contracts.

Sellers Dorsey's analysis of 40 governors' proposed FY2027 budgets reveals emerging themes that will shape Medicaid managed care operations, including budget pressures driving spending cuts, workforce pay adjustments, and targeted investments in behavioral health and children's services. The review provides MCO executives and state Medicaid directors an early look at policy priorities before legislatures finalize budgets this summer, helping plans anticipate rate pressures, program changes, and investment opportunities across states.

Sellers Dorsey experts argue that Medicaid can serve as a primary prevention tool against child abuse and neglect by funding upstream interventions including behavioral health treatment, home visiting programs, and postpartum depression screening for at-risk parents. The discussion frames child maltreatment prevention as a multi-sector healthcare challenge rather than solely a child welfare issue, emphasizing how managed care organizations and state Medicaid programs can support families experiencing substance use disorders, mental health conditions, and other stressors that compromise parenting capacity before crises escalate.

A Manatt-supported health technology convening found that while AI reduces individual health plan costs for prior authorization and medical coding, it increases transaction volume system-wide and may drive up overall spending. Provider AI tools are inflating billing intensity, prompting plans to respond with blanket downcoding and reimbursement cuts, though their effectiveness remains unclear. The analysis suggests reimbursement policy changes offer stronger levers for administrative efficiency than technology alone.

Health care investors are showing renewed interest in home- and community-based services as a strategy to reduce costs for high-complexity Medicaid populations, particularly those requiring long-term services and supports. The investor focus reflects both emerging regulatory clarity and a shift toward care models that can demonstrate near-term return on investment rather than long-horizon value-based arrangements. While the piece addresses broader health care investment trends, it identifies Medicaid LTSS as a specific area where institutional capital sees opportunity to bend the cost curve.

Milliman's analysis of 2026 Medicare Advantage data reveals that D-SNP enrollment growth remains minimal outside of states transitioning Medicare-Medicaid Plans, while plans increasingly use C-SNPs to enroll dual eligibles and sidestep state Medicaid agency contracting requirements. The trend reflects MAO responses to tightening CMS integration requirements and state policies limiting D-SNP availability, with implications for how dual eligibles access coordinated Medicare-Medicaid benefits. The shift raises questions for state Medicaid agencies about care coordination oversight and whether dual eligibles in C-SNPs receive comparable integration as those in contracted D-SNPs.

The $50 billion Rural Health Transformation Program is moving from federal framework to state-level implementation, with significant state flexibility in designing models across five strategic areas including workforce, access, and digital capabilities. While the program targets rural providers broadly, states' implementation choices will affect Medicaid managed care operations in rural markets, particularly around network adequacy, alternative payment models, and care delivery innovation. Providers are advised to align early with state priorities and begin operational planning as program details crystallize.

Dual Eligible Special Needs Plans were designed to seamlessly coordinate Medicare and Medicaid for beneficiaries, but most health plans remain far from achieving this operationally. Medicaid-dominant plans bring strong LTSS and community relationships but lack Medicare Star rating and risk adjustment expertise, while Medicare-focused plans excel at utilization management but struggle with state oversight and community-based service coordination. The article argues this structural mismatch between organizational capabilities and D-SNP requirements remains the defining operational challenge for plans serving dually eligible populations.

The piece argues that Medicaid-financed healthcare encounters—from pregnancy through early childhood—represent underutilized prevention opportunities to identify family risk factors and connect vulnerable families to services before child maltreatment occurs. It highlights specific Medicaid payment strategies (value-based care, bundled maternity payments) and care delivery models that support early identification of maternal behavioral health needs, housing instability, and other social determinants that can lead to neglect or abuse. The analysis is directly relevant to MCO care management strategies, provider network design, and how states structure maternity and pediatric benefit packages to achieve cross-system outcomes.

Milliman examines how state Medicaid agencies and managed care plans can leverage HHS's newly released open-source dataset of provider-level Medicaid spending from 2018-2024, which includes service-level payments across both fee-for-service and managed care. The analysis identifies four strategic applications including contract negotiation support, fraud detection, network adequacy planning, and benchmarking—while noting data limitations and interpretation challenges MCOs should consider when using national aggregated claims data for operational decisions.

A new California Health Care Foundation report co-authored by Manatt reveals that approximately half of county behavioral health, public health, and social services agencies have minimal or no electronic data exchange with healthcare partners, with 71% of behavioral health agencies unable to receive hospital alerts for mental health emergencies. The research identifies four priority areas—technology standards, workforce, financing, and policy guidance—to address fragmentation that particularly affects Medicaid enrollees with complex needs. These findings are directly relevant to California Medicaid managed care plans that contract with counties for behavioral health services and must coordinate care across siloed systems.

CMS is overhauling kidney care through transplant system modernization, new organ procurement standards, and the mandatory IOTA Model launched in mid-2025, while simultaneously sunsetting underperforming value-based care models like ESRD Treatment Choices. The piece examines how federal payment reforms, emerging xenotransplant technology, and refined Kidney Care Choices models are reshaping the dialysis and transplant ecosystem. While primarily Medicare-focused, these structural changes affect Medicaid managed care plans covering dual-eligible populations and states with integrated care models for members with end-stage renal disease.

Manatt Health and two Telehealth Centers of Excellence examine how artificial intelligence can streamline provider-to-provider electronic consultations in Medicaid and CHIP, which became reimbursable in 2023 but face adoption barriers from workflow burden and billing constraints. The analysis argues AI integration could reduce administrative friction, expand specialty access in underserved areas, and help Medicaid managed care organizations scale asynchronous specialty consultation programs more effectively. This is part of a four-brief series exploring AI applications across telehealth use cases relevant to payer and provider strategy.

This piece outlines six implementation requirements for hospitals entering global budget arrangements, which shift traditional insurance risk from health plans to provider systems. While focused primarily on Medicare models like CMS's AHEAD program and state all-payer demonstrations, the shift affects how Medicaid managed care organizations structure provider contracts and share risk. MCO compliance and finance teams should understand these models as they increasingly appear in Medicaid alongside Medicare and commercial payers.

Manatt outlines operational and compliance considerations for state Medicaid agencies as they design consumer notices for new federal work reporting requirements under H.R. 1. The piece emphasizes that poorly designed notices have historically contributed to inappropriate coverage loss and increased administrative burden, and urges states to invest in plain-language, user-tested communications before rolling out new outreach and non-compliance notices. For MCOs partnering with states on eligibility operations or member communications, this guidance offers practical design principles to support continuity of coverage.

The 2026 CMS Quality Conference outlined major policy directions affecting both Medicare and Medicaid managed care, emphasizing prevention-focused models, technology-enabled whole-person care, real-time quality measurement, and AI integration. CMS leadership signaled that quality strategies will increasingly prioritize upstream preventive interventions and align payment incentives with clinical outcomes, requiring health plans to demonstrate how their programs contribute to prevention and reduce downstream utilization. These emerging federal priorities will shape how Medicaid MCOs structure their quality improvement programs, demonstrate value, and respond to evolving state contract requirements.

Milliman explains why state savings from Medicaid enrollment reductions are often overstated in managed care environments. When lower-cost members disenroll—such as through work requirements—average capitation rates rise because the remaining enrolled population becomes sicker and more expensive, meaning states don't save the full per-member capitation amount. The firm provides an interactive modeling tool to help states understand the complex fiscal dynamics of eligibility changes, including federal match implications, MCO tax structures, and administrative costs.

The piece examines how Medicaid 1115 waivers evolved over the past decade from narrow pilots to comprehensive program frameworks encompassing managed care, behavioral health integration, and LTSS redesign. It reviews what worked—particularly improved access to SUD treatment and mental health services—while noting the administrative complexity, budget neutrality pressures, and increased federal scrutiny states now face. The analysis is directly relevant to MCO executives and state Medicaid officials navigating waiver renewals, expansions, and changing federal policy.