State modernizes quality assurance and expands tools to bolster program integrity and access to care  IRVING, Texas – April 8, 2026 — Gainwell Technologies LLC today announced that New Mexico has deployed a comprehensive suite of the Health Management Systems, Inc. (HMS) program integrity and quality assurance capabilities to support the state’s modernization efforts and strengthen its fight against fraud,…

Rural Medicaid programs operate under constraints that make every decision more consequential. Smaller, geographically dispersed populations rely heavily on Medicaid but often use services less frequently because care is distant and local capacity is limited. Fixed administrative costs—billing, information technology, compliance, and staffing—remain constant. This results in higher per-service costs,…

Irving, Texas – March 31, 2026 – Gainwell Technologies LLC today announced a new solution to help state Medicaid agencies identify medically frail members as part of Community Engagement Verification (CEV) programs required under H.R. 1. As part of its pledge to CMS, Gainwell is making the underlying proprietary clinical logic—the rules that determine whether someone qualifies as medically frail—available to every state…

Implementing medical frailty exceptions for Community Engagement Verification (CEV) is a massive administrative hurdle for state agencies. Recent legislative changes, such as H.R. 1, require states to assess medical frailty exemptions rapidly and accurately despite complex data environments. The process demands sophisticated clinical logic, seamless data integration, and highly adaptable…

Immunization technology is moving smarter and faster—and Gainwell is at the center of it at the AIRA 2026 National Meeting. We can’t wait to see you to share hands-on insights, proven strategies, and real‑world solutions that help states strengthen data quality, boost interoperability, and modernize IIS platforms with confidence.

Fraud, waste, and abuse (FWA) in Medicare and Medicaid are significant challenges that threaten the sustainability of these programs, reduce access to care for vulnerable Americans, increase taxpayer costs, and undermine trust in the healthcare system. The recent House Energy and Commerce Committee Oversight and Investigations Subcommittee hearing, titled “Protecting Patients…