Medicaid Transformation

What is the Medicaid Transformation?

The Medicaid Transformation work is a five-year agreement between the state and the Centers for Medicare and Medicaid Services (CMS) that provides up to $1.5 billion federal investment for regional health system transformation projects that benefit Apple Health (Medicaid) clients.

The transformation effort contains three initiatives.

Initiative 1 provides financial incentive payments for projects that build health systems capacity, redesign the delivery of care, and target health prevention and promotion.

For Initiative 1, each participating region has an Accountable Community of Health (ACH) that works with tribes, IHCPs, and other providers and social service partners to:

• Deliver coordinated and timely physical and behavioral health care that takes into account the needs of the whole person; and
• Increase value-based payments that reward medical providers for the quality care they provide—rather than simply paying them for each service.

Additionally, HCA has agreed to target a portion of the Initiative 1 incentive payment funding for tribes and IHCPs to achieve one or more of these same benefits, taking into account the unique needs of their health care systems and populations.