Jun 2, 2026 – By Meghan Harris, President and Chief Operations Officer Mental Health Burden According to the World Health Organization, an estimated one billion people[1] live with a mental health or addictive disorder. That’s one out of every eight people on the planet. In the U.S., estimates suggest that only half of people with mental illnesses receive treatment.[2] And according to the Substance Abuse and Mental Health Service Administration (SAMHSA)’s National Survey on Drug Use and Health, only a small proportion of individuals who need substance use treatment receive it, leaving approximately 90% who go without treatment.[3] The burden of mental health disorders and the associated economic costs are enormous — to individuals, the economy, and society. Despite growing awareness, physical and behavioral health services largely operate separately, with minimal coordination. This fragmentation leads to gaps in care, inappropriate treatment, increased hospitalizations, and, ultimately, higher costs.[4] CMS and Medicaid use “behavioral health” as an umbrella term that encompasses mental health, substance use disorders (SUD), and other behavioral conditions.[5] Medicaid and Behavioral Health Mental health issues disproportionately affect those on Medicaid. According to the Kaiser Family Foundation, more than one in three adult Medicaid enrollees have a mental illness and Medicaid enrollees diagnosed with mental illness have higher rates of chronic conditions and substance use disorder compared to those without a mental health diagnosis.[6] Given this, it’s no surprise that Medicaid is also a major source of financing for mental health services. The Medicaid program finances more than one-quarter of the U.S. spending on behavioral health care; it is, by far, the largest single source of funding for public mental health services. However, Medicaid coverage for mental and behavioral health services varies significantly by city, county, and state. While all state Medicaid programs mu

May 15, 2026 – By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions States have developed a wide range of services to help individuals who have disabilities or chronic conditions and need long-term care. Over 30% of Medicaid expenditures go toward long-term services and supports (LTSS) for both institutional and home-based care. Because LTSS programs often span multiple waiver authorities, eligibility pathways, delivery systems, and community partners, creating a seamless beneficiary experience can be operationally complex. Many states are balancing modernization efforts with evolving federal requirements, workforce considerations, and the need to preserve continuity of care for vulnerable populations. As part of these ongoing modernization efforts, some State Medicaid Agencies (SMAs) are exploring opportunities to further align enrollment and assessment processes to support both operational efficiency and person-centered care. Because eligibility and assessment requirements often vary across programs, beneficiaries and caregivers may experience multiple touchpoints during enrollment and reassessment. To help LTSS beneficiaries access services that support them in living as independently and safely as possible in the setting of their choice, many SMAs are exploring ways to further align and streamline enrollment and assessment processes. These modernization efforts can enhance person-centered care while also helping states improve coordination and administrative efficiency. Improving Enrollment and Assessments with Technology Advances and Person-Centered Care When states implement a unified enrollment and assessment process, they can create more coordinated access points where assessors determine eligibility and beneficiaries receive consistent information and support across programs and regions. This approach can help streamline communication while maintaining a person-centered experience regardless of a beneficiary’s location, provider, or ci

May 13, 2026 – By Nirav Dalal, Senior Vice President of Sales Leadership With more Medicaid Management Information Systems (MMIS) moving to modular, multi-vendor models, vendor selection is no longer just about technology; it’s about building a network of partners who work together to deliver better outcomes for priority populations. The shift is reshaping Medicaid operations and demands a more strategic, deliberate approach to vendor selection. There is no single path to modularity. The “modularity sequence” varies widely. Some states begin with a single module, such as provider management or claims, while others procure and implement multiple modules concurrently. Each approach brings different levels of complexity, integration risk, and dependency management. Vendor strategies must align not only with technical requirements, but also with where the state is in its modernization journey and the pace at which it plans to expand. They should also reflect the needs of the broader ecosystem, including managed care organizations, beneficiaries, providers, and other connected stakeholder groups and systems to maintain continuity across the enterprise. Here are the top three considerations for State Medicaid Chief Information Officers (CIOs) and Chief Technology Officers (CTOs) to make confident choices and build a high-performing, resilient system: 1. Identify Vendors with Proven Collaboration Skills While technical expertise is crucial, the real value in a multi-vendor ecosystem comes from how well vendors work together to deliver a seamless experience across the enterprise. This is especially important given that states adopt modularity at different speeds, with some introducing vendors incrementally and others onboarding several simultaneously, placing varying demands on coordination and integration from day one. Advanced systems should have no problem being technically integrated, but managing the operational handoffs between vendors and ensuring alignment are the true challenges

Mar 19, 2026 – By Ryan Bosch, MD, FACP, Chief Health & Informatics Officer As state Medicaid agencies adopt modular, specialized systems to meet Centers for Medicare and Medicaid Services (CMS) requirements, they gain flexibility but lose a single, unified view of their data. Each module stores and organizes data in its own way, which makes it efficient for generating reports from that specific system, but harder to combine and use data across systems. Meaningful data-to-action insights, especially in population health and value-based care, only emerge when data from multiple modules and external systems is brought together in a shared, structured format. When data is integrated in this way, it enables broader analysis, deeper insights, and more coordinated action. Acentra Health, an AWS Advanced Partner, serves numerous state Medicaid programs, federal agencies, and commercial clients. We address the multi-system data analysis challenge through our Unified Data Platform (UDP) built upon a unique cloud-based data foundation designed to support scalable, cross-domain analytics while preserving operational flexibility. A Unified Operational Data Store Foundation Model Managing a Medicaid program’s performance requires both operational awareness and a longitudinal perspective. Leaders must use data to answer questions like: Is eligibility determination accurate and occurring within required timeframes? Are prior authorizations correct, and are they being managed efficiently? Are claims processing smoothly or encountering delays? Are providers legitimate, and are they being paid accurately, and on time? Acentra Health’s UDP, powered by our own proprietary data model and the AWS secure cloud infrastructure, is designed to help answer these questions, supporting timely reporting, service line benchmarking, and predictive analytics for Medicaid programs. Our Whole Person, Whole Population (WP2) Data Model Acentra Health's UDP goes well beyond legacy data warehouse aggregation. With t

Mar 6, 2026 – By Amanda Ramsey, Marketing Director Acentra Health returned from the 16th Annual State Healthcare IT Connect Summit energized by the urgency and scale of change facing Medicaid and Health and Human Services (HHS) leaders nationwide. Held February 24–26, 2026, in New Orleans, the well-attended conference brought together state and federal leaders, technologists, and industry partners at a pivotal time for health IT transformation. Across sessions and conversations, several themes consistently surfaced: Artificial Intelligence (AI), rural health transformation, community engagement requirements under H.R. 1, interoperability, and the operational impact of sweeping federal policy changes. At its core, this year’s Summit reinforced a simple reality: policy change and technology modernization are no longer separate efforts; they must move forward together. A Pivotal Policy Moment The conference convened amid significant federal changes affecting Medicaid eligibility, cost-sharing, provider payments, and IT system requirements. Provisions within H.R. 1 are reshaping how states administer programs and how technology must support them. Eligibility systems must incorporate new work and community engagement requirements. Financial and claims platforms must align with updated payment rules. Oversight and reporting expectations continue to expand. At the same time, federal initiatives such as the Centers for Medicare and Medicaid Services (CMS) Health Technology Ecosystem and CMS Aligned Networks emphasize interoperability, digital identity, and responsible data use, signaling a national vision for more connected, person-centered systems. States now face a critical challenge: modernizing in ways that are compliant, scalable, and sustainable amid fiscal pressure and evolving priorities. What We Heard: Key Themes Artificial Intelligence in Action AI has moved from theory to implementation. Sessions highlighted practical applications including intelligent document processing, pre

Nov 26, 2025 – By Marnie Keogh, Senior Vice President, Marketing Reflections from the National Association of Medicaid Directors 2025 Conference: Challenges, Changes, and Opportunities Acentra Health returned from NAMD 2025 energized by the dedication of our nation’s Medicaid Directors and their teams. The conference, held November 18-21 at the Gaylord National Resort & Convention Center in Oxon Hill, Maryland, was the largest to date, giving us the opportunity to speak with many Directors. In a nutshell, here’s what we heard: the challenges brought on by market constraints will force them to change how they operate, giving them opportunities to do new things. Challenges At the highest levels, most states are dealing with significant challenges, and all agencies are feeling the pressure. Specifically, Medicaid agencies are struggling with: Funding Gaps: States are grappling with decreasing funding across many programs, at a time when inflation, tariffs, and medical costs are increasing. Medicaid agencies are looking at rate reductions, service limits, or elimination of optional benefits. Staff Shortages: Decreased funding has led to Medicaid agency staff reductions, leaving fewer people to do the same, if not more, work. New Requirements: Implementing H.R. 1 requirements and new rules from the Centers for Medicare and Medicaid Services (CMS) will tax already resource-strapped Medicaid agencies. Outdated Technology: Many Medicaid eligibility, claims, and other programs run on old hardware with software that is expensive and time-consuming to modify to meet new requirements. Systems are fragmented, making inter- and intra-agency data sharing difficult at a time when it’s needed the most. Heightened Expectations: States are expected to boost Medicaid program integrity with improved eligibility and auditing processes. Payment Error Rate Measurement (PERM) program scores were discussed at length. CMS also stressed the need for better health outcomes and long-term stability for bene

Aug 5, 2025 – By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions Acentra Health applauds the steps taken by private health insurance leaders, the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS) leadership to collaborate on accelerating care decisions and enhancing transparency around the prior authorization (PA) process. As this process with private insurers moves forward, we welcome the opportunity to contribute to this national discussion with our perspectives and highlight the work we are doing on behalf of our clients. As a trusted partner to state and federal health programs across the country, Acentra Health is dedicated to improving the beneficiary and provider experience with an approach that is grounded in thoughtful design, transparency, and a focus on access to care. As such, we remain deeply committed to advancing PA practices that optimize clinical value, reduce administrative burden, and promote timely access to care for members. Our mission is rooted in helping our clients execute their policies while fostering a transparent, efficient, and equitable utilization management (UM) process. Commitment to Reducing Administrative Burden We recognize the importance of ensuring that the PA process supports — rather than hinders — access to necessary services. Acentra Health continues to work closely with our state and federal clients to evaluate PA requirements and identify opportunities to eliminate or streamline review of procedures that consistently receive high approval rates. This data-driven, client-focused strategy has been a priority area for us and will remain central to our UM evolution. Aligning with CMS Interoperability and Access Rules The final CMS rule (CMS-0057-F) underscores the need for electronic PA tools that improve data exchange and transparency. Acentra Health has been actively engaged in developing application programming interfaces (APIs) for PA, pat

Jun 12, 2025 – By Todd Stottlemyer, Chief Executive Officer At Acentra Health, innovation isn’t just a buzzword — it’s a commitment to driving real change in how government healthcare programs serve the American public. Three of our executive leaders are being recognized by WashingtonExec for their pioneering work in government healthcare technology innovation. Dr. Ryan Bosch, Sean Harrison, and Harish Nanda were each featured in WashingtonExec, a trusted publication for federal decision-makers. Their profiles spotlight how Acentra Health is solving some of the most complex challenges in access, affordability, quality, and accountability — by putting data and technology to drive public health improvements. Advancing Whole-Person Data Models in Government Healthcare Dr. Ryan Bosch, Chief Health & Informatics Officer, was named one of WashingtonExec’s 2025 Top Health Care Execs to Watch. The article highlights his leadership in advancing Acentra Health’s Whole Person, Whole Population (WP2) model, which is a step toward more intelligent, individualized, and population-level care. This model is powered by our Unified Data Platform (UDP), which integrates diverse datasets into a centralized system for cross-functional analysis, delivering smarter insights and interventions. It helps providers and agencies make smarter decisions and drive better health outcomes. Read Dr. Bosch’s profile here. Deploying Safe AI to Power Medicaid Innovation Sean Harrison, Chief AI & Analytics Officer, was named a finalist in the Chief Officer Awards for his leadership in leveraging artificial intelligence to improve Medicaid delivery. His work exemplifies how AI in government healthcare can deliver savings and scale, with humans firmly in the lead, ensuring safe, ethical, and informed decision-making. A major milestone this year was his leadership in helping Acentra Health launch a public-private AI alliance focused on responsible, scalable AI practices for public health systems. This alliance un

May 29, 2025 – By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions Incarcerated individuals often leave prison with complex health needs and little support waiting for them outside. Medicaid’s Section 1115 reentry waivers offer a chance to change that, but translating policy into impact takes more than paperwork. It requires strategic design, on-the-ground knowledge, and systems that don’t fall apart after the pilot phase. To help states navigate this terrain, Acentra Health convened a panel of Medicaid and corrections leaders from Washington, Arizona, and Michigan, states at the forefront of reentry innovation. Together, they shared lessons learned, pitfalls to avoid, and strategies that can scale nationwide to serve this at-risk population. The result? Five grounded insights that can help states turn reentry waivers into real-world results. Build a Data Foundation Early: Design with Evaluation in Mind All successful programs are built on clear goals and the ability to measure progress, as well as performance, over time. From the start, it’s important to think about how you’ll collect and use data. Not just to coordinate care, but also to assess what’s working (or not) at every point in the member’s journey. States like Arizona and Michigan are already investing in systems that track care before and after release. This helps them evaluate outcomes like ER use, medication continuity, and recidivism. As Vikki Wachino, Executive Director of the Health and Reentry Project (HARP), put it, “states are really eager to know if these efforts are working, and that means building evaluation plans early, not after launch.” Pro Tip: Before launching, map how data will flow across Medicaid systems, correctional health records, and MCOs both before and after release to set the stage for smoother coordination, stronger impact, and better outcomes. Account for Wide Variation in Facility and Community Readiness Facility readiness varies widely, from clinical s