A federal push to standardize Medicaid technology, led by a former health-tech CEO now running the program, could ease the credentialing and scaling barriers behavioral health operators say throttle access, even as new work requirements and audits raise the compliance bar.
Key Takeaways
- Fragmentation is operators’ top structural complaint. Running care across state lines means navigating 50 different Medicaid programs and 50 licensure regimes, with credentialing that can take a year or more per clinician. Panelists called this one of the largest non-clinical barriers to expanding access.
- A federal standardization push is underway. CMS is requiring standardized Medicaid systems templates and funding the bulk of states’ technology modernization, with a former health-tech executive now leading the Center for Medicaid and CHIP Services. Investors framed this as a potential unlock for multistate models.
- The same agenda raises the compliance bar. The modernization drive arrives alongside new work and community-engagement requirements, intensified audits, and provider revalidation mandates. Operators gain standardization but inherit heavier documentation and program-integrity obligations.
- Outcomes measurement is the hardest and most valuable problem. Panelists said no single organization holds enough data to understand this population at a personalized level, making interoperable, standardized data the path to both better care and outcomes-based payment. The infrastructure being built now is the foundation for that shift.
Ask the people building multistate behavioral health companies what slows them down most, and the answer often has nothing to do with clinical care. “Medicaid is 50 different systems,” said George Boghos, CEO of Imagine Pediatrics, at the Autism Impact Fund Investment Roundtable moderated by Kelly Evans, anchor of CNBC’s “The Exchange” and co-anchor of “Power Lunch.” “Each state does it a bit differently, and it’s very, very difficult to standardize and scale across states when they just think about the benefits differently, who qualifies and for what.” The variation is not abstract: state-by-state Medicaid coverage rules and rate schedules can leave a provider billing one rate in one state and a sharply lower one across the border for the same service.
The second barrier he named compounds the first. “It is crazy to me that we have 50 different licensure boards for doctors, and every health plan and insurance company has to credential every practitioner their own way,” Boghos said. For a clinician with 20 years of experience who wants to serve patients in a new state, the process “sometimes you have to go through a year or year and a half” of licensing, followed by separate payer credentialing. “That just seems like that we can do better as a society, particularly with data.” The friction compounds an already acute behavioral health workforce shortage, where every administrative obstacle to deploying a clinician translates directly into reduced access.
The panel’s notable claim was that Washington is, for once, trying to do exactly that. And the contours of the federal effort, drawn from the panelists’ account and from public CMS actions, suggest a genuine shift, alongside a set of new obligations that will land hardest on the same operators who stand to benefit.
A Health-Tech Operator Now Runs Medicaid and CHIP
The clearest signal of intent is who is in charge. In October 2025, Dan Brillman, co-founder and former CEO of Unite Us, became Deputy Administrator at CMS and Director of the Center for Medicaid and CHIP Services, the office that oversees Medicaid and CHIP. Unite Us built the closed-loop referral infrastructure that connects healthcare to social services across more than 40 states, and Brillman’s appointment fit a pattern of the current administration tapping technology executives for key health roles.
Lamont, founder and managing partner of Oak HC/FT, framed the appointment as cause for optimism regardless of partisan view. “For those of you who may not support the administration, I will say that there are some wonderful people that they’ve brought into CMS,” she said, citing Brillman’s arrival from a company she described as “not just a noble enterprise, but sort of the win-win-win for patients.” Her central claim was about direction: “He is massively investing in technology, and the federal government is redoing all of the fundamental Medicaid infrastructure systems, and they will fund, at least on the tech and infrastructure side, 90% for the states.”
That 90% figure is not new in mechanism, but it is real. CMS has long offered enhanced federal funding (often described as 90-10) for the design, development, and implementation of state Medicaid IT systems, covering up to 90% of qualifying costs. What is changing is the push toward standardization on top of that funding. In December 2025, the Office of Management and Budget cleared a set of standardized Medicaid Enterprise Systems templates that become required for states effective July 1, 2026, with the stated goals of expediting funding reviews, promoting reuse of components across states, and supporting a unified certification process for system modules. It is the kind of plumbing change that rarely makes headlines but directly shapes how quickly a company can operate in a new state.
Lamont went further, predicting a broad convergence. “Before COVID, states wanted to do their own thing in Medicaid,” she said. “Post-COVID, it’s very interesting. He’s going to standardize 70% of what they’re doing across all states.” That specific 70% figure is her characterization rather than a published federal target, and the precise scope of standardization remains to be seen. But she argued the long-promised benefit of state-level experimentation never materialized: “The lack of sharing among states in terms of information and technology is sort of stunning.” In her view, applying common systems, AI, and data would make it far easier to link Medicaid with adjacent programs such as SNAP and TANF, supporting beneficiaries more coherently.
Medicaid Standardization Comes Bundled With a Heavier Compliance Load
The same federal energy driving modernization is also raising the bar operators must clear, and the two are arriving together. The Medicaid technology effort is, in part, a response to the work and community-engagement requirements enacted in 2025, which states must implement. In early 2026, a group of Medicaid technology vendors pledged $600 million in savings and discounts to help states modernize their eligibility and enrollment systems for those requirements. “From the outset, our focus has been on helping states implement these requirements efficiently while supporting new innovations in Medicaid that improve the beneficiary experience,” Brillman said in announcing the commitments.
Program integrity is tightening in parallel. In April 2026, CMS Administrator Dr. Mehmet Oz announced that all 50 state Medicaid programs must submit plans to audit and revalidate their enrolled providers. For behavioral health specifically, the federal audit posture has already produced consequences: a series of Office of Inspector General reviews of state ABA programs has recommended more than $123 million in refunds across four states, driven largely by documentation and credentialing deficiencies rather than fraud. The standardized systems that promise to ease multistate scaling also create cleaner audit trails, which cuts both ways for providers.
For operators, the practical upshot is a barbell. On one end, the friction of entering new states, the credentialing delays, the divergent benefit definitions, the redundant payer enrollment, may ease as systems converge, which matters when demand for behavioral health care continues to outrun supply. On the other, the documentation and compliance expectations attached to those systems are rising, and the providers who scale across many states will face that elevated bar in every one of them. The same data infrastructure that lets a clinician get credentialed faster also lets a payer or auditor see exactly how a session was documented.
The Behavioral Health Data Gap Underneath Everything
If standardization is the policy story, the panel’s deeper preoccupation was data, and specifically the absence of any shared, longitudinal picture of this population. Chris Male, co-founder and managing partner of the Autism Impact Fund, named it as the field’s central unsolved problem. “One of the biggest hurdles, or even the opportunity, the holy grail, is really being able to measure outcomes and identify them,” he said. “No one institution or organization has enough data currently to really understand at a personalized level what’s occurring with most of this population.”
That gap is why the infrastructure question is not merely administrative. Boghos described Imagine layering third-party claims, pharmacy, and hospitalization data with ZIP-code-level social data and the company’s own record of patient interactions to build predictive models, including one flagging which children are likely to be hospitalized for a mental health issue within 90 days. The accuracy he cited, above 80%, is only possible because the data is assembled in one place. Standardized state systems and interoperability requirements (the federal push toward common data formats and exchange) are what could eventually make that kind of view possible at population scale rather than one company at a time.
David Haber, a general partner at Andreessen Horowitz, sees a related opportunity in the relationship between providers and payers, which he argued need not stay adversarial. There is “a ton of opportunity to apply AI on the other side of the ledger” to reduce fraud, waste, and abuse, he said, and a longer-term possibility of a clearinghouse “sitting in the middle” that accelerates payment to trusted providers while helping payers police improper spending. The vision builds on what companies like Camber are already doing in autism-care billing, and it depends entirely on standardized, interoperable data, the same foundation the federal modernization effort is trying to lay.
The convergence the panel described, then, is larger than any single rule. A former health-tech CEO is running Medicaid; the federal government is funding and standardizing state systems; work requirements and audits are forcing modernization; and the data infrastructure that results could underpin both better care and a shift toward paying for outcomes. For multistate behavioral health operators, the standardization that has long felt impossible may be arriving. So is the scrutiny that comes with it. “There are some really great people in the administration that know the current system isn’t working,” Male said, “the payers know it’s not working.” Whether the fix delivers on its promise will be measured, fittingly, in data that until now no one has been able to see.
