NNews March 2026

March 2026 7 NJAMHAA’s Expert Partners Share Advice for Copingwith Impending Medicaid Cuts continued frompage 6 Provider-MCO Partnerships Are Essential Creating shared churn-reduction playbooks: Ensure that plans and providers coordinate on contact information updates and outreach to people served. Create a joint handoff workflow fromproviders to care plan managers for renewal support. Sharing data and ensuring that it is usable: For example, maintain monthly lists of people at risk of losing eligibility and identify potential red flags. Close the loop between providers and plans to ensure information is shared (e.g., providers must tell plans who re-enrolled after losing coverage; plans need to inform providers of who lost coverage and why). Adjusting contracts: • In the short term, reduce administrative friction if possible. • In the medium term, think about shifting to value-based care (e.g., shared savings tied to diversion; per member/per month reimbursement). Advocating jointly: “Present a unified front, especially with shared uniform data, including workforce shortages, to make the case for mitigation strategies. Align around shared line defenses and continuity strategies,” Williams advised. S ervice providers and managed care organizations (MCOs) can and should work together to mitigate the effects of these new policies and budget reductions. “Historically, providers and plans pulled in opposite directions. As a result, costs went up and outcomes went down,” Duck said. “Providers haven’t had a reason or the expertise to partner with managed care. This needs to be figured out. Sweeping change will force providers and MCOs to be more collaborative.” According to Williams, “The biggest shared risk for providers and MCOs is avoidable disenrollment.” For example, individuals could lose coverage for paperwork or processing reasons. These are avoidable and if they are not prevented, they will result in higher costs and poor health outcomes. Williams recommended: Duck added that providers need to plan for risk-based contracting because “the move to block grants on the state level will meanmore pressure on bothMCOs and providers. Thismay lead to higher taxes or payers and providers being put at risk.” “MCO plans are taking financial risk. Providers take performance risk, as well as financial risk, especially with block grants,” Duck explained. “A risk environment is inevitable in the next few years. Providers need a handle on their unit costs in all service lines, and they need to identify what makes money andwhat doesn’t. In addition, provider organizations need to identify, with data, what services differentiate their organizations fromothers – in other words, what are you good at?” In addition, MCOs and providers need to establish a high level of trust. Providers will need to give MCOs access to their electronic health records and there “needs to be a meeting of the minds on what data to share – the fear factor of giving additional data needs to stop. Payers generally already know more about providers in their networks from just the claims data submitted,” Duck said. continued on page 8