Medicaid Policy

Medicaid VBC activity is concentrating around managed care accountability, maternal health, and administrative burden: states are using maternity-specific Medicaid payment reforms and ACO structures to tie perinatal outcomes, care coordination, and disparity reduction to financing, while Medicaid ACO leaders are emphasizing that quality gains depend on data sharing, community partnerships, and flexible care management infrastructure—not just upside/downside risk (Milbank Medicaid ACO maternal health analysis; NASHP Medicaid maternity VBP overview). At the same time, CMS is tightening prior authorization transparency and interoperability expectations for Medicaid managed care plans under CMS-0057-F, signaling that operational readiness—API implementation, denial reporting, and payer-provider workflow redesign—is becoming a core Medicaid VBC capability rather than a compliance back-office issue. For ACOs, health systems, and Medicaid MCOs, the strategic tension is shifting from whether Medicaid can support value-based models to whether states and plans can align risk, quality incentives, maternal/population health goals, and administrative simplification quickly enough to make those models financially durable.