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The Rural Health Transformation Program: Options to Address the Maternity Care Crisis

This article is part of 量子资源网鈥檚 Weekly Roundup series on the RHT Program, highlighting key opportunities and considerations for states and healthcare organizations.

The Centers for Medicare & Medicaid Services (CMS) recently launched the , which is intended to help states reimagine and rebuild rural healthcare delivery. As outlined in our earlier In Focus article, Rural Health Transformation Program Represents a One-Time Opportunity to Reshape Rural Care, this historic $50 billion federal investment provides states with flexibility to design and implement strategies that improve access, quality, and outcomes in rural communities.

As states develop their RHT applications, they can consider a range of approaches to address persistent gaps in care particularly in maternal health, where rural residents often face limited access to local services. A range of solutions is needed to expand and stabilize access to maternal care, given the shortage of close-to-home birthing care. This article explains one such option: investing in midwifery.

Maternity Care in Rural Communities

Maternity Care Deserts Driving a National Maternal Health Crisis

Families in rural communities鈥攁nd some urban communities鈥攆ace 鈥�,鈥� meaning they do not have access to a birthing facility or obstetric clinician. are another reality in rural communities, with additional closures projected. Even in larger communities where a hospital is open, obstetric services could be shut down. These deserts are a key driver of the national maternal health crisis. In , the March of Dimes (MOD) reported that 鈥渢wo in three maternity care deserts are rural counties (61.5%)鈥� and that 鈥渃ounties with low access to telehealth were 30% more likely to be maternity care deserts.鈥�

Midwifery as an Option for Rural Communities

are trained healthcare professionals who specialize in supporting women through typical, low-risk pregnancies. They provide care during pregnancy, labor, and the postpartum period. There are several types of midwives, each with different training and credentials. States determine which types of midwives may practice and under what conditions.

Expanding the midwifery workforce can be part of a broader strategy to improve access, particularly in rural areas where hospitals and obstetric providers are scarce. In some places, midwives already serve as a critical access point for maternal care in rural communities, with midwives attending to .

The Rural Health Transformation Program Can Help Address the Crisis

The strategic goals of the RHT, as outlined in the CMS application materials and Notice of Funding Opportunity (NOFO), are designed to guide states in transforming rural healthcare delivery. These goals are grounded in the statutorily approved uses of funds and must be explicitly addressed in each state鈥檚 RHT application.

Midwives have long contributed to expanding access to maternal care across diverse settings. For example, midwives can support preventive health by providing prenatal and postpartum care in community settings. Their integration into rural care teams may help sustain where hospitals and obstetric providers are limited. States may also consider workforce development strategies, such as expanding midwifery training and retention programs, and innovative care models鈥攊ncluding hub-and-spoke systems鈥攖hat incorporate midwives to improve coordination and person-centered experiences (Figure 1).

According to Ginger Breedlove, PhD, CNM, founder of , one of the nation鈥檚 leading , 鈥渕idwifery aligns with all strategic goals of the RHT program.鈥�

States may consider midwifery as one of many options to help build sustainable, community-centered maternity care systems that reflect the RHT Program鈥檚 vision for rural health transformation.

Figure 1. Midwifery Alignment with RHT Strategic Goals

RHT Strategic Goals	Midwifery Alignment
Make Rural America Healthy Again	Midwives support preventive, community-based maternal care and contribute to , such as higher rates of spontaneous vaginal delivery and breastfeeding and lower rates of preterm birth and low birthweight.
Sustainable Access	Midwives can serve as consistent local access points for maternity care, particularly in areas with limited obstetric services.
Workforce Development	Midwifery workforce initiatives of high-skilled providers practicing at the top of their license, aligning with goals to strengthen recruitment, retention, and licensure flexibility in rural areas.
Innovative Care	Midwives can be integrated into flexible care arrangements鈥攈ub-and-spoke or CMS鈥� model鈥攁longside doulas and community health workers, improving care coordination and patient experience.
Tech Innovation	Midwives can leverage telehealth, remote monitoring, and data-sharing and digital care platforms to extend the reach of maternal care in rural communities and connect patients to the broader maternal care system, including remote specialist consultations. Tech innovations ensure that women receive the appropriate level of care for their risk and needs.

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量子资源网 (量子资源网) has deep expertise in supporting states and healthcare organizations across all phases of rural health transformation. Our team can assist with strategy and writing grants, program design, and implementation plans tailored to specific state goals and approaches. Whether states choose to explore midwifery or other care delivery models, 量子资源网 can help define the approach that best fits the needs of rural communities and support organizations in transforming workflows and operations, implementing new initiatives, and enhancing the systems and IT enhancements that sustains them.

量子资源网 brings together experts in maternal health, finance, rural communities, and delivery systems, contact our experts below.

Coding, Coverage, and Reimbursement: Considerations for Women’s Health Access

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Persistent gaps in women’s health research, funding, clinical outcomes and access are increasingly well-studied, however less emphasis is placed on the role of coding, coverage, and reimbursement and whether male or female gaps exist in each of these key market access domains. The paper, Coding, Coverage and Reimbursement: Considerations for Women鈥檚 Health Access, examines challenges in these areas and offers recommendations to increase awareness, establish evaluative processes, and collaborative action to achieve incremental policy changes that can have a significant impact over time.

Navigating the Government Shutdown: Safeguarding the RHT and 鈥淢ake Rural America Healthy Again鈥� Initiatives

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As of October 1, 2025, federal budget negotiations have led to a temporary government shutdown, prompting healthcare leaders to monitor potential impacts on programs administered by the Centers for Medicare & Medicaid Services (CMS). While federal agencies have contingency plans in place, to date CMS has not announced any potential impacts, including to the timelines for the application and award dates for the Rural Health Transformation (RHT) Program.

State governments and healthcare leaders should continue to develop and prepare to submit their applications for the RHT program, which provides a significant opportunity to revitalize rural healthcare infrastructure through strategic investments in access, workforce, innovation, and technology.

Strategies for States to Efficiently Develop Winning Applications

To maintain momentum and optimize their resources during this period of uncertainty in federal government funding and operations:

1. Strengthen Internal Coordination

Establish cross-agency working groups to manage RHT program planning and execution
Use internal policy experts to interpret the Notice of Funding Opportunity (NOFO) guidance and align initiatives with CMS priorities

2. Leverage Existing Data and Evidence

Use state-level health data to identify high-impact areas for investment
Prioritize initiatives that align with the RHT program鈥檚 five strategic goals:
- Prevention and chronic disease management
- Sustainable access
- Workforce development
- Innovative care models
- Technology innovation

3. Utilize Project Management Tools

To support strategic planning and initiative tracking, 量子资源网 (量子资源网) is offering a free RHT Project Management Tool. This resource helps states:

Organize and manage initiative development
Cross-reference projects with NOFO categories
Track progress and performance metrics
Facilitate collaboration across stakeholders

Access the RHT Project Management Tool from 量子资源网:

Complete the form to download
the RHT Project Management Tool

Engage with CMS Resources Proactively

States and their partners can continue to refer to key CMS resources:

States can also submit questions to [email protected].

Final Thoughts

While the government shutdown presents challenges for many federal programs, it remains unclear whether there will be any direct impact on CMS鈥檚 engagement with states regarding the Rural Health Transformation Program. Regardless of federal circumstances, this moment highlights the value of state-level leadership and innovation. By leveraging tools like 量子资源网鈥檚 project management platform and aligning with CMS鈥檚 strategic goals, states can continue advancing rural health transformation and position themselves for success, even in uncertain times.

MAHA Children’s Health Strategy Report: Driving a New Era for Child Health Policy

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The September 2025 release of the “” marks a pivotal moment in the Trump Administration鈥檚 effort to address childhood chronic disease. Building on the work of the Make America Healthy Again (MAHA) Commission鈥攅stablished by in February 2025 and led by US Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr.鈥攖he Strategy Report provides a proposed road map for federal, state, and local action.

The MAHA child-focused Strategy Report is already driving the Trump Administration鈥檚 healthcare agenda. Though the report sets ambitious goals, public health entities, state governments, and other experts have raised concerns that several recommendations run counter to established scientific research or lack sufficient evidence.

In this article, 量子资源网 (量子资源网) experts highlight the areas of focus in the Make Our Children Healthy Again Strategy Report and offer specific recommendations, initiatives, and considerations for stakeholders. Earlier editions of In Focus have addressed the commission鈥檚 formation, initial assessment, and the administration鈥檚 growing focus on childhood health (Spotlight on Development of President Trump鈥檚 Children鈥檚 Health Strategy).

Key Components of the MAHA Strategy

Advancing Critical Research to Drive Innovation

The strategy identifies broad areas of research to inform healthy outcomes and positions HHS to direct initiatives in collaboration with the US Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and other agencies. Examples include:

Support the MAHA Chronic Disease Initiative, advance the Real-World Data Platform linking data from claims, electronic health records (EHRs), and wearables
Establish a working group on mental health diagnosis and prescription, led by several HHS agencies, to focus on SSRIs (selective serotonin reuptake inhibitors), antipsychotics, mood stabilizers, and stimulants
Study food for health, with the National Institutes of Health (NIH) Office of Nutrition coordinating research initiatives across HHS and the US Departments of Agriculture and Veterans Affairs (VA)
Identify opportunities to strengthen the use of repurposed drugs for chronic disease
Address vaccine injury data collection and analysis, as well as mental health research focused on screen time and prescription practices

Realigning Incentives and Systems to Drive Health Outcomes

The report recommends improvements to transparency and efficiency in regulatory processes to address nutrition, fitness, pharmaceuticals and vaccines, and care delivery and payment to address chronic disease. Specific initiatives include:

Updating the Dietary Guidelines for Americans and developing an 鈥渦ltra-processed food鈥� definition
Promote breastfeeding through the Special Supplemental Nutrition Program for Women, Infants, and Children
Updating hospital food service nutrition guidance
Developing options to get 鈥淢AHA boxes鈥� of healthy food to Supplemental Nutrition Assistance Program (SNAP) enrollees
Support states with SNAP waivers to encourage healthy food purchases among SNAP participants
Enhance oversight of direct-to-consumer pharmaceutical advertising and develop a new vaccine framework
Establish Medicaid managed care quality metrics for nutrition coaching and fitness, and work with states to develop prescribing safeguards for school-age children
Promote evidence-based prevention and wellness initiatives and restructure agencies to reduce conflicts of interest

Increasing Public Awareness and Knowledge

Major campaigns will involve:

Launching the “Make American Schools Healthy Again” initiative to assist states with promoting physical activity and nutrition in schools
Expanding education on environmental exposures, fluoride, and pesticide safety
Increasing awareness of opioid dangers, vaping, and screen time impacts
Training school and library staff to respond to opioid overdoses

Fostering Private Sector Collaboration

The strategy emphasizes the administration鈥檚 work to advance private sector partnerships aligned with MAHA priorities, including partnerships to achieve the following:

Improve nutrition in government-funded programs (schools, VA hospitals, prisons)
Support community-led initiatives to reduce chronic disease in children

Key Considerations for Partners and Stakeholders

Early engagement is critical as federal agencies begin implementing over 120 recommended actions.

States, providers, health plans, and community organizations should identify how their current approaches to children鈥檚 health could align with the MAHA initiative and strategy report, as well as where these new ideas might conflict with present policies. This assessment will identify opportunities to maximize new federal funding opportunities and additional resources.

Progress toward the Strategy Report鈥檚 specific goals will require coordinated efforts across agencies, sectors, and communities. Stakeholders should consider how and when to engage in research, policy development, and public awareness campaigns outlined in the report.

Connections to Trump Administration Priorities and Broader Opportunities

The report鈥檚 recommendations are already influencing federal agency actions and are driving congressional hearings and new legislation at the federal and state levels.

The US Department of Agriculture鈥檚 (USDA), for example, is working with states to approve SNAP waivers to restrict the purchase of junk food with federal benefits. 量子资源网 experts are tracking the SNAP waiver actions, and as of September 2025, a total of 12 states have received USDA approval for waivers that restrict the purchase of soda, candy, and other unhealthy foods with SNAP benefits. Other states are considering similar waivers, and the USDA is providing technical assistance to support these efforts.

The FDA has enhanced oversight of direct-to-consumer pharmaceutical advertising, including new enforcement activities and rulemaking on drug safety disclosures in ads. This approach aligns with MAHA recommendations and Trump Administration priorities for transparency and consumer protection.

HHS is also pursuing a new vaccine framework; however, states retain significant authority over school-based immunization requirements, and several are considering alternative approaches or maintaining broader vaccine recommendations than those outlined in the MAHA report. Recent legislative actions in some states seek to shift authority for determining school-based immunization requirements solely to the legislature, reflecting ongoing debate and federal-state dynamics.

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As implementation of the Make Our Children Healthy Again Strategy Report advances, all stakeholders must be ready to engage, partner, innovate, and drive change that will shape the future of child health.

量子资源网 guides state and local government, providers, plans and other partners through the multi-pronged strategies and recommendations in the report as well as the complexities of federal funding opportunities, such as the new Rural Health Transformation Program. We are helping state and local policymakers plan for MAHA and Trump Administration priorities, which includes guidance on how to leverage innovative approaches like SNAP waivers to promote healthy food access for children and families.

With deep expertise in policymaking and operational management, 量子资源网 consultants are enabling states and their partners to accelerate their work, build sustainable models for child health improvement, and position themselves to take advantage of new federal, state, and local policy opportunities driven by the MAHA report. To discuss questions about the impact of the report contact our experts below.

Rural Health Transformation Program Represents a One-Time Opportunity to Reshape Rural Care

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The Centers for Medicare & Medicaid Services (CMS) has officially opened the window for the (RHTP)鈥攁 $50 billion federal initiative designed to stabilize and transform rural health systems across the country. This one-time opportunity allows states to submit a comprehensive plan that could redefine how rural communities access care, manage chronic conditions, and sustain their healthcare infrastructure.

As outlined in our earlier In Focus article, , RHTP represents one of the most significant federal investments in rural health in decades.

Applications must be signed by governors and submitted by November 5, 2025, and awards are expected by December 31, 2025, providing states with a very narrow window to act.

The remainder of this article explains key aspects of the RHTP application, including the evaluation and scoring aspects. Notably, the structure of the scoring system will reward states that are already aligned with these , as well as those willing to implement new initiatives or make state policy changes to achieve alignment.

Program Overview and Funding Structure

Created under HR.1, the 2025 Budget Reconciliation Act, the RHTP allocates $10 billion annually from federal fiscal year (FY) 2026 to FY 2030, totaling $50 billion over five years. Funding is split into two tranches:

Tranche 1 (Baseline funding): $25 billion distributed evenly听across all states with approved applications.
Tranche 2 (Workload funding): $25 billion distributed based on CMS scoring criteria, which include:
- The percentage of the state population in rural census tracts
- The proportion of rural health facilities in the state
- The financial and operational status of hospitals
- Other factors explained in the RHTP application notice

States must submit a single, one-time that covers the full five-year period. Stand-alone provider applications will be declined. Hence, states must coordinate across agencies, providers, and stakeholders to develop a unified transformation strategy.

Importantly, this award is not a grant; rather, it is a cooperative funding agreement, which means CMS will play an active role in oversight and collaboration. States must be prepared to meet higher standards of accountability, transparency, and performance monitoring. According to the RHTP application, continued funding requires states to demonstrate satisfactory progress toward implementing their plan.

Application Requirements and Strategic Priorities

To be eligible for funding, states must submit a Rural Transformation Plan that addresses eight core priorities as follows:

Within these core priorities, state plans must propose activities that address several specific issues.

Technical Factor Weighting for Workload Funding Reflects Federal Policy Priorities

CMS outlines the eligibility criteria for baseline funding and the scoring components for workload funding. Baseline funds will be distributed equally among states, while workload funding will be based on each state’s rural facility and population score as well as their technical score. Evaluators will score technical factors based on state policy actions and initiative-based plans for each state.

The technical factors, and the weighting of these factors, in the RHTP application are not just neutral scoring mechanisms; rather, they are closely linked to the Trump Administration鈥檚 health policy priorities.

Weighting Structure: The RHTP funding is split evenly between baseline funding (50%) and workload funding (50%). Although baseline funding ensures all states receive support, the workload funding is directly tied to technical scores that reflect how well a state鈥檚 plan aligns with federal objectives and demonstrates readiness to implement transformative change that furthers federal objectives.
Scoring Criteria: Technical factors, such as rural population share, facility density, hospital financial status, scope of proposed activities, administrative capacity, stakeholder engagement, evaluation framework, and especially alignment with federal priorities, all contribute to the overall score. States that have already adopted or are willing to adopt federal policy priorities are positioned to score higher and receive more funding.
Annual Recalculation: CMS will recalculate each state鈥檚 technical score and workload funding annually to incentivize ongoing alignment with federal priorities and measurable progress toward transformation goals.
Alignment with Federal Priorities: One of the explicit scoring factors is 鈥淎lignment with Federal Priorities,鈥� which measures the degree to which a state鈥檚 plan supports CMS goals for rural health transformation and sustainability. Under the Trump Administration, these priorities may include promoting value-based payment models, encouraging technology adoption, advancing adoption of Supplemental Nutrition Assistance Program (SNAP) food restriction waivers that prohibit the purchase of non-nutritious items, availability of integrated care plans for the Medicare-Medicare dually eligible population, reporting of full Medicaid T-MSIS data, and align policies with federal guidance on short-term limited duration insurance plans.

Preparing for What Happens Next: Implications for States, Providers, and Health Plans

The RHTP offers a rare opportunity to reshape rural healthcare. But success will require strategic coordination and a commitment to long-term change. States in the short and long term should consider include:

Identifying stakeholders who will be involved: Hospitals, rural health clinics, federally qualified health centers (FQHCs), behavioral health providers, and community organizations must be part of the planning process.
Reexamining priorities: States will need to reconcile competing needs across regions and provider types, balancing infrastructure investments with service delivery redesign.
Understanding infrastructure needs to support their project: Technology, workforce, and models of care must be strengthened to support long-term transformation.
Designing evaluation frameworks: States must include robust performance monitoring and reporting mechanisms to meet CMS expectations and secure future funding.

Providers and other stakeholders should also prepare to align with state strategies. Examples include:

Participating in regional partnerships
Adopting new care models and payment arrangements
Investing in technology and workforce development
Contributing data and insights to support evaluation efforts

The scoring structure also incentivizes states that may not yet be fully aligned to implement new initiatives or make policy changes that would improve their technical scores and secure greater funding. States and their partners will need to be united on the goals and initiatives, disciplined about implementing and evaluating the plans based on data informed reports, nimble and willing to make strategic pivots based on feedback and experiences.

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States that are already aligned with Trump Administration priorities鈥攕uch as those with established value-based payment models, short-term limited duration plan options, preferred technology infrastructure, or strong rural hospital support policies鈥攁re positioned to be rewarded in the scoring and funding process.

量子资源网 (量子资源网), is actively supporting states in developing compliant and compelling RHTP applications. Our advisory services include:

Strategic assessments and stakeholder engagement
Program design and grant writing
Implementation support and technical assistance
Actuarial support
Evaluation and performance monitoring

We help clients navigate the complexities of federal funding, align transformation goals with community needs, and build sustainable models for rural care delivery. For details about the RHTP, including the 量子资源网IS State Action Tracker, contact 量子资源网 experts below.

Webinar Replay- Beyond the Bill: How Pair Team and MCOs Are Meeting Community Needs Under HR 1

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This webinar was held on October 2, 2025.

As Medicaid evolves under HR 1, Managed Care Organizations face increasing pressure to meet new engagement requirements while ensuring vulnerable communities don鈥檛 fall through the cracks. This shifting landscape demands scalable, innovative care models that go beyond compliance 鈥� focusing instead on meaningful connections, coordinated support, and whole-person care.

In this session, Jami Snyder, former HHSC Commissioner of TX and Medicaid Director of AZ, joined Neil Batlivala, CEO and Co-Founder of Pair Team, and Dr. Nate Favini, Chief Medical & Strategy Officer, to explore how Pair Team and its MCO partners are meeting this moment. Learn how their model combines technology, care coordination, and community-based partnerships to engage hard-to-reach members and address social drivers of health.

We heard real-world examples of how payers and partners can come together in smarter, more connected ways. By aligning efforts and building trust, they can drive better outcomes and create stronger community connections for the people who need support the most.

Learning Objectives:

Briefly break down HR 1鈥檚 most critical provisions and what they mean for Medicaid and MCO operations.
Discover how Pair Team and MCOs are co-designing solutions leveraging technology.
Identify best practices for engaging populations facing barriers such as behavioral health needs, housing instability, and transportation challenges.

Featured Speakers:

Carter Kimble, Principal (Moderator) Health Management Associate
Jami Snyder, Former HHSC Commissioner, Texas; Former Medicaid Director, Arizona
Neil Batlivala, Founder and Chief Executive Officer Pair Team
Nate Favini, MD,MS, Chief Medical Officer Pair Team

States Begin to Engage with the Rural Health Transformation Program

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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 量子资源网, including our Information Services team (量子资源网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 量子资源网IS State Action Tracker鈥攁 living resource for 量子资源网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.听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:
- 听requires submissions to identify which of the nine categories are addressed and to discuss outcomes and sustainability.
- Delaware and听听use structured prompts to sort feedback by activity type.
Pre-guidance tools.听States like听听听and听听are using RFIs and statewide surveys to gather ideas and identify viable projects before CMS guidance is finalized.
Tech-enabled care.听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:
- 听explicitly references technology-enabled care models.
- 听and听听highlight health IT/cybersecurity and value-based purchasing.
Local coordination.听States are encouraging regional partnerships/community hubs and rebalancing or right sizing service lines to match local demand.听听and听听emphasize right sizing service lines and coordinated care across the continuum of pre-hospital, emergency, acute inpatient, outpatient, and post-acute services.听听solicitation prioritizes regionally coordinated partnerships and explicitly calls out right sizing the care continuum as a focus area.听听highlights strengthening partnerships between rural hospitals and other providers as a required component of the state plan.
Sustainability and value-based readiness.听States are asking how projects will be sustained after federal funding ends and how these can support and sustain alternative payment models.听听and听听request implementation details and financial durability plans.听听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, 量子资源网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 量子资源网IS State Action Tracker, contact 量子资源网 experts听below.

Webinar Replay – Navigating Medicaid Managed Care Shifts: Financial Pressures, Federal Policy, and Medicaid MCO Implications

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This webinar was held on September 17, 2025.

Medicaid managed care organizations face mounting pressure as enrollment patterns shift, federal policy evolves, and state budgets tighten. In this webinar, experts from 量子资源网IS, Wakely, and 量子资源网 shared exclusive analysis of Medicaid Managed Care Organization (MCO) financial performance, explored the implications of HR 1 and other federal policies, and offered State and MCO perspectives.

Learning Objectives

Interpret 2024 Medicaid MCO financial trends and historical benchmarks to anticipate future market performance.
Assess how federal policy changes, including HR 1, are reshaping Medicaid enrollment and creating new fiscal pressures for States and MCOs.
Evaluate state considerations around risk corridors, medical loss ratios (MLRs), and similar mechanisms in a challenging budget environment.
Identify strategies and planning initiatives that promote resilience, sustainability, and adaptation for Medicaid managed care organizations in a shifting landscape.

This webinar was for Medicaid managed care leaders, state officials, vendors, budget officers, and investors navigating financial pressures and policy shifts.

Federal Shifts and the Potential Impacts on Healthcare Quality Oversight

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This week, our听In Focus听section explores how recent federal shifts鈥攑articularly under the Trump Administration鈥攁re reshaping healthcare quality oversight. 量子资源网 (量子资源网) has published several analyses on the 2025 Budget Reconciliation Act (H.R. 1, formerly known as the One Big Beautiful Bill), Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), and the 2025 Centers for Medicare & Medicaid Services (CMS) Quality Conference. Together, these federal changes and the policy priority shifts described at the Quality Conference, have implications for monitoring and oversight of healthcare quality for publicly insured, commercially insured, and uninsured individuals.

In this article, 量子资源网 experts highlight potential areas for state Medicaid programs, healthcare organizations, and other industry partners to watch for as the rollout of new policies and programs begins to affect programs that monitor quality and creates the imperative to develop new oversight mechanisms.

Overview of Key Federal Policy Shifts

2025 Budget Reconciliation Act/H.R. 1

In July 2025, President Trump signed H.R. 1, the sweeping budget reconciliation legislation that directly affects publicly financed health coverage. Notable policy changes with quality implications include:

Mandatory six-month redetermination and community engagement for select populations
Stricter rules on healthcare-related provider taxes and state-directed payment policies
Elimination of Affordable Care Act (ACA) subsidy eligibility for certain lawfully present immigrants
An end to conditional eligibility for ACA subsidies, as well as passive re-enrollment
Required compliance with community engagement and work policies

Personal Responsibility and Work Opportunity Reconciliation Act of 1996

On July 10, 2025, the US Department of Health and Human Services () and other agencies, redefined 鈥渇ederal public benefits鈥� to exclude individuals with 鈥渦nsatisfactory immigration status鈥� from certain healthcare programs. Examples include Certified Community Behavioral Health Clinics (CCBHCs), Community Health Centers/Federally Qualified Health Centers (FQHCs), grant-funded programs administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), and Title X Family Planning.

2025 CMS Quality Conference

During the 2025 , Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz and senior CMS officials, emphasized CMS鈥檚 and HHS鈥檚 evolving priorities under the Trump Administration. Notable priorities include empowering patients with data, reducing waste and tackling fraud, focusing on prevention, and transitioning to digital quality measures.

Quality Oversight Impacts

Key impacts on quality monitoring programs resulting from these federal changes and evolving priorities include:

Budget constraints elevate monitoring and value-based care metrics. Reduced Medicaid funding and tighter payment rules heighten the need for real-time monitoring of value-based care metrics to ensure financial sustainability in the changing market, optimize reimbursement.

Enrollment changes challenge quality tracking. Tighter eligibility and enrollment policies are expected to decrease enrollment in Medicaid (particularly among the adult expansion population) and the Affordable Care Act Marketplace program. Frequent redeterminations may cause coverage gaps and churn, distorting quality measure denominators and complicating performance tracking 鈥� especially for preventive and chronic care metrics.

Specifically, as the population mix in publicly funded programs changes or as gaps in enrollment exceed the 30鈥�45-day continuous enrollment criteria for many quality measures, the eligible population/denominators of quality measures will likewise fluctuate. Populations that lose coverage or churn on and off eligibility rolls can result in differential impacts for various quality measures (e.g., healthier individuals losing coverage affects prevention measures more than measures of chronic disease care).

Although performance on value-based care quality measures will have increased importance, the ability to track and trend performance will be increasingly challenging. Healthcare organizations will benefit from forecasting potential changes to patient mix and volume and real-time monitoring and improvement opportunities.

Rise in uncompensated care requires new quality monitoring. H.R. 1 changes that reduce eligibility, paired with PRWORA changes that limit treatment for certain individuals who receive public benefits, are likely to lead to increases in the uninsured population and inhibit access to preventive care. These populations tend to use emergency departments more often for health issues that could have been treated earlier or more effectively in outpatient settings, yet quality oversight is limited for populations that receive care outside of publicly or commercially funded programs. New mechanisms for quality oversight鈥攁nd funding of those mechanisms鈥攚ill be needed to monitor the health of these populations.

New programs and priorities warrant updated monitoring. H.R. 1鈥檚 Rural Health Transformation Program and CMS鈥檚 dual-track quality measurement approach (鈥渢reating illness鈥� versus 鈥渕aintaining health鈥�) necessitate a reevaluation of current metrics and monitoring systems.

Implementation of digital quality measures will support these efforts when fully implemented. The accelerated movement toward digital quality measurement and interoperability may create an imperative for healthcare organizations to make the shift. For example, the transition to digital quality measures will be necessary to ensure real-time oversight and improvement of quality measures, population health analytics, maximizing value-based care payments and efficiencies needed to effectively respond to federal changes. At the same time, healthcare organizations will need strategies to effectively deploy digital quality and interoperability within and across their organizations to not just comply, but to maximize their capabilities.

Connect with Us

量子资源网 works with state agencies, payers, health systems, and providers to assess and implement quality systems, value-based care programs, performance improvement and digital health. To discuss how federal changes will affect your organization鈥檚 quality programs, contact our featured experts below.

Health Tech Ecosystem Leaders to Speak at 量子资源网鈥檚 National Conference

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The Trump Administration鈥檚 new Health Tech Ecosystem initiative is reshaping how patients and providers access health data, with the bold Kill the Clipboard road map offering a federal blueprint for modernization. At its being held October 14鈥�16 in New Orleans, 量子资源网 (量子资源网) is bringing together healthcare leaders to explore how federal policy and industry innovation are driving smarter, more connected care.

量子资源网 the Sessions

Driving Digital Health Forward: Federal and Industry Enablers of Smarter, Connected Care听
The Digital Health 鈥淪tate of the Art鈥�: Success Stories, Trends and Opportunities听
Seizing Disruption to Make a Lasting Impact in Healthcare听

These and other reflect the federal government鈥檚 evolving priorities around digital transformation, interoperability, and patient empowerment. The Health Tech Ecosystem initiative and CMS鈥檚 Interoperability Framework are setting new expectations for how healthcare organizations manage data, engage patients, and collaborate across sectors

Featured Digital Healthcare and Innovation Leaders Speaking at the 量子资源网 Conference

Our will unpack the far-reaching impact of these advancements, spotlighting opportunities for smarter data exchange and care coordination in a connected ecosystem. In addition, experts from across the healthcare industry will share practical strategies for advancing digital maturity and overcoming operational challenges, with a focus on improving patient care and organizational efficiency.

, Louisiana Department of Health听听
, DNP, RN, Chief Executive Officer, CyncHealth听
, Principal, Leavitt Partners (an 量子资源网 Company) and co-author of Kill the Clipboard听
, MD, MBA, Assistant Secretary for Technology Policy and National Coordinator for Health IT, US Department of Health and Human Services听听
, President & Chief Executive Officer, HealthShare Exchange听
Juan Montanez, MBA, Managing Director, IT Advisory Services, 量子资源网听
, Vice President, Enterprise Clinical Enablement, Optum听
, Associate Vice President of Enterprise Transformation-Interoperability, Humana听

Healthcare organizations need to prepare for a future regulatory environment that is significantly more digital, interoperable, and chronic disease鈥揻ocused. From health plan executives and state Medicaid directors and policy teams, to provider organizations and health IT and digital health innovators, our speakers will discuss what changes are coming in the digital health space and how you can get your organization ready. for the conference today with the code HOTTOPIC25 to receive 20% off the standard conference rate through August.

Streamlining Healthcare with AI: The Administration鈥檚 Plan and What Comes Next

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On July 23, 2025, the Trump Administration , a comprehensive federal strategy designed to position the United States as the global leader in artificial intelligence (AI). The plan, developed in accordance with 14179, outlines over 90 policy initiatives across three strategic pillars: Accelerating Innovation, Building AI Infrastructure, and Leading International AI Diplomacy.

Healthcare and Medicaid Impacts

CMS AI-Enabled Prior Authorization Pilot
The AI Action Plan explains the Centers for Medicare & Medicaid Services (CMS) plan to launch a six-year pilot to improve, streamline, and where possible, automate prior authorizations using AI. Consistent with the AI Action Plan, CMS on June 27, 2025, announced a new Innovation Center model, the Wasteful and Inappropriate Service Reduction (WISeR) Model. WISeR will test ways to improve the prior authorization process relative to Original Medicare鈥檚 existing processes. This initiative is expected to dramatically reduce approval times鈥攆rom days to, potentially, minutes in some cases 鈥� while easing administrative burdens for providers and improving access to timely care for beneficiaries. CMS will evaluate the pilot using metrics such as efficiency gains, cost savings, satisfaction levels, and decision accuracy.

Enhanced Fraud Detection and Program Integrity
CMS will also expand its use of AI to detect and prevent fraud, waste, and abuse (FWA) in Medicaid and Medicare. By leveraging predictive analytics and real-time data, the agency aims to identify anomalies and improper payments before they occur鈥攅nhancing program integrity and public trust. CMS is also encouraging state Medicaid agencies to bolster its investments in FWA systems, and enhanced federal funding continues to be available for such investments.

Regulatory Streamlining and Innovation Incentives
The plan calls for removing outdated regulatory barriers to AI adoption in healthcare. Proposed measures include revising compliance requirements and offering financial incentives or preferential funding access to states that foster innovation-friendly environments. While specifics are pending, states are encouraged to modernize regulations to support AI adoption.

Key Differences from Prior Administration鈥檚 AI Policy

The following table outlines key differences between the Biden and Trump administrations鈥� approaches to AI policy:

Considerations for Healthcare Organizations and Partners

Medicaid agencies, healthcare providers, and industry stakeholders should track the next wave of federal actions to implement the AI Action Plan and the healthcare sector鈥檚 response. Data from pilot initiatives will inform future federal policy decisions on broader AI deployments within Medicaid administration. In addition, healthcare organizations will need to remain nimble as variability may emerge in how states pursue regulatory changes to align with federal incentives under the Action Plan.

Sector specific considerations include:

Health Plans: Plans should proactively pursue initiatives such as AI-driven prior authorization, claims adjudication, fraud detection, and member engagement to improve their operations, their position in the markets in which they operate, and ideally, their performance. This effort will require significant investments in information technology, new workflows, and continuous quality improvement initiatives, staff training, enhanced compliance protocols, and a culture that embraces AI. In addition, plans must implement robust AI oversight mechanisms that incorporate the necessary level of transparency, avoid bias, and are appropriate across all functions that use AI, including population health analytics, member engagement, care management, prior authorization management, claims processing, and fraud detection.

State Government: States will face pressure to modernize health and human services regulatory frameworks to align with federal requirements and access federal incentives. Moreover, states should proactively pursue initiatives that improve the operations of health and human services agencies with a particular focus on improving program design, oversight, and evaluation functions. In addition, agencies should assess current rules regarding AI and consider how to support AI adoption while safeguarding desired outcomes and accountability.

Health Systems and Providers: Providers can benefit from reduced administrative overhead, improved care delivery, and the use of AI to augment the ability of providers to diagnose and treat patients. Providers will have to adapt to new workflows that incorporate use of AI, ensure data quality, and monitor data for unintended consequences such as unintended bias. In addition, providers must incorporate AI literacy training to align with federal expectations and remain competitive in a deregulated, innovation-driven landscape. Providers will also have to implement robust compliance protocols.

Looking Ahead

The signals a substantial shift toward streamlined regulatory approaches and expanded AI deployment in Medicaid and broader healthcare administration. Stakeholders should anticipate federal guidance updates, pilot program evaluations, and further clarifications regarding state incentives in the months ahead.

To discuss the implications of the AI Action Plan or for further policy analysis, contact 量子资源网 experts below.

CMS and Tech Leaders Unite to Build a Patient-Centric Digital Health Ecosystem

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The White House and Centers for Medicare & Medicaid Services (CMS), on July 30, 2025, new commitments from leading technology 鈥攊ncluding Amazon, Apple, Google, OpenAI, and Anthropic鈥攖o create a smarter, more secure, and patient-centered digital health ecosystem. At the Make Health Tech Great Again event, CMS unveiled voluntary criteria for trusted data exchange across networks, electronic health records (EHR), and tech platforms, emphasizing interoperability, personalized tools, and reduced provider burden.

This announcement echoes many of the priorities laid out in Leavitt Partners鈥� road map鈥攁 federal policy and industry blueprint for modernizing patient and provider access to health data. The priorities outlined at today鈥檚 White House event and the administration鈥檚 recent regulatory announcements closely reflect the multisector road map鈥檚 recommendations. A recent webinar hosted by Leavitt Partners, an 量子资源网 Company, explored how the recommendations are shaping federal policy and creating strategic opportunities for early adopters.

What鈥檚 Next

量子资源网 (量子资源网) experts, including those with Leavitt Partners, will delve further into the new initiative and considerations for the healthcare industry in an upcoming Weekly Roundup.

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