By: Kate Honsberger

Last month, I had the opportunity to attend AHIP’s Medicare, Medicaid, Duals & Commercial Markets Forum 2026 (MMDC26) in Washington, D.C. This annual gathering continues to bring together leading health care policy minds, and this year was no exception. Across three days, discussions spanned Medicaid financing, community engagement requirements, rising drug costs, and CMS’s push toward integrated, value-based care.

Below are five key takeaways and the opportunities they present for the field.

Community Engagement Requirements: January 1 Is Just the Beginning

The implementation of Medicaid community engagement requirements was a dominant theme across sessions. Speakers emphasized that the January 1, 2027, deadline is not an endpoint, but the start of an iterative process requiring significant operational and administrative shifts. Health plans will be indispensable partners, building on lessons from Medicaid unwinding, supporting member outreach, and helping states accurately identify exemptions.

One particularly compelling idea discussed was aligning community engagement requirements with workforce needs, connecting Medicaid members to care workforce opportunities to address both compliance and workforce shortages.

Opportunity:

Health plans can position themselves as implementation partners by leveraging data, outreach infrastructure, and member insights. There is also a unique opportunity to pilot innovative models that connect community engagement requirements with workforce pathways, addressing labor shortages while supporting member participation.

Keeping Older Adults and People with Disabilities at Home Is Under Pressure and Needs a Defense

Caring for older adults and people with disabilities is facing a convergence of pressures, including budget constraints, workforce shortages, increased program integrity scrutiny, and growing population complexity.

At the same time, HCBS remains central to care delivery. Growth driven by rebalancing efforts reflects progress, but rising spending has drawn increased federal scrutiny that could threaten continued expansion.

This moment underscores the need to more clearly define and communicate the value of HCBS to policymakers making key funding decisions.

Opportunity:

Plans and providers can lead by building a stronger, evidence-based narrative about HCBS that demonstrates outcomes, cost-effectiveness, and member impact. Proactively highlighting program integrity safeguards and measurable value will be critical to sustaining investment and protecting access.

Specialization in Managed Care Is Raising the Bar for Complex Populations

Specialized managed care models are advancing rapidly. Medicare Advantage Special Needs Plans and Medicaid MLTSS programs are becoming more sophisticated in identifying and serving individuals with complex needs.

This shift toward specialization is enabling more tailored benefits, better assessments, and stronger person-centered care models delivering more targeted and accountable care.

Opportunity:

Health plans can continue to differentiate by investing in specialized models, data-driven segmentation, and integrated care strategies. There is also an opportunity to demonstrate how these models improve outcomes and reduce costs, strengthening the case for continued policy and market support.

Drug Pricing Is About More Than Just Manufacturers

The conversation around drug pricing is expanding beyond manufacturers to include the full supply chain, PBMs, distributors, and other intermediaries. Policymakers are increasingly focused on transparency, questioning where dollars flow and whether value aligns with cost.

This shift reflects broader demands for accountability across the system.

Opportunity:

Health plans can step forward as transparency leaders, clearly articulating how they manage pharmacy benefits, control costs, and deliver value. By proactively engaging in this conversation, plans can help shape more balanced and sustainable drug pricing policies.

Now Is the Time for Health Plans to Demonstrate Their Value

A consistent theme throughout the conference was the elevated role of health plans and the expectations that come with it. CMS officials highlighted plans’ unique ability to integrate clinical expertise, quality infrastructure, and multi-level stakeholder engagement.

This position plans as an essential partners in navigating system-wide change.

Opportunity:

Health plans have a clear opening to more proactively demonstrate their value not just as payers, but as strategic partners in care delivery and system transformation. Elevating their role in improving outcomes, coordinating care, and advancing innovation will be key to shaping future policy and market direction.