By Nilay Patel, Executive Vice President and General Manager Despite a dip when COVID-era provisions ended, Medicaid enrollment continues to go up.
By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems When you hear the words "claim denial" or "encounter processing," it's easy to assume that the organization handling those transactions is making decisions about a person's medical care. In reality, claims and encounters processing occurs after healthcare services have already been delivered. Claims and encounters processing is fundamentally different from clinical decision-making. Understanding this distinction is important for healthcare providers, Medicaid members, policymakers, and the public.
By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems Medicaid agencies are operating in a shifting environment. Federal oversight is increasing. Provider shortages continue to strain access. Program integrity expectations are rising. At the same time, states are being asked to modernize operations, reduce administrative burden, and protect public funds without disrupting care delivery.
By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions Medicaid is one of the most complex healthcare programs in the United States, serving more than 90 million Americans through a combination of federal and state-administered programs, eligibility categories, and waiver authorities. The program finances acute care, behavioral health, long-term services and supports (LTSS), and home- and community-based services (HCBS) for older adults, children, individuals with disabilities, and medically vulnerable populations.
By Meghan Harris, President and Chief Operations Officer Mental Health Burden According to the World Health Organization, an estimated one billion people[1] live with a mental health or addictive disorder. That’s one out of every eight people on the planet. In the U.S., estimates suggest that only half of people with mental illnesses receive treatment.[2] And according to the Substance Abuse and Mental Health Service Administration (SAMHSA)’s National Survey on Drug Use and Health, only a small proportion of individuals who need substance use treatment receive it, leaving approximately 90% who go without treatment.[3] The burden of mental health disorders and the associated economic costs are enormous — to individuals, the economy, and society.
By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions States have developed a wide range of services to help individuals who have disabilities or chronic conditions and need long-term care. Over 30% of Medicaid expenditures go toward long-term services and supports (LTSS) for both institutional and home-based care.
By Nirav Dalal, Senior Vice President of Sales Leadership With more Medicaid Management Information Systems (MMIS) moving to modular, multi-vendor models, vendor selection is no longer just about technology; it’s about building a network of partners who work together to deliver better outcomes for priority populations. The shift is reshaping Medicaid operations and demands a more strategic, deliberate approach to vendor selection.
By Ryan Bosch, MD, FACP, Chief Health & Informatics Officer As state Medicaid agencies adopt modular, specialized systems to meet Centers for Medicare and Medicaid Services (CMS) requirements, they gain flexibility but lose a single, unified view of their data. Each module stores and organizes data in its own way, which makes it efficient for generating reports from that specific system, but harder to combine and use data across systems.
By Amanda Ramsey, Marketing Director Acentra Health returned from the 16th Annual State Healthcare IT Connect Summit energized by the urgency and scale of change facing Medicaid and Health and Human Services (HHS) leaders nationwide. Held February 24–26, 2026, in New Orleans, the well-attended conference brought together state and federal leaders, technologists, and industry partners at a pivotal time for health IT transformation. Across sessions and conversations, several themes consistently surfaced: Artificial Intelligence (AI), rural health transformation, community engagement requirements under H.R. 1, interoperability, and the operational impact of sweeping federal policy changes. At its core, this year’s Summit reinforced a simple reality: policy change and technology modernization are no longer separate efforts; they must move forward together.
