MESC 2026 Tracks and Themes

Track 1: Program Integrity, Fraud, Waste, and Abuse (FWA); and Third-Party Liability:

Safeguarding the Mission: Collaborative Strategies for Program Integrity
This track addresses the evolving landscape of Medicaid oversight, where Program Integrity (PI) is no longer a “back-office” audit function but a proactive, data-driven partnership. Sessions will focus on the technical and operational shift toward real-time anomaly detection and predictive modeling to identify improper payments before they occur.
Topics include the integration of PI tools within the modular MES ecosystem, enhancing provider screening through cross-state data sharing, and strengthening Third-Party Liability (TPL) processes. A key focus will be on the collaboration between PI units and IT leads to build automated “system edits” that balance rigorous compliance with the need to maintain timely access to care for legitimate members.

Track 2: Operational Excellence and Compliance:

The 2027 Interoperability Mandate: APIs, Compliance, and Data Exchange
This track focuses on the urgent technical and policy work to meet the January 1, 2027, CMS Interoperability and Prior Authorization API deadlines. Sessions will cover the implementation of the Patient Access API, Provider Access API, and Payer-to-Payer API for Medicaid FFS and Managed Care. Topics include Fast Healthcare Interoperability Resources (FHIR) standards adoption, managing the exchange of five years of patient data for continuity of care, and leveraging APIs to streamline the Prior Authorization process.

Track 3: Data-Driven Decision Making and Analytics:

Data-Driven Health Improvements and Quality: From Universal Foundation to Consolidated Reporting
This track focuses on the systems needed to advance health improvements and measure quality across the Medicaid program. Topics include technical implementation of the Universal Foundation for quality measures, leveraging data analytics to identify and address health issues in high-risk populations (e.g., dual-eligibles and FFS members), and building the technical infrastructure for mandated Consolidated Critical Incident Reporting systems to ensure whole-person care for vulnerable groups.

Track 4: Integrated Eligibility and Enrollment (IE&E):

Fiscal Cliff & System Overhaul: Navigating Eligibility and Enrollment Policy Shifts
State systems are under pressure to rapidly adapt to major federal policy changes. This track addresses the technical challenges of implementing new work requirements and potential premiums for adult expansion populations, managing more frequent eligibility redeterminations, and leveraging new data sources for income and employment verification. The focus is on system configuration and process automation to minimize administrative burdens and reduce the number of eligible individuals who lose coverage.

Track 5: Modernizing the Medicaid Enterprise: Navigating the Future:

Modular Enterprise (MES) Evolution: Modernization, Integration, and Cloud Strategy
Dedicated to the continued journey of Enterprise Systems modernization. This track focuses on strategies for breaking down legacy systems, effectively integrating Certified Modules, and maximizing the value of the modular ecosystem. Topics include cloud migration best practices, data migration challenges, vendor management for a multi-vendor environment, and establishing robust System Integrator (SI) governance models to ensure successful module deployment and interoperability.

Track 6: Artificial Intelligence (AI) and the Future of Medicaid: A Vision for 2030 and Beyond:

AI, Automation, and the Future of the Medicaid Enterprise
Moving beyond simple RPA, this track explores the strategic integration of Artificial Intelligence (AI) and advanced automation to transform core Medicaid functions. Sessions will cover using AI for predicting claim denials, automating complex call center and member outreach tasks, optimizing financial forecasting, and leveraging AI tools to quickly analyze new federal regulations for system impact and compliance needs. The discussion centers on the governance, ethics, and tangible ROI of AI in Medicaid.

Track 7: The Unified Agency: Aligning Policy, Operations, and IT for Better Outcomes:

In the modern Medicaid landscape, technology is no longer just a “support function” – it is the foundation upon which policy is built and operations are executed. However, when these three pillars operate in silos, the result is often delayed implementations, budget overruns, and fragmented member experiences.
“The Unified Agency” track is designed to dismantle these silos. This track moves beyond technical specifications to explore the vital intersection of human collaboration and system performance. By bringing State Medicaid Directors, Policy Leads, and IT Chiefs into the same room, we aim to foster a culture where:

• Policy is designed with technical scalability in mind.
• Operations are streamlined through automated, user-centric workflows.
• IT is empowered by a deep understanding of the program’s mission and the people it serves.

Through cross-functional panels, integrated case studies, and collaborative workshops, attendees will learn how to sync their internal “languages” and build a unified roadmap. Join us to discover how a truly integrated agency can better navigate federal mandates, optimize CMS funding, and ultimately deliver faster, more reliable services to Medicaid members.

Track 8: Rapid Response: Medicaid Hot Topics & Late-Breaking Developments:

Navigating the Mid-Year Shift: Real-Time Policy and System Impacts
In the fast-moving Medicaid ecosystem, the landscape can shift between the time a conference agenda is set and the moment the doors open. This track is a dedicated, agile space for addressing the most significant late-breaking policies, federal regulations, and emerging trends that have surfaced mid-year.
Sessions in this track will move beyond “planned” content to tackle the immediate impacts of high-priority initiatives. Drawing on recent examples like the One Big Beautiful Bill (OBBB) and evolving CMS ecosystem updates, these sessions provide a direct line to the experts and agencies currently navigating these shifts. Topics may include:

• Emergency Federal Guidance: Deep dives into new State Health Official (SHO) letters or Information Bulletins released in the months leading up to the conference.
  
• Legislative Aftershocks: Technical and operational strategies for implementing major budget reconciliation or healthcare reform mandates on accelerated timelines.
• CMS Ecosystem Innovations: Real-time updates on federal toolkits, new certification shortcuts, or changes to the 90/10 funding landscape.

This track is essential for leaders who need to understand not just what was planned for 2026, but what is happening now and how it will redefine the Medicaid enterprise for 2027 and beyond.

NOTE: The MESC Planning Committee will select the abstracts for this track.