InCK (Integrated Care for Kids) Model

Analysis updated November 9, 2026

Strategic questions for your team

Given that InCK model funding caps at $16 million per awardee over seven years and explicitly prohibits using cooperative agreement funds to deliver direct services to beneficiaries—permitting only infrastructure, staff training, data sharing, and planning costs—do we have sufficient existing operational budget and Medicaid/CHIP reimbursement streams to sustain the actual care coordination, case management, and Core Child Services delivery that the model requires, particularly for SIL 2 and SIL 3 beneficiaries who need intensive integrated case management?
Can our organization serve as a legally eligible Lead Organization—specifically, are we a HIPAA-covered entity capable of convening a Partnership Council that includes representation from all Core Child Services domains (physical and behavioral health, early childhood care, education, food, housing, Title V, child welfare, and mobile crisis response), and can we execute the service integration protocols and information-sharing arrangements across those sectors within our geographic service area?
Do we have the data infrastructure and MCO contracting capability to design and implement a functional Alternative Payment Model within Medicaid managed care, given that by the end of 2023 several InCK awardees had only partial APM coverage—IL-Village InCK covering 50% of its population, NY InCK only 22%, and OH InCK 50%—and that MCO engagement was consistently identified as the most significant APM implementation barrier across all award recipients?
What is our realistic population engagement capacity, given that even the highest-performing awardees by end of 2023 achieved screen-based assessment completion rates of only 4.3% (All Hands InCK, 41,478 attributed beneficiaries) to 12.6% (Village InCK, 11,366 beneficiaries), and that beneficiary contact failures—including inaccurate addresses, distrust of program names, and faulty digital outreach technology—were universal challenges that delayed impact detection and APM payment distribution across all seven awardees?
Can we staff and sustain a Service Integration Coordinator workforce at the caseload levels the model demands, recognizing that All Hands InCK Service Integration Coordinators were serving only 3–26 beneficiaries per month against an originally projected caseload of 60–90, and that staffing churn was a persistent operational challenge that required salary increases to partially address, suggesting significant ongoing workforce cost and management burden?
Are we prepared to meet the model's annual population-wide needs assessment requirement across all 10 Core Child Services domains—physical health, behavioral health, maternal and child health, functional symptoms, functional impairments, special education/early intervention, child welfare, imminent or at-risk OOHP, housing instability, and food insecurity—using a combination of administrative and screen-based assessment methods, and do we have the data-sharing agreements and technical infrastructure to execute SIL stratification for every attributed Medicaid/CHIP beneficiary ages 0–20 in our designated geographic service area at least annually?
What is our tolerance for a long impact timeline and regulatory uncertainty, given that the model runs through December 31, 2026, that only 3 of 7 awardees had sufficient implementation maturity to support impact evaluation by end of 2023 (IL-All Hands, IL-Village, and NC InCK), that IL-Village InCK's best-documented financial result was only a 4.8% relative reduction in total cost of care, NC InCK showed a 3.3% relative increase in total cost of care alongside a 2.9% increase in well-child visits, and that the model is operating under the Trump administration's CMS leadership—including Administrator Dr. Mehmet Oz and CMMI Director Abe Sutton—whose appetite for continuing or expanding pediatric Medicaid innovation models remains an active policy variable?
Do we have the community trust infrastructure and cultural competency capacity to overcome the engagement barriers documented across all InCK awardees—including beneficiary distrust of health systems, stigma around behavioral health, lack of culturally competent providers, and general distrust of government programs—recognizing that All Hands InCK found that only 7 of 5,720 families who received a digital outreach message completed a screen-based assessment through the online platform, and that successful engagement required leveraging pre-existing community relationships and in-person outreach at food pantries, schools, vaccine clinics, and community events?

Traps and concerns

MCO Contract Fragmentation Stalls APM Payments
InCK APMs require negotiated contracts with every Managed Care Organization serving the attributed population before payments can flow — yet by end of 2023, three of seven award recipients had only partial MCO coverage: IL-Village InCK's APM covered 50% of its attributed population, NY InCK's covered only 22%, and OH InCK's covered 50%. This structural gap means providers serving the remaining 50-78% of attributed children receive no APM incentive signals, undermining the financial accountability logic that justifies the model's $16 million per-awardee cooperative agreement. Organizations that budgeted for full APM revenue to offset care coordination staffing costs by Year 3 face a liquidity shortfall if MCO contracts remain incomplete through the model's December 31, 2026 end date. Delayed MCO engagement was the most commonly cited barrier in Year 1, with evaluators noting 'limited MCO interest in pediatric APMs' and 'no facilitators identified' for provider contract negotiations — suggesting this is a structural market failure, not a solvable operational problem.
Beneficiary Attribution Errors Corrupt Performance Calculations
All Hands InCK (Lurie Children's Hospital, Chicago) experienced a documented case where incorrect PCP attribution directly delayed 2022 incentive payment distribution and prevented interim performance data from being shared with network providers. The APM pays up to $4.50 PMPM ($3.00 quality + $1.50 total cost of care) to PCPs, behavioral health providers, and CBOs — but payment eligibility requires accurate linkage of attributed children to specific providers. With an attributed population of 41,478 children across two Chicago ZIP codes (60639 and 60651), even a 5% attribution error rate affects over 2,000 beneficiary-provider assignments. Organizations building financial sustainability plans around APM distributions — All Hands InCK distributed only $246,421 in incentive payments through end of 2023 — must recognize that data quality failures in Medicaid claims-based attribution can cascade into deferred or voided payments, provider disengagement, and CMS compliance findings under the cooperative agreement terms.
Medicaid Churn Erodes Attributed Population Stability
InCK requires continuous enrollment for meaningful care coordination — particularly for SIL 2 and SIL 3 children who require intensive case management — yet Medicaid administrative churn (temporary loss and regain of coverage) is endemic across all six participating states. NJ InCK's attributed population reached 160,458 children in 2023 partly because COVID-19 continuous coverage provisions inflated enrollment; when the Public Health Emergency ended May 11, 2023, and eligibility redeterminations resumed, award recipients faced sudden population contraction mid-model-year. Children cycling out of Medicaid lose access to their assigned Service Integration Coordinator and forfeit accumulated care coordination continuity — precisely the population in SIL 2 and SIL 3 facing out-of-home placement risk. The evaluation documents that Medicaid churn was a persistent contextual factor influencing SIL stratification reliability across all award recipients, with churn disproportionately affecting Hispanic and Black beneficiaries — the core high-need populations InCK targets — creating both equity and operational measurement risks for the OOHP composite outcome measure.
Screen-Based Assessment Reach Too Low to Trigger Detectable Outcomes
The evaluation's power simulations establish minimum detectable effect thresholds that require substantial beneficiary engagement to produce statistically valid population-level impact estimates — yet by end of 2023, five of seven award recipients had engagement rates insufficient for impact assessment. NJ InCK screened only 0.8% of its 160,458 attributed beneficiaries; NY InCK engaged less than 0.2% (129 beneficiaries) of its 56,710-child population; CT InCK assigned fewer than 11 beneficiaries to SIL 2 or SIL 3. The evaluation determined impact assessment was only feasible for three of seven recipients (IL-All Hands, IL-Village, NC InCK). For NJ InCK, the threshold required increasing well-child visits by 2,138 — yet the program had engaged only 505 total beneficiaries. This is not merely an evaluation problem: CMS's 1115A authority requires CMMI models to demonstrate savings or quality improvements, and with the model ending December 31, 2026, award recipients with sub-1% engagement rates through Year 2 of implementation have insufficient runway to generate measurable results, creating renewal, scaling, and sustainability risk for participating state Medicaid agencies that have invested infrastructure in the APM.
CBO Performance Measurement Incompatible with APM Infrastructure
InCK APMs designate community-based organizations (CBOs) as eligible for incentive payment distributions — 25% of total APM incentive dollars in All Hands InCK's structure — but CBO data systems are fundamentally incompatible with claims-based performance measurement. All Hands InCK documented that CBOs 'typically use manual processes to collect data and often report data at the family level, not individual level by beneficiary,' directly preventing attribution of performance metrics to individual Medicaid beneficiaries. As of end of 2023, All Hands InCK was still refining CBO payment methodology two years into implementation. For organizations like NC InCK (112,057 attributed beneficiaries) or NJ InCK (160,458 attributed beneficiaries) that depend on CBO networks to deliver housing, food security, and mobile crisis response — Core Child Services domains not covered by Medicaid claims — the inability to measure and pay CBOs for performance means the non-health social determinants component of the model operates entirely outside the APM accountability structure, directly undermining the model's whole-child integration premise.
HIPAA Data Sharing Gridlock Blocks Cross-Sector Integration
InCK's core theory of change requires real-time data sharing across clinicians, schools, child welfare agencies, food programs, and housing providers — yet the evaluation documents persistent gridlock in establishing data use agreements (DUAs) and information sharing arrangements across multiple award recipients throughout 2022 and 2023. HIPAA-covered Lead Organizations face legal constraints in sharing beneficiary data with non-HIPAA-covered partners like schools and child welfare agencies without explicit beneficiary consent, which is particularly difficult to obtain for the high-churn, high-mobility SIL 2 and SIL 3 populations. All Hands InCK's closed-loop referral system (NowPow/Unite Us) showed that network partners completed zero of 130+ closed-loop referrals provided to families by end of 2023, partly because some providers lacked system access. OH InCK's APM footprint expanded slowly while data collection (the prerequisite first phase of APM payment distribution) remained incomplete. For organizations that received up to $16 million in cooperative agreement funding explicitly earmarked for 'infrastructure costs for data sharing' and 'service integration process planning' — not direct service delivery — failure to operationalize cross-sector data exchange before the December 31, 2026 model end represents a total loss of the model's core infrastructure investment.
NC InCK Cost Increase Signals Adverse APM Incentive Design
NC InCK — the model's largest single award recipient with 112,057 attributed beneficiaries across five North Carolina counties — generated a statistically significant 3.3% relative increase in total cost of care compared to its comparison group, simultaneously with a 2.9% increase in well-child visits. This finding, drawn from 2022-2023 Medicaid claims (T-MSIS Analytic Files), demonstrates the core payment design risk in preventive care APMs: improved access to previously foregone services mechanically increases near-term Medicaid expenditures before long-term avoidable utilization reductions materialize. NC InCK's APM incentivizes screening for upstream drivers of health, preventive services, and reduced utilization — but if MCOs and state Medicaid agencies are absorbing higher PMPM costs without corresponding reductions in ED visits or inpatient behavioral health admissions within the model's remaining timeline (through December 31, 2026), the APM fails CMS's 1115A statutory requirement that Innovation Center models reduce program expenditures or improve quality without increasing expenditures. State Medicaid agencies in participating states must budget for the possibility that InCK APMs generate measurable cost increases — not savings — through the model's terminal period, potentially jeopardizing both CMS approval for model continuation and state legislative support for pediatric APM infrastructure investments.