AHIP 2026 Medicare, Medicaid, Duals and Commercial Markets Forum (MMDC26)

The 2026 Medicare, Medicaid, Duals and Commercial Markets Forum (MMDC26), organized by America’s Health Insurance Plans (AHIP) and held on March 23–25 in Washington, DC, convened more than 1,000 leaders from health plans, government agencies, and the broader healthcare ecosystem. The forum addressed the intersection of government program administration, commercial market dynamics, and a rapidly shifting federal policy environment. In 2026, total US healthcare spending is projected to reach approximately $5.3 trillion[i], marking the largest cost surge in over 15 years, driven by major policy changes, rising medical prices, and costly new therapies. Against this backdrop, MMDC26 served as a platform for payors, regulators, and health technology organizations to address the structural challenges facing Medicare Advantage, Medicaid managed care, duals integration, and the commercial markets simultaneously.

AHIP President and CEO Michael Tuffin opened the forum by framing healthcare affordability as the association’s central organizing objective in 2026. Tuffin articulated four institutional commitments: promoting competition in prescription drug coverage, advancing site-of-service reforms, reducing administrative complexity, and strengthening value-based incentive alignment. The forum drew senior decision-makers from organizations, including Kaiser Permanente, CVS Health, Humana, Elevance Health, CareFirst BlueCross BlueShield, GuideWell and Florida Blue, UPMC Health Plan, Blue Cross Blue Shield of Michigan, and CareSource, alongside regulators from CMS, the US Department of Labor, the FDA, and the HHS Office of the National Coordinator for Health Information Technology.

Medicare Advantage Under Structural Pressure: Enrollment Trends and Benefit Contraction

Medicare Advantage continues to expand, but the 2026 plan year reflects significant market-level corrections. According to KFF analysis, the average Medicare beneficiary had 39 plan options available in 2026, down from 42[ii] in 2025. In 35 states, the District of Columbia, and Puerto Rico, average plan availability declined year over year. Concurrent with reduced plan choice, the value of benefits contracted.

Forum sessions examined how major Medicare Advantage organizations are recalibrating strategy in response to margin compression. Representatives from CVS Health, Humana, and Oscar Health participated in discussions on Individual Medicare and the trajectory of the Part D market. A dedicated session on the Part D program addressed cost and market trends, emerging policy uncertainties, and structural considerations for plan sponsors as the program continues to evolve following the Inflation Reduction Act. The Institute for Clinical and Economic Review (ICER) contributed perspectives on drug cost evaluation methodology, a recurring point of tension between plan administrators and pharmaceutical manufacturers in the context of Part D negotiations.

Duals Integration: From Demonstration Models to Scaled Implementation

The integration of Medicare and Medicaid benefits for dual-eligible individuals, approximately 12 million[iii] Americans who qualify for both programs, remained a structural theme across MMDC26. The number of Dual Eligible Special Needs Plans (D-SNPs) accounts for 59%[iv] of all Medicare Advantage plans offered for 2026, highlighting its growing importance within the Medicare Advantage landscape. This reflects a sustained carrier interest in serving this high-need, high-cost population. The acceleration of D-SNP availability and enrollment has coincided with CMS policy requiring greater integration between Medicare and Medicaid delivery systems.

Forum sessions featured state Medicaid directors and CMS leadership examining the operational mechanics of integrated care models. Gary Bacher, director of the CMS Federal Coordinated Health Care Office, and Abe Sutton, deputy administrator of the Center for Medicare and Medicaid Innovation (CMMI), presented on the policy architecture supporting duals integration. Amir Bassiri, Medicaid director for the New York State Department of Health, and Ann Jensen, administrator of the Nevada Medicaid Division, contributed state-level perspectives on implementation challenges. Texas and California both advanced major duals integration transitions, effective January 2026: Texas implemented its Integrated D-SNP model as a successor to the Medicare-Medicaid Plan (MMP) demonstration, while California expanded its Medi-Cal Matching Plan Policy statewide. WellCare Medicare’s Greg LaManna, senior vice president and chief duals integration officer, discussed plan-level operational approaches to managing these transitions. At the enterprise level, organizations such as Elevance Health and Health Care Service Corporation (HCSC) presented frameworks for aligning government program compliance with broader health equity and population health objectives.

Medicaid Managed Care: Financing Uncertainty and Workforce Constraints

Medicaid managed care organizations entered 2026 facing concurrent pressures: federal budget deliberations that introduced uncertainty into program financing, ongoing workforce shortages in provider networks, and increasing regulatory requirements for quality measurement and reporting. Dan Brillman, director of the Center for Medicaid and CHIP Services (CMCS), and Kate McEvoy, executive director of the National Association of Medicaid Directors (NAMD), framed the federal-state tension inherent in managed care rate development, particularly as states navigate actuarial soundness requirements under evolving CMS guidance. Martha Roherty of ADvancing States presented on the long-term services and supports (LTSS) dimension of Medicaid managed care, an area of growing fiscal exposure as the aged and disabled population expands.

Session content also addressed the erosion of pharmacy access as a Medicaid program risk. Pharmacy closures are widening geographic pharmacy deserts, disrupting historically reliable point-of-care access for high-need Medicare, Medicaid, and dual-eligible members. For Medicaid managed care organizations, this creates compounding risks: reduced quality performance on pharmacy-sensitive HEDIS measures, increased avoidable utilization, and increased patient safety risks for members managing chronic conditions. Presentations from Anew Health’s Samantha D’Onofrio and Eric Lessard explored how turnkey, clinically led pharmacy and medication management models can restore access and integrate with care teams to improve quality and total cost outcomes.

Data-Driven Outcomes and Accreditation: Enterprise Evidence at Scale

A defining orientation at MMDC26 was the convergence of outcome measurement, AI governance, and accreditation frameworks as mutually reinforcing pillars of program accountability, moving the forum’s substantive focus decisively away from aspirational commitment toward verifiable, repeatable evidence. A dedicated session on March 25 featured URAC President and CEO Shawn Griffin, MD, alongside leaders from Blue Cross and Blue Shield of Kansas (BCBSKS)—the first organization to achieve URAC Health Outcomes Accreditation (formerly Health Equity Accreditation). The session presented a real-world framework for addressing maternal health disparities and scaling that work across populations, focusing on how organizations can move from data collection to action by aligning stakeholders, building community partnerships, and establishing repeatable systems for continuous improvement. BCBSKS’s Virginia Barnes, director of Blue Health Initiatives, and Sonia Jordan, health equity manager, presented the data architecture underlying the program, demonstrating how accreditation reinforces accountability across programs and populations. Avasant’s Healthcare Provider Digital Services 2025 Market Insights™ report situates this approach within a broader industry shift: payors are using data analytics and AI to support value-based care, aligning incentives with patient health outcomes, tracking population risk, and collaborating with providers on models that reward quality and share financial risk—a trajectory the BCBSKS-URAC framework directly operationalizes at the plan level.

AI governance emerged as a cross-cutting operational concern at MMDC26. Aisha Rahim, MD, medical director and co-lead of the AI governance council at Johns Hopkins Health Plans, and Svetlana Bender, PhD, vice president of AI and behavioral science at GuideWell and Florida Blue, presented frameworks for responsible AI deployment in government health programs. The forum’s AI-focused sessions addressed how health plans can use intelligent information exchange to align clinical and administrative signals earlier in the care journey, examining real-world examples of AI-enabled intermediary models that support more informed care decisions, improved coordination across care teams, and clearer care pathways. Thomas Keane, MD, MBA, National Coordinator for Health Information Technology at HHS, presented on federal interoperability policy as foundational infrastructure for AI deployment at scale.

Commercial Markets and Affordability: Prior Authorization and Administrative Reform

The commercial markets dimension of MMDC26 addressed the structural forces driving premium increases and the challenges to plan sustainability. AHIP CEO Michael Tuffin specifically identified electronic prior authorization as a 2027 legislative priority, reflecting the persistent friction that manual prior authorization processes create for both health plans and providers. A panel moderated by the Healthcare Leadership Council’s Clara Keane addressed policy and regulatory strategies to advance affordability and sustain coverage amid market changes.

Enterprise-level engagement at MMDC26 reflected the convergence of technology and health plan operations. Oracle Health, represented by Mick Hubner and Alex Mugge, addressed payor-side technology modernization and global health policy integration. Cognizant’s Stephanie Rickard presented on the TriZetto® Unify platform’s approach to administrative simplification in government programs. The conference’s operational sessions drew on data from NCQA, represented by its president and CEO Vivek Garg, MD, MBA, on quality measurement evolution, and from the Institute for Clinical and Economic Review (ICER), represented by Sarah Emond, on evidence-based cost evaluation frameworks.

Health Equity and Maternal Health: From Policy Commitment to Measurable Outcomes

Health equity programming at MMDC26 moved beyond definitional framing toward evidence-based accountability structures. The BCBSKS-URAC presentation on maternal health disparities illustrated a replicable model: baseline measurement of disparities by population segment, targeted intervention design, integration of community partnerships, and iterative outcome tracking. This approach aligns with broader federal quality program evolution, as CMS incorporates health equity adjusters into Medicare Advantage Star Ratings and Medicaid quality incentive frameworks. Leah Chan, director of health justice at the Georgia Budget and Policy Institute, and David Granger, MD, market chief medical officer at AmeriHealth Caritas DC, presented state and plan-level perspectives on how Medicaid managed care can serve as an equity delivery mechanism when aligned incentives and data infrastructure are in place.

The forum’s equity sessions also addressed the intersection of social determinants and care coordination. Bamboo Health, a participant at MMDC26, develops real-time care intelligence solutions that integrate behavioral health, care coordination, and prescription drug monitoring program (PDMP) for health plans and state governments, representing the type of enterprise infrastructure increasingly required to operationalize equity commitments at population scale. Kyu Rhee, MD, president and CEO of the National Association of Community Health Centers (NACHC), presented on the role of Federally Qualified Health Centers (FQHC) in serving dually eligible and Medicaid populations, providing numerical context: FQHCs serve approximately 32 million patients annually, with more than 90%[v] at or below 200% of the federal poverty level.

What MMDC26 Signals for Healthcare Leaders

MMDC26 presented a unified set of structural signals for health plan executives, technology organizations, and government program administrators. The benefit contraction in Medicare Advantage, marked by a $26 per member per month (PMPM) reduction in D-SNP value and reduced plan availability in 35 states, signals that carrier margin recovery strategies will constrain supplemental benefit expansion through at least 2027. The doubling of D-SNP plan count since 2020 and the rollout of Integrated D-SNP frameworks in major states indicate that duals integration has transitioned from a federal demonstration model to a scaled program architecture, with corresponding operational and compliance demands. Medicaid managed care organizations face actuarial pressure, workforce constraints, and erosion of pharmacy access simultaneously, requiring integrated technology and clinical management capabilities to maintain quality performance and contractual compliance.

The forum’s consistent emphasis on data-driven accountability, reflected in sessions on accreditation, AI governance, health equity measurement, and quality program evolution, positions verifiable outcome evidence as a baseline requirement rather than a differentiator in government program contracting. As total US healthcare expenditure approaches $5.3 trillion, organizations operating across Medicare Advantage, Medicaid managed care, and commercial markets that build integrated data infrastructure, governance frameworks, and outcome measurement capabilities will be positioned to navigate the regulatory and competitive pressures converging across government health programs in 2026 and 2027.

References

[i] https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet#:~:text=Projected%20NHE%2C%202024%2D2033:,2024%2D2033%20in%20downloads%20below.

[ii] https://www.kff.org/medicare/medicare-advantage-2026-spotlight-a-first-look-at-plan-offerings/

[iii] https://www.cms.gov/priorities/innovation/innovation-models/financial-alignment#:~:text=The%20Financial%20Alignment%20Initiative%20is,the%20Medicare%20and%20Medicaid%20programs.

[iv] https://www.kff.org/medicare/medicare-advantage-2026-spotlight-a-first-look-at-plan-offerings/?

[v] https://data.hrsa.gov/topics/health-centers?

By Parnika Gupta, Research Analyst, and Eratha Poongkuntran, Associate Director, Avasant