State implementation

State Medicaid operating designs, implementation choices, and evidence architectures.

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Same Federal Rule, Different Evidence Architecture

Oct 13, 2026

Same Federal Rule, Different Evidence Architecture

Insight | Updated October 13, 2026. Compare Missouri 1 / Nebraska 1 / Iowa 2 / Indiana 3 and their community-engagement evidence, verification, and audit-reconstruction demands.

Ralph Choate

Federal claiming

Oct 9, 2026

Minnesota’s Medicaid Evidence Test

Perspective | Federal claims. Defensible decisions. Proof that corrections work.

Ralph Choate

Before 2027: What Recent State Medicaid Control Failures Are Warning Us About

Corrective action

Oct 1, 2026

Before 2027: What Recent State Medicaid Control Failures Are Warning Us About

Perspective | A practical readiness test—and a companion checklist—for proving Medicaid corrective actions work.

Ralph Choate

Medical Frailty Litigation: What States Should Track Before Changing Their Controls

State implementation

Sep 13, 2026

Medical Frailty Litigation: What States Should Track Before Changing Their Controls

Reference | A current-status reference for Medicaid leaders managing medical-frailty implementation while the federal framework remains under legal challenge.

Ralph Choate

When One Medicaid Eligibility Decision Requires Two Systems

State implementation

Sep 13, 2026

When One Medicaid Eligibility Decision Requires Two Systems

Insight | When Medicaid eligibility depends on multiple platforms, audit risk moves into the handoff.

Ralph Choate

One Federal Rule, Many Medicaid Eligibility Risk Models

State implementation

Sep 13, 2026

One Federal Rule, Many Medicaid Eligibility Risk Models

Insight | The same federal requirement will create different audit risks depending on how each state operationalizes eligibility control.

Ralph Choate

Source Presentation: Wyoming’s PERM Transformation Through System Modernization

PERM readiness

Aug 26, 2026

Source Presentation: Wyoming’s PERM Transformation Through System Modernization

Reference | Presented by the Wyoming Department of Health and Acentra Health at MESC 2026, August 19, 2026.

State implementation

Same Federal Rule, Different Evidence Architecture

Minnesota’s Medicaid Evidence Test

Before 2027: What Recent State Medicaid Control Failures Are Warning Us About

Medical Frailty Litigation: What States Should Track Before Changing Their Controls

When One Medicaid Eligibility Decision Requires Two Systems

One Federal Rule, Many Medicaid Eligibility Risk Models

Source Presentation: Wyoming’s PERM Transformation Through System Modernization

PERM Insights & Perspectives