States We Serve

Our home state of New Jersey uses five distinct FamilyCare Medicaid plans, enforces out-of-network laws, and recently ended telehealth parity.

New York has a split Medicaid market, a surprise-billing law with explicit dispute fees, and a local Medicare Administrative Contractor recently changed its name.

Pennsylvania uses five HealthChoices Medicaid zones, lacks surprise-billing laws, and enforces unique medical-debt collection rules that national vendors overlook.

Connecticut is one of four states with zero percent Medicaid managed care. HUSKY Health runs fee-for-service through three separate administrative services organizations, not commercial plan rosters.

Vermont's pioneering all-payer ACO model has ended. OneCare Vermont wound down in late 2025, and providers returned to traditional fee-for-service billing models starting January 1, 2026.

Rhode Island's largest hospital network renamed itself, while the state canceled a $15 billion Medicaid procurement rather than risk a flawed process.

MassHealth currently operates three distinct ACO models simultaneously. A hospital network bankruptcy redrew the provider map, prompting the state's cost regulator to expand its own financial oversight authority.

MaineCare operates on a traditional fee-for-service model. It reimburses hospitals at roughly 72% of Medicare rates, a rate structure the legislature is debating in 2026.

New premiums and work requirements hit Granite Advantage enrollees this year, while only 7 of the state's 26 hospitals remain unmerged.

As the nation's largest Medicaid program, Medi-Cal has now expanded dual-eligible plans to 41 counties. California also enforces a surprise-billing law that runs completely independently from federal rules.

Texas's surprise-billing law applies only to 16% of enrollees on state-regulated plans. Also, the state's Medicare contractor secured a new multi-year Medicare MAC contract.

Florida overhauled its Medicaid managed care system in 2025, reducing to nine regions and removing a major insurer from the state's highly saturated and competitive Medicare Advantage market.

Illinois recently finalized new $431 billion HealthChoice Medicaid contracts for the first time since 2018. Also, a single commercial insurer controls a massive 61% of the state's private market.

Ohio transitioned its dual-eligible Medicaid population to a new coordinated model, manages behavioral health through a single statewide plan, and uses a state-specific surprise-billing arbitration process that operates completely independently from the federal system.

Michigan is transitioning its dual-eligible program to a new statewide model. Simultaneously, the state's largest hospital systems merged, while new legislative efforts aim to regulate nonprofit hospital pricing and merger structures.

Georgia now operates Pathways to Coverage, a limited, work-structured Medicaid program rather than a full expansion model. It also enforces its own state surprise-billing law alongside Medicare rules shared with two neighboring states.

North Carolina offers both Standard Medicaid plans and specialized Tailored Plans for complex behavioral health needs. One major dominant managed care insurer is merging in 2026, while state lawmakers are actively debating new, strict legislative limits on hospital facility fees and tax exemptions.

Virginia routes most Medicaid enrollees through Cardinal Care managed care. The state introduced a new federal provider enrollment portal under the Act, while its own balance-billing law covers a narrower range of services than the federal No Surprises Act, requiring close tracking.