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 Outdated Technology: Many Medicaid eligibility, claims, and other programs run on old hardware with software that is expensive and time-consuming to modify to meet new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

May 8, 2025 – By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems Across the country, Medicaid programs face growing demands for greater agility, stronger compliance, and better overall experience for the people they serve. In this environment, the state of Utah has emerged as a blueprint for what is possible when vision, technology, and strategic partnership align. Utah’s recent Centers for Medicare & Medicaid Services (CMS) certification of its modernized Provider Reimbursement Information System for Medicaid (PRISM) represents more than a technology achievement. It signals that the future of Medicaid systems is modular, data-driven, and built on thoughtful collaboration. Achieving CMS certification is a rigorous process that signifies the gold standard for clinical and operational excellence. Certification is not simply a milestone to reach. CMS certification is a federal vote of confidence that a state’s Medicaid Enterprise System meets the highest performance, security, and compliance standards. Earning that trust through transparency and integrity is critical in today's environment. PRISM was developed through close collaboration between Utah's Department of Health and Human Services (DHHS) and the Acentra Health team, with Acentra Health’s evoBrixSM platform to support key Medicaid functions such as provider management, claims processing, member eligibility, and financial reporting. The final CMS certification validates the last major release, which included claims and related modules, and completes a multi-phase rollout. And the results speak for themselves. Since August 2024, the system has maintained 99.5% production uptime and achieved a perfect record of error-free federal data submissions. These outcomes are critical benchmarks that protect data integrity and help avoid the compliance risks that can arise from reporting gaps. The larger story is about the intentional design choices and commitment to stewardship that made these results

Dec 6, 2024 – By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions Youth transitioning out of residential facilities face numerous challenges, including inadequate healthcare and social support. Justice-involved youth (JIY) are at high risk for poor health outcomes, recidivism, and struggles with reintegration into society. In recognition of these needs, the Omnibus Reconciliation Act of 2022 mandated that states receiving Medicaid funding must provide health and social risk assessments to JIY 30 days before and post-release. With a compliance deadline looming at the start of 2025, state agencies must act quickly and proactively to establish systems that meet these requirements. Understanding the Mandate: Why It Matters The federal mandate recognizes the need for continued support of the JIY population in order to help their successful reentry into society. However, for state Medicaid agencies, the mandate presents a complex challenge that requires specialized knowledge, collaboration, and, often, comprehensive support services. By proactively aligning with the 2025 federal mandate, enhancing assessments, and implementing coordinated aftercare services, states can offer targeted, tailored services to the JIY population and prevent their return to the justice system. State agencies should prioritize the following three initiatives to be successful: Understand Their Needs through Specialized Assessments Comprehensive support systems that include health risk assessments, case management, and coordinated care significantly reduce the risk of recidivism and offer these young individuals a better chance at a stable future. It's critical for your agency to deliver assessments that consider the immediate health risks and the social factors-such as housing and employment-that play a crucial role in long-term success. For example, Acentra Health uses an advanced care management platform and sophisticated analytics to seamlessly integrate health risk and

Nov 20, 2024 – By Verlon Johnson, Chief Government & Corporate Affairs Officer As always, Medicaid policy is shifting in ways that will profoundly impact state programs over the next few years. These mandates fall into four primary areas of focus: Justice-Involved Youth Services, Prior Authorization (PA) Modernization, Critical Incident Reporting, and Health Equity initiatives. Each mandate can significantly shape state Medicaid programs, and it is essential for Medicaid directors and state agencies to be vigilant and proactive in their preparations. Justice-Involved Youth Services and Reentry Care Federal mandates are placing new emphasis on ensuring care for justice-involved youth, particularly as they transition back into society. By January 2025, Medicaid programs must have processes in place for providing pre-release assessments, developing care management plans, and supporting the reentry process. State agencies should focus on creating robust assessment systems that prevent recidivism and ensure continuity of care. States should prioritize building systems that encompass both pre-carceral (before incarceration) and post-carceral (after incarceration) assessments and care plans. Oregon, for instance, is taking an active approach to implementing these services, focusing on reducing recidivism by maintaining continuous support. Prior Authorization (PA) Modernization The prior authorization process has long been a point of friction between healthcare providers and state Medicaid programs. The upcoming PA modernization mandate will focus on reducing provider abrasion and improving patient access to timely care. By January 2026, new business and technology standards will be required for the PA process, including the use of API integrations for provider access and peer-to-peer communications. State Medicaid agencies must invest in modernizing their IT systems to meet these regulatory requirements. CMS aims to streamline processes that previously caused delays, ensuring that ca

Oct 24, 2024 – By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions In today’s digital age, enhancing the client experience is key for any organization. It’s especially important in public health. State Medicaid programs are increasingly focused on delivering personalized, timely, and effective services. Better services drive improved health outcomes, higher beneficiary satisfaction, and enhanced organizational performance. One area that continues to demand a client-first approach is Medicaid eligibility assessments. This activity requires a strategic approach that harnesses human expertise and technology to maximize impact. Implementing a client-centered approach to service delivery can be challenging, especially for agencies serving diverse regions and unique communities. However, turning these challenges into opportunities is where the real impact begins. State agencies should adopt a top-down commitment to a comprehensive client experience program, training staff on cultural competency and client-centric concepts, and aligning each role to a client-first model. It's also crucial to keep a consistent focus on the client in organizational meetings and communications, and establish a recognition system that encourages and celebrates client-centric behaviors. With a structured, client-focused approach at every level, agencies can greatly enhance Medicaid eligibility assessments and overall service delivery. Recommendation 1: Understanding Client Journeys and Diverse Populations To become a truly client-centric organization, it's essential to "walk in the shoes" of your clients. Every interaction should be carried out with empathy and respect, and documenting client journeys provides key insights for better understanding their needs. By seeing things from the client’s perspective, your organization can align its focus accordingly. Additionally, understanding the diverse populations you serve through Social Determinants of Health (SDOH) and Healt

Sep 9, 2024 – By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems With more than 74.6 million enrollees, Medicaid is one of the largest healthcare programs in the U.S. Yet, outdated systems pose challenges to meeting the growing demands of Medicaid populations. Today, Medicaid accounts for one-sixth of all healthcare spending and half of long-term care spending, making it a large share of state budgets.¹ This significant financial commitment underscores the critical need for efficient, modernized systems. Recognizing the limitations of its older infrastructure, the Utah Department of Health and Human Services decided to overhaul its Medicaid system completely. This effort, recently discussed at the 2024 Medicaid Enterprise Systems Conference (MESC), provided valuable insights into how Utah’s successful implementation could serve as a model for other states facing similar challenges. Ensuring Success Through Rigorous Testing & Certification One key step in Utah’s system overhaul was its rigorous approach to testing and quality assurance. The state implemented a multi-phase testing strategy – including parallel testing and user acceptance testing (UAT) – to ensure every aspect of the new system was thoroughly vetted before going live. Did you know? Utah’s testing process involved around 30,000 test scenarios. This thoroughness was essential to identifying and addressing potential issues early, minimizing disruptions during the transition. Utah executed a three-month soft launch period before the official go-live date to ensure a seamless transition. This phase involved extra validation, comparing the new system against the legacy system to verify all functions. This careful approach allowed Utah to identify and resolve discrepancies, ensuring a smooth rollout. Another key component of Utah’s success was the early adoption of CMS certification processes. By engaging with these processes early, Utah maintained alignment with federal requirements, ensu