Articles

Can Community-Based Care Become a Preventive Infrastructure Rather Than a Crisis Response System in the United States?
Community-based care has the potential to become a preventive infrastructure that identifies emerging needs, sustains independence and reduces avoidable crises. This USA flagship analysis examines how Medicaid, HCBS, behavioral health, crisis systems, managed care and community partnerships could support that transition, including the funding, workforce, governance, data and accountability arrangements needed to demonstrate meaningful outcomes for people and families. Read more...
The Future of State Medicaid Oversight in an Increasingly Complex Provider Market
State Medicaid agencies are overseeing increasingly diverse provider markets spanning home- and community-based services, long-term supports, behavioral health, managed care and technology-enabled delivery. This flagship analysis examines how states can strengthen accountability without undermining provider capacity, access or innovation, and what changing oversight expectations mean for contracting, payment, workforce assurance, data quality, participant rights and sustainable community-based care. Read more...
What Could Outcomes-Based Contracting Mean for HCBS Providers?
Outcomes-based contracting could change how Medicaid-funded Home- and Community-Based Services providers are paid, evaluated and held accountable. This flagship analysis examines value-based payment design, state and managed care contracting, financial risk, workforce capacity, participant-defined outcomes and evidence requirements. It explores what providers need to negotiate, implement and govern arrangements that reward meaningful results without compromising access, choice or service sustainability. Read more...
Can Value-Based Payment Work in Community-Based Long-Term Services and Supports? Evidence, Incentives and Provider Sustainability
Value-based payment promises to connect Medicaid HCBS and LTSS funding more closely with quality, independence and outcomes, but community-based services face challenges that traditional healthcare payment models often overlook. This article examines federal and state policy, managed care contracts, outcome measurement, workforce costs, provider risk and practical payment design, showing when value-based arrangements can create genuine value and when they may undermine access and sustainability. Read more...
Could Medicaid Move From Paying for Services to Paying for Independence? The Future of Outcome-Based HCBS Funding
Medicaid traditionally reimburses many community-based providers for authorized services and delivered units of support. But could future payment models reward greater independence, personal choice and sustained community living? This flagship analysis examines outcome-based HCBS funding, federal-state Medicaid architecture, managed care, provider economics, workforce incentives, quality measurement and safeguards against inappropriate service reduction. It explores how states and providers could develop payment arrangements that recognize meaningful progress without penalizing people with complex or lifelong support needs. Read more...
The Future of LTSS: Can Community-Based Care Keep Pace With an Aging America?
America's aging population is increasing pressure on long-term services and supports, but expanding community-based care requires more than shifting spending away from institutions. This flagship analysis examines Medicaid financing, HCBS capacity, workforce sustainability, managed care, family caregiving and the operational realities of aging at home. It explores how states, health plans and providers can build more resilient, equitable and accountable LTSS systems over the coming decade. Read more...
What Could the Next Generation of Medicaid HCBS Look Like? Funding, Workforce, Quality and System Redesign
The next generation of Medicaid Home- and Community-Based Services will depend on more than expanding access or introducing new payment models. This flagship analysis examines how federal policy, state administration, managed care, provider networks, workforce investment, person-centered outcomes and digital infrastructure could reshape HCBS, and what states, health plans and community providers need to demonstrate for reform to deliver sustainable improvements. Read more...
The Next Phase of Medicaid Managed Care Access and Quality: What Providers Should Be Preparing For
Medicaid managed care is moving toward stronger evidence of whether provider networks deliver timely, usable and high-quality access in practice. This flagship analysis examines appointment wait-time standards, secret-shopper testing, payment transparency, quality oversight, state-directed payments and the operational evidence providers should be building as federal requirements move through state-specific implementation. Read more...
Medicaid Prior Authorization Is Changing: What 2026 and 2027 Mean for Providers, Plans and People Receiving Services
Prior authorization reform is moving from policy into operations. This flagship analysis examines the 2026 requirements for faster decisions, specific denial reasons and public performance reporting, the major FHIR API changes arriving in 2027, and what Medicaid agencies, managed care plans, providers and people receiving services should do now to turn regulatory change into faster, more transparent and better-governed access to care. Read more...
Medicaid HCBS Access Rule: What Providers and State Systems Need to Prepare for Next
The Medicaid Access Rule is moving from federal regulation into phased operational implementation across HCBS. This flagship analysis examines the changing timetable for grievances, incident management, access reporting, quality measures and direct-care payment adequacy, and explains what state Medicaid agencies, providers, managed care partners and governance leaders should prepare, measure and evidence before the later requirements take effect. Read more...
What Could Medicaid Purchasing and Community-Based Care System Design Look Like in 2040?
By 2040, purchasing community-based care could look very different from today’s mix of fee-for-service reimbursement, managed care contracts, waivers and grant-funded programs. This flagship analysis examines how Medicaid agencies, health plans, providers and communities could use better population intelligence, payment design, provider-market stewardship and accountability to build more preventive, person-centered and sustainable systems. Read more...
Data-Driven System Design for IDD Services: Turning Intelligence into Better Access, Quality and Medicaid Decisions
Better data can help states, Medicaid programs, managed care organizations and providers make stronger decisions about intellectual and developmental disability services. This flagship analysis examines how need, access, authorization, workforce capacity, provider sustainability, quality-of-life outcomes and participant experience can be connected to improve purchasing, program administration, network design and long-term IDD system planning. Read more...