January 7, 2026

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Webinar Replay – The ACCESS Model: Essentials for Applicants

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Federal Policy News

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CMS Announces New ACO Model to Replace ACO REACH

The Centers for Medicare & Medicaid Services (CMS)听听on December 18, 2025, the Long-term Enhanced ACO Design (LEAD) Model, which will replace the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. LEAD is a 10-year voluntary Medicare initiative model that runs from January 1, 2027, through December 31, 2036. The request for applications will be released in March 2026.

The LEAD model is intended to include more small, rural, and independent providers and community health centers, enhance evidence-based prevention and care coordination, and allow patients to be more involved in their care. The model will integrate high-needs patients, including patients with complex needs and dually eligible beneficiaries, and provide flexible, capitated population-based payments to support team-based care and downstream value-based care arrangements. During the initial planning phase from March 2026 through December 2027, CMS will also identify two states to partner with to develop a framework for ACO-Medicaid partnership arrangements. ACOs in these states will have the opportunity to enter partnership arrangements with Medicaid organizations.

CDC Finalizes Changes to U.S. Childhood Vaccine Schedule

On January 5, Acting CDC Director Jim O鈥橬eill signed a adopting a revised childhood and adolescent immunization schedule for the U.S. The new schedule recommends fewer vaccines but continues to follow a three-category approach: Immunizations Recommended for All Children; Immunizations Recommended for Certain High-Risk Groups or Populations, and Immunizations Based on Shared Clinical Decision-Making.

As had been reported in the weeks leading up to the release of the memo, HHS seeks to base the U.S. schedule largely off of Denmark鈥檚, and recommends all children receive immunizations for measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (Hib), pneumococcal disease, and human papillomavirus (HPV). The revised schedule also includes the varicella vaccine in Category 1, which is not on the Danish schedule. The revised schedule recommends one dose of the HPV vaccine rather than two.

Vaccines for RSV, hepatitis A, hepatitis B, and meningococcal disease will now be in Category 2 and only recommended for those at high risk. Vaccines for dengue will remain in this category and are recommended for children with laboratory-confirmed previous dengue virus infection and who are living in dengue-endemic areas.

Vaccines for rotavirus, COVID-19, influenza, meningococcal disease, hepatitis A, and hepatitis B will no longer be universally recommended, but shifted to Category 3 in which they are recommended based on 鈥渟hared clinical decision-making.鈥�

The decision memorandum notes that as all immunizations remain on the schedule they will continue to be covered without cost-sharing by private insurance, Medicaid, CHIP, and the Vaccines for Children program. CDC specifically states in the regarding the changes that 鈥淎ll immunizations recommended by the CDC as of December 31, 2025, will continue to be fully covered by Affordable Care Act insurance plans and federal insurance programs, including Medicaid, the Children鈥檚 Health Insurance Program, and the Vaccines for Children program.鈥�

Telemedicine Flexibilities for Controlled Medications Extended

On December 31, HHS and the Drug Enforcement Administration (DEA) jointly issued the of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications through December 31, 2026. The agencies had previously extended these COVID-19 pandemic-era flexibilities through the end of 2025. The extension will allow providers to continue to prescribe certain controlled medications via telemedicine, even if the provider has not evaluated the patient in person. In the rule, HHS and DEA state that the year-long extension will provide time for DEA to promulgate a final set of regulations, 鈥渢o ensure a smooth transition for patients and providers that have come to rely on the availability of telemedicine to prescribe controlled substances to patients for whom they have never had an in-person medical evaluation, and allow sufficient time for providers to come into compliance with any new DEA registration, recordkeeping, or security requirements eventually adopted in a final set of regulations.鈥�

CMS Updates Medicaid and CHIP Quality Measures for 2026鈥�2027

On December 30, CMS a State Health Official (SHO) letter outlining updates to the 2026 and 2027 Child and Adult Core Set of Quality Measures for Medicaid and CHIP, with a focus on immunizations. As part of the 2026 revisions, CMS is removing four pediatric and prenatal immunization measures from the Child and Adult Core Sets:

Childhood Immunization Status (CIS鈥慍H);
Immunizations for Adolescents (IMA鈥慍H);
Prenatal Immunization Status: Under Age 21 (PRS鈥慍H); and
Prenatal Immunization Status: Age 21 and Older (PRS鈥慉D).

According to the letter, states may continue to voluntarily report results for these four Utilization Measures, enabling CMS to 鈥渕aintain a longitudinal dataset while evaluating alternative immunization metrics.鈥� Additionally, the Childhood Immunization Status (CIS鈥慍H) and Immunizations for Adolescents (IMA鈥慍H) measures will no longer be subject to mandatory stratification in 2026.

In the letter, CMS also notes it plans to develop new vaccine-related measures that assess whether families are informed about 鈥渧accine choices, vaccine safety and side effects, and alternative vaccine schedules.鈥� Stakeholder engagement with states, measure stewards, immunization registry managers, providers, and EHR vendors will help shape these measures, with consideration for religious exemptions. These changes follow a series of vaccine policy shifts initiated under the Trump Administration, including the HHS recommended vaccine schedule changes announced today and recent changes to recommendations for hepatitis B vaccination in newborns, removing universal vaccination recommendations and instead advising vaccination only for infants born to mothers with hepatitis B or unknown infection status.

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State Policy News

Georgia

Georgia Proposes Restructuring 1915c Waiting List for Individuals with IDD. GPB/Georgia Recorder听听on January 2, 2026, that Georgia鈥檚 Department of Behavioral Health and Developmental Disabilities is evaluating proposed changes to the state鈥檚 1915(c) Home and Community-Based Services (HCBS) waiver waiting list for individuals with intellectual and developmental disabilities. The recommendations would replace the current single planning list with a three-tiered system based on urgency of need, enhance assessment and data collection, and potentially introduce an additional waiver option for individuals who do not qualify under existing programs such as the New Options Waiver and Comprehensive Supports Waiver Program. The proposals have not yet been finalized or assigned an implementation timeline and are being considered amid broader Medicaid funding constraints.

Illinois

Cityblock, Centene Launch Value-Based Medicaid Partnership in IL.听Cityblock听Health鈥�鈥痮n January 7, 2026, that it has partnered with Centene鈥檚 Meridian Health Plan of Illinois to serve approximately 10,000 Medicaid members across 17 counties in the Springfield and St. Louis Metro East regions of Illinois.听Cityblock听will deliver 24/7 wrap-around, value-based care, including primary, behavioral, social, pharmacy, and care management services, integrated with Meridian鈥檚 provider network. The collaboration expands听颁颈迟测产濒辞肠办鈥檚听Illinois footprint and听represents听the fourth regional partnership between听Cityblock听and Centene, following New York, Ohio, and Florida. The partnership aims to improve care coordination, access, and outcomes for high-need Medicaid听

Nevada

Nevada Implements Medicaid Billing Platform for School Health Services. The Nevada Health Authority announced on December 31, 2025, that it has launched a statewide initiative to help schools access Medicaid reimbursement for eligible student health services by implementing a shared electronic health record and Medicaid billing platform through an external vendor. The program is intended to reduce administrative and billing barriers that have historically limited schools鈥� ability to claim Medicaid funds, while expanding support for student mental health services, primary and preventive care, and special education. Funded by a federal grant to Nevada Medicaid, the initiative aims to strengthen the sustainability and reach of school-based health services across the state.

Indiana

Indiana Medicaid Forecast Projects Nearly $466 Million in Savings Over FY 2026-27 Biennium. The Indiana Family and Social Services Administration (FSSA)听听on December 18, 2025, that its December 2025 Medicaid forecast shows the state is on track to save $314.1 million in fiscal 2026 and $151.8 million in fiscal 2027, totaling $465.9 million over the biennium. The savings are largely due to declining Medicaid enrollment in the Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW) after changes to eligibility redetermination procedures, which included a ban on Medicaid advertising. State officials are still cautioning of challenges ahead, including economic uncertainty, policy shifts, and high-cost service areas, which could affect Medicaid鈥檚 long-term sustainability.

Minnesota

MN Releases Strategy, Supports RFPs for Individuals with Disabilities, SMI. The Minnesota鈥檚 Department of Human Services has鈥�鈥痑 request for proposals (RFP) on January 5, 2026, seeking innovative solutions to improve outcomes for people with disabilities. The solicitation prioritizes projects serving individuals eligible for or receiving Section 1915(c) home and community-based services and supports initiatives focused on integrated housing, competitive employment, accessible transportation, and community-centered, culturally responsive services. Letters of Interest are due January 27, 2026.鈥� , the Department of Human Services鈥� Behavioral Health Administration issued a request for proposals on January 2, 2026, for a one-time $400,000 grant to a women-led organization to provide mental health services and supports to New Americans that are adults living with serious mental illness and residing in Minneapolis. Full proposals for this opportunity are due January 26, 2026.听

Private Market News

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FDA Gets Mixed Feedback on Performance Monitoring for AI

Medtech industry groups said the FDA should use existing regulatory and quality tools to monitor performance, while medical groups said device manufacturers should be responsible for monitoring AI. .

Changes to Healthcare Price Transparency Rules Planned

On December 19, CMS, in partnership with the Department of Labor and the Department of the Treasury, released a building on healthcare price transparency rules established during President Trump鈥檚 first term. The proposed rule specifically seeks to address three key challenges identified by the administration: 鈥渋naccessibility due to the large size of the machine-readable files, data ambiguity due to lack of contextual information alongside the raw data, and areas of misalignment with the Hospital Price Transparency rule that make comparing data across disclosures challenging.鈥� The provisions of the rule primarily apply to non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage.

The rule proposes several requirements intended to address the burden of reporting on providers and plans issuers, and simplify the organization and accessibility of the data for consumers and researchers. These include reduced reporting frequency, expanded out-of-network pricing disclosures, and requirements for new change-log and utilization files to improve data usability. CMS also proposes to require issuers to provide personalized cost-sharing estimates via online tool, paper, and (starting for policy years on/after January 1, 2027) by phone, in line with price comparison guidance mandate requirements of the No Suprises Act.

The proposed rule is open for public comment until February 21, 2026.

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Webinar: The ACCESS Model: Essentials for Applicants

CMS鈥檚 new ACCESS model represents one of the most ambitious federal efforts to modernize chronic care through technology-supported services. This national, voluntary, decade-long model creates a new payment pathway for digital health tools, continuous monitoring, behavioral support, and other tech-enabled interventions that complement traditional care. With beneficiaries able to enroll directly and clinicians eligible for co-management payments, ACCESS introduces a fundamentally different approach to chronic condition management across Medicare.

In this webinar, HMA and Leavitt Partners experts will break down what is known today, what to expect in the forthcoming Request for Applications, and what organizations can do to prepare. We will walk through the model鈥檚 four clinical tracks, outcomes-aligned payments, beneficiary engagement expectations, the TEMPO pilot鈥檚 implications for digital device manufacturers, and how it relates to the CMS Health Tech Ecosystem initiative.

Webinar: Meeting the Healthcare Needs of Unhoused People Part 1: Service and Care Responses

Join听HMA experts and our featured speakers听for the first of two webinars exploring how current events are impacting people experiencing homelessness and their access to care. This webinar will highlight the model of care for healthcare for the homeless clinics and medical respite care providers and how these services interact with broader systems of care. Additionally, we will explore how the current environment is impacting delivery and financing of care for some of our most vulnerable neighbors.听

Webinar: Meeting the Healthcare Needs of Unhoused People Part 2: State Policy Responses

Recent federal policy changes, such as the 2025 Budget Reconciliation Act (OBBBA), bring significant challenges to听retaining听the Medicaid coverage gains and added 1115听demonstration听services that have been so successful in the last decade. States will be under tremendous pressure to meet new requirements鈥攂ut they also have options to reduce the negative impact on vulnerable populations and the healthcare providers that serve them. Join听HMA and our featured experts听for this听webinar听to discuss state-level policy options, share resources, and consider how to move forward in the current environment.听

Wakely

Enrollment Dynamics and Health Care Utilization in the ACA Individual Market

Wakely was retained by America鈥檚 Health Insurance Plans (AHIP) to evaluate the potential reasons for reported changes in the percent of non-claimants in some individual health insurance markets over the reported period. This report explains what that statistic measures and how best to interpret it.

To gain additional understanding of potential drivers of the elevated non-claimant ratios in the individual market, Wakely reviewed its ACA database to highlight key dynamics contributing to the higher non-claimant ratios. The paper discusses the data used to measure non-claimant ratios and its limitations, changes in enrollment patterns in 2022 and 2023 in the individual market, as well as how changes in 2025 relative to 2024 may result in lower non-claimant ratios.

ESRD: The Forgotten Group

End-Stage Renal Disease (ESRD) represents one of Medicare鈥檚 most medically complex and financially costly populations yet historically has been underserved in both Medicare and Medicare Advantage (MA). Despite representing less than 1% of total beneficiaries, ESRD accounts for a disproportionately large share of Medicare expenditures. Traditional MA plans often lack the specialized networks, care coordination, and benefit designs required to address ESRD patients鈥� intensive needs. While ESRD Chronic Condition Special Needs Plans (C-SNPs) have begun to fill this gap, their adoption remains extremely limited nationwide.

In 2026, CMS is expanding the C-SNP condition category from ESRD to CKD (chronic kidney disease), allowing plans to serve beneficiaries across the full kidney disease continuum鈥攆rom earlier-stage CKD to dialysis-dependent ESRD. This policy shift enables MA plans to intervene sooner, coordinate care more effectively, and help patients avoid or delay kidney failure, ultimately improving quality of life and reducing long-term costs. Integrating CKD and ESRD into a single SNP also aligns with CMS鈥檚 value-based care strategy and addresses significant equity gaps. This paper outlines the challenges ESRD patients face, the limitations of current MA benefits, the unique requirements of ESRD C-SNPs, and the potential impact of the upcoming CKD-ESRD SNP model.

Summary of CMS鈥檚 CY2027 Proposed Rule

On November 25, 2025, the Centers for Medicare and Medicaid Services (CMS) released the 鈥淐Y2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program鈥�. The deadline to听submit听comments is January 26, 2026. This summary is primarily focused on the financial and actuarial aspects of the Proposed Rule.听

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RFP Calendar

RFP Release

Proposals Due

Awards

Implementation

Date	State/Program	Event	Beneficiaries
Date: DELAYED	State/Program: Texas STAR & CHIP	Event: Implementation	Beneficiaries: 4,600,000
Date: December 2025 - February 2026	State/Program: Texas STAR Kids	Event: Awards	Beneficiaries: 150,000
Date: January 1, 2026	State/Program: Wisconsin LTC GSR 2,7	Event: Implementation	Beneficiaries: 56,000 (all GSR)
Date: January 1, 2026	State/Program: Michigan HIDE SNP	Event: Implementation	Beneficiaries: 35,000
Date: January 1, 2026	State/Program: Nevada D-SNP	Event: Implementation	Beneficiaries: 88,000
Date: January 1, 2026	State/Program: Ohio Duals	Event: Implementation	Beneficiaries: 250,000
Date: January 1, 2026	State/Program: Illinois D-SNP	Event: Implementation	Beneficiaries: 79,000
Date: January 1, 2026	State/Program: Nevada	Event: Implementation	Beneficiaries: 674,000
Date: January 1, 2026	State/Program: Massachusetts One Care, Senior Care Options	Event: Implementation	Beneficiaries: 120,000
Date: January 6, 2026	State/Program: Nevada Children's Specialty	Event: Proposals Due	Beneficiaries: NA
Date: January 16, 2026	State/Program: Wisconsin LTC GSR 3	Event: Proposals Due	Beneficiaries: 56,000 (all GSR)
Date: January 21, 2026	State/Program: Illinois Tailored Care Management Program	Event: Proposals Due	Beneficiaries: 22,400
Date: February 2026	State/Program: Illinois	Event: Awards	Beneficiaries: 2,400,000
Date: February 19, 2026	State/Program: Nevada Children's Specialty	Event: Awards	Beneficiaries: NA
Date: June 24, 2026	State/Program: Wisconsin LTC GSR 3	Event: Awards	Beneficiaries: 56,000 (all GSR)
Date: December 2026 - February 2027	State/Program: Texas STAR Kids	Event: Implementation	Beneficiaries: 150,000
Date: January 1, 2027	State/Program: Illinois	Event: Implementation	Beneficiaries: 2,400,000
Date: January 1, 2027	State/Program: Nevada Children's Specialty	Event: Implementation	Beneficiaries: NA
Date: January 1, 2027	State/Program: Wisconsin LTC GSR 3	Event: Implementation	Beneficiaries: 56,000 (all GSR)
Date: January 1, 2027	State/Program: Illinois Tailored Care Management Program	Event: Implementation	Beneficiaries: 22,400
Date: January 1, 2028	State/Program: Wisconsin LTC GSR 4,6	Event: Implementation	Beneficiaries: 56,000 (all GSR)
Date: Fall 2027	State/Program: Oregon	Event: RFP Release	Beneficiaries: 1,200,000
Date: 2028	State/Program: North Carolina	Event: RFP Release	Beneficiaries: 2,200,000

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