Health Equity & SDoH

CMS under the Trump administration is pushing Medicaid quality oversight toward outcomes-based accountability, with 37 states joining an initiative to reassess measures around whether beneficiaries are getting healthier rather than whether plans and providers satisfy process checklists—an important signal for Medicaid MCOs, ACOs, and health systems preparing for tighter linkage between population health performance and payment strategy (CMS-state Medicaid quality initiative). At the same time, the 2025 reconciliation law’s Medicaid work requirements and eligibility restrictions for certain lawfully present immigrants create a competing coverage-stability risk, especially for disabled adults awaiting Medicare and other high-need populations, raising churn, uncompensated care, and care-management continuity challenges for VBC entities (KFF on Medicaid work requirements and SSDI waiters). Within that tension, Medicaid ACOs—particularly in Massachusetts maternal health initiatives—are being positioned as vehicles to translate equity and SDoH interventions into measurable outcomes such as improved prenatal, postpartum, and midwifery-supported care, but their success will depend on maintaining enrollment continuity while CMS shifts the quality agenda toward results.