MHPA26 gave our team the opportunity to hear directly from Medicaid leaders to discuss issues shaping managed care today. If you were unable to attend, here are some of the key themes and insights from this year’s conference.
Big Themes & Trends
Three themes consistently emerged throughout the conference:
- Policy is driving operational change. HR1, the evolving political environment, program integrity, and rate setting are creating new challenges for health plans as they translate policy changes into day-to-day operations.
- Access to care remains a priority. Increasingly complex member needs highlight the importance of accurate assessments, appropriate service planning, and access to care across behavioral health, maternal health, and LTSS.
- Data, documentation, and oversight matter more. Discussions around fraud, waste, and abuse (FWA), utilization management, payment integrity, and rate development highlighted the need for strong visibility, particularly in home and community-based services (HCBS).
Standout Sessions
Two sessions stood out to our team for their focus on strengthening program integrity:
Actuarial Implications of Fraud, Waste, and Abuse: Rylan Austin (CareSource) and Colby Schafield (Ripple Actuarial Group)
This session explored how FWA impacts HCBS, managed care, rate development, and Medicaid oversight. It also highlighted the importance of distinguishing between fraud, waste, and abuse, along with the need for accurate data and documentation to support stronger program integrity.
Correcting the Record on FWA, How Plans are Acting to Safeguard Program Integrity: Sean Finnegan (Centene), Steven Johnson (HCSC), Kate Paris (UnitedHealthcare), and Jeanine Boyle (Rock Creek Policy Advisors)
A key takeaway from this session was the importance of identifying potential inconsistencies in LTSS assessments and care plans earlier in the process. Rather than relying solely on reviews after an assessment is completed, health plans can identify and address issues while assessors are still engaging with members.
Both sessions reinforced a common theme: moving program integrity efforts earlier in the assessment and service planning process can improve accuracy, reduce avoidable errors, and strengthen oversight.
Networking & Community
Beyond the conference sessions, MHPA provides valuable opportunities to connect with Medicaid leaders and exchange perspectives on the challenges facing health plans and states.
A highlight was the Sellers Dorsey dinner, where conversations continued beyond the formal agenda. These more relaxed conversations offered additional perspectives on how organizations are actually navigating policy changes, operational challenges, and evolving program priorities.
Key Takeaway
One of the clearest takeaways from MHPA 2026 was the importance of taking a more proactive approach to program integrity.
While retrospective claims remain essential, identifying potential inconsistencies earlier in the assessment and service planning process creates opportunities to prevent avoidable errors and improve oversight.
For HCBS, accurate assessments and service planning are essential to helping members live safely and independently in their communities. Strengthening these processes can help identify inconsistencies earlier, reduce inappropriate utilization, improve oversight, and ensure services align with member needs.
Looking Ahead
As Medicaid oversight evolves, stronger program integrity, accurate data, and proactive approaches will remain priorities for health plans and states.
Ultimately, the goal is to ensure Medicaid resources are used appropriately, and members receive the care and services they need to live safely and independently in their communities.
Photo Credit: MHPA Website