Medicaid Innovation Models

Medicaid innovation activity in the last 24 hours is centering less on new CMMI models and more on operational accountability inside Medicaid managed care: HHS OIG found Health Share of Oregon did not always meet federal and state requirements when denying prior authorization requests, reinforcing scrutiny on whether capitated Medicaid plans are managing utilization in ways that preserve access and documentation integrity. At the same time, CMS’s push toward FHIR-enabled electronic prior authorization—and Epic’s rollout of instant prior auth checks at Ochsner, Froedtert ThedaCare, Denver Health, and Summit Health—signals near-term pressure on Medicaid agencies, MCOs, and VBC providers to modernize UM workflows, reduce avoidable delays, and generate auditable data for quality and equity oversight ([OIG finding](https://news.google.com/rss/articles/CBMi8gFBVV95cUxNcVV0R3ozajRKaS1ENFBpbGl4ei15WS1PTGpCQ2d3SDBEUC1SQzQ5UFBnUExTUmtHbFEyWGhDMlk5MUVqMzkxNFlLQThGWUtpUV9FT3k2MllRckF3ZWJFYVZGdm5NbFctWnJkUE5sVnAwb0h3YkhUVzVhcjBHeU9BZUJ3aGxTaW84U1