Health Care Matters | September 18
CMS Expands ACCESS Model to More Chronic Conditions
The Centers for Medicare & Medicaid Services (CMS) is expanding the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model to include heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, and tobacco cessation beginning in spring 2027. The model already supports people with conditions including high blood pressure, diabetes, depression, and chronic musculoskeletal pain. ACCESS allows participating organizations to deliver technology-supported services such as virtual care, health coaching, remote monitoring, and connected devices, with Medicare payments tied to measurable improvements in health rather than individual services. CMS says 160 organizations are now participating, and major health plans representing 165 million people have pledged to adopt outcomes-based payment approaches aligned with the model. Read more here and here.
Why It Matters
The expansion moves ACCESS beyond a limited set of chronic conditions and further tests whether Medicare can create a scalable payment pathway for technology-enabled care between traditional office visits. Adding conditions such as heart failure and substance use disorder also broadens the types of clinical needs and care teams that will have to integrate with ACCESS participants, making coordination with primary care and other providers increasingly important. The growing number of participating organizations and alignment from other payers could also give the model influence beyond Original Medicare, potentially creating a more consistent market for outcomes-based digital and chronic care services. The next test will be whether those arrangements produce measurable improvements without adding another disconnected layer to patients’ care.
California Moves to Reduce Coverage Losses Under New Medicaid Work Requirements
California Gov. Gavin Newsom has signed legislation directing the state to use existing data and outreach tools to help Medi-Cal beneficiaries comply with new federal work and community engagement requirements before asking them to submit additional documentation. Beginning January 1, 2027, certain adults ages 19 to 64 will generally need to complete 80 hours per month of work, education, job training, or community service to maintain Medicaid eligibility. California’s new law, AB 2161, does not change the federal requirement, but it directs state and county agencies to prioritize continued coverage and reduce avoidable disenrollment tied to paperwork or verification gaps. State estimates cited by SFGATE suggest nearly 1.7 million Californians could lose coverage over two years because of noncompliance or administrative barriers. Read more here.
Why It Matters
California’s approach illustrates how much discretion states may still have in determining how burdensome Medicaid work requirement implementation becomes for beneficiaries. CMS requires states to verify compliance and terminate coverage when individuals do not meet the requirement or qualify for an exemption, but states control many of the operational processes around outreach, data matching, documentation, and renewal. California is choosing to invest in systems that can verify eligibility using information the state already has before requiring beneficiaries to take additional steps. As every state prepares for implementation in 2027, differences in these administrative choices could become a major factor in how many eligible people retain coverage and how much additional work falls on Medicaid agencies, health plans, providers, and community organizations.
Look for the Helpers: Training the Next Generation of Pediatricians Where They’re Needed Most
Children’s Healthcare of Atlanta is partnering with Emory and Morehouse schools of medicine to train pediatric residents at a new clinic in Atlanta’s Adamsville community. About 65 residents will rotate through the site each year, gaining experience caring for children with a range of needs while helping expand access in a state where more than 60 counties have no practicing pediatrician. The effort connects workforce training directly to community need, giving future physicians experience in the places where their work can have an immediate impact. Read more here.
What We Are Reading
A Vision for Modernizing Medicare Risk Adjustment: Building the Evidence for Reform
A Duke-Margolis white paper outlines a path for modernizing Medicare risk adjustment so it better reflects current care delivery, data capabilities, and the goals of accountable care. Read here.
How Ownership-Based ‘Food Is Medicine’ Initiatives Can Advance Structural Change
A Health Affairs Forefront article examines how Food Is Medicine programs can go beyond improving access to food by directing more investment toward local ownership, community businesses, and long-term economic capacity. Read here.
Saving America’s Primary Care System Requires Bold Action Now
A Medical Economics article argues that continued underinvestment in primary care is worsening access and workforce shortages, and makes the case for stronger payment and policy support. Read here.
Same-Insurer Coverage Associated With Fewer Hospitalizations, More Outpatient Visits Among Dual-Eligible Enrollees
A Health Affairs study found that dual-eligible beneficiaries using long-term services and supports had fewer hospitalizations and more outpatient visits when their Medicare and Medicaid coverage was administered by the same insurer. Read here.
Pop Health Podcast
Making Collaboration a Core Population Health Capability
Strong population health programs can still fall short when the clinical, behavioral health, and community-based organizations surrounding them lack the shared workflows, communication structures, and alignment needed to work effectively together. Purva Rawal, PhD, and Leigh Wilson-Hall, MSW, Senior Advisors at the Camden Coalition, join Coral Director Ashley Fitch to discuss the Community Ecosystem Alignment Tool, or CEAT, and how it helps organizations turn cross-sector collaboration into a more intentional and operational capability. Their conversation explores why fragmented ecosystems can undermine otherwise promising interventions, how CEAT helps partners identify and reduce friction, what implementation looks like in practice, and how stronger alignment can support better execution across maternal health, behavioral health, transitions of care, and integrated or value-based models.