HMS is proud to help celebrate a major milestone: the California Association of Health Plans' 40th anniversary. We're bringing our expertise to the CAHP 2026 Annual Conference, where more than 1,000 healthcare professionals gather to shape how the state's health plans adapt to new laws, take on expanded responsibilities, and plan for what's next. Trusted by health plans nationwide and focused on your mission, HMS is dedicated to making possible the outcomes that matter most to you—improving access, boosting efficiency, and managing costs so your plans can achieve their goals and deliver better results for the members you serve. Stop by our booth to see what we can make possible together.

Medicaid program integrity is moving upstream.  That shift came into sharp focus at NAMPI 2026 in Portland, where HMS and Gainwell presented to  state, federal, clinical, product, and market leaders for Upstream Controls, Downstream Payoff: The Power of Prepayment Review. The session explored how Medicaid agencies can stop more improper payments before dollars leave…

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) marks a critical turning point for health and human services. This new ruling is a catalyst for comprehensive Medicaid transformation. It establishes requirements for real-time, standardized data exchange, requiring Medicaid programs and their partners to modernize how healthcare data flows between payers, providers, and patients.  For…

Inside MESC 2026 with Medicaid Leaders  Every Medicaid agency in the country is drowning in data and starving for decisions. That gap was exactly why we created our session for the recently held  Medicaid Enterprise Systems Conference in Portland, Oregon, Aug. 17-20: "From Data Overload to Decisive Action.” We brought together a former state Medicaid commissioner, a former CMS executive, and…

AI-driven modernization is helping agencies turn data into action—modernizing operations, strengthening program integrity, and delivering better outcomes at lower cost  Irving, Texas – August 12, 2026 – Gainwell Technologies LLC will spotlight accelerating Medicaid modernization at the 2026 Medicaid Enterprise Systems Conference (MESC), showcasing how states are transforming data, workflows, and decision-making to deliver better outcomes, including improved workforce participation,…

The CMS interim rule released June 1, 2026, makes clear that medical frailty in Medicaid cannot be confirmed by a diagnosis code alone. States must evaluate condition category, functional impairment, severity, and condition-specific context to determine whether a person's health status significantly impairs their ability to meet community engagement requirements. A multidimensional…

Medicaid oversight has a timing problem. For years, Medicaid fraud, waste, and abuse (FWA) efforts have chased questionable claims after the money has already left the system. But a major shift may be on the horizon.  Recent federal actions and interoperability mandates suggest a new era is coming. Early signs indicate the Centers for Medicare and Medicaid Services (CMS) is preparing states for a future…