National Medicaid Intelligence

Texas Executive Command Surface

Enrollment
5.84M
-8.2% YoY
12-Mo Delta
-508K
vs -420K peers
Per Enrollee
$7,450
+4.2% YoY
Managed Care
92%
Quality Score
62/100
+2 pts
Procurement Items
3 active
1 new this week
OIG Signals
2 open
encounter data focus
Next Major Milestone
47 days
EVV renewal window
Enrollment
5.84M
-8.2% YoY
12-Mo Delta
-508K
vs -420K peers
Per Enrollee
$7,450
+4.2% YoY
Managed Care
92%
Quality Score
62/100
+2 pts
Procurement Items
3 active
1 new this week
OIG Signals
2 open
encounter data focus
Next Major Milestone
47 days
EVV renewal window

Texas at a Glance

Anchor State

Executive Attention Now

AI-Ranked
1

HHSC Procurement Forecast Signals Adjacent Opportunity

CompetitiveCritical
High

The Q3 2026 HHSC procurement forecast includes a new data analytics modernization RFP scoped at $45-60M, directly adjacent to current TMHP BusOps capabilities.

Why it matters

This is the first major HHSC analytics procurement since the modular transition. Accenture's BusOps incumbency and data access create a structural advantage if positioned early.

TX

Brief growth team on adjacency; request pre-RFP engagement with HHSC analytics lead

HHSC Procurement Forecast
Apr 7
2

Texas Enrollment Decline Accelerating Beyond Peer Median

OperationalHigh
High

Texas enrollment declined 8.2% YoY vs. the non-expansion peer median of 6.8%. The gap widened 1.4 points in the last quarter, driven by redetermination pacing.

Why it matters

Faster-than-peer enrollment declines may trigger HHSC scrutiny of call center capacity and outreach effectiveness, both within BusOps scope. Also affects managed-care capitation revenue projections.

TXFLTN

Review outreach metrics with BusOps ops lead; prepare proactive HHSC talking points

CMS Enrollment Snapshot + Pipeline Analysis
Apr 6
3

CMS All-State Call: New FMAP Methodology Takes Effect Oct 2026

RegulatoryHigh
Medium

CMS confirmed the revised FMAP calculation methodology in the March all-state call. Texas FMAP may shift 1.2-1.8 points, affecting state budget allocation for FY2027.

Why it matters

FMAP changes directly affect the state/federal cost split. If state share increases, HHSC will face budget pressure that could accelerate scope negotiations and amendment activity on all major contracts.

TX

Model FMAP impact scenarios; align finance team on amendment strategy

CMS All-State Call Materials
Apr 3
Source: AI Intelligence Analysis (Claude)·Mar 2026

Texas vs. Peer States: Enrollment

Monthly Medicaid & CHIP enrollment by state

2025
Source: CMS Monthly Medicaid & CHIP Enrollment

Compare States

Selected states appear in the Enrollment chart above and Benchmarking table below.

TX
CaliforniaFloridaNew York

Signals from the Edge

HHSC posts RFI for Medicaid data lake modernization

HHSC released a Request for Information seeking vendor capabilities in cloud-based Medicaid data integration and analytics, with responses due May 15.

HHSC Procurement2w ago
TX

CMS issues guidance on Medicaid unwinding data reporting

New CMS guidance requires states to submit monthly ex parte renewal rates and procedural disenrollment counts starting July 2026.

CMS Policy2w ago

Texas OIG quarterly report: focus on managed care encounter data

The OIG's Q1 2026 report flags incomplete encounter data submissions from two Texas MCOs, recommending enhanced data validation protocols.

Texas OIG2w ago
TX

Ohio Medicaid MMIS modernization RFP released

Ohio released its next-generation MMIS procurement with a $200M ceiling. Timeline targets vendor selection by Q4 2026.

Ohio Procurement3w ago
OH

TMHP notice: claims processing system maintenance window extended

TMHP notified providers of an extended maintenance window for the claims adjudication system, April 12-14, due to infrastructure upgrades.

TMHP Notice2w ago
TX

Senate Finance Committee schedules Medicaid block grant hearing

The Senate Finance Committee announced a May 2026 hearing on Medicaid per-capita cap proposals, with CBO scoring expected by mid-April.

Congressional3w ago

North Carolina begins Medicaid managed care transition

NC launched Phase 2 of its Medicaid managed care transition, shifting behavioral health populations to managed care as of April 1.

NC DHHS3w ago
NC

Intelligence Alerts

AI-detected changes and notable events

5 alerts
high2025-12-15

Florida enrollment dropped 11.3% YoY

Florida's Medicaid enrollment decline is the steepest among large states, likely driven by aggressive redetermination processes post-unwinding.

medium2025-12-08

Federal work requirements take effect Jan 2027

The 2025 Reconciliation Act's work requirements may affect partial expansion planning and legislative discussions. While Texas hasn't expanded, this may shape legislative posture.

medium2025-11-30

NY per-enrollee spending up 9.2%

New York's per-enrollee costs continue to rise faster than the national average, driven by pharmacy and behavioral health spending.

high2025-12-20

Georgia partial expansion under review

Georgia's Pathways to Coverage 1115 waiver (partial expansion with work requirements) faces federal review under the new reconciliation framework.

high2025-12-01

Mississippi quality score lowest in nation

Mississippi's composite quality score of 48 ranks last among all states, with particular weakness in maternal health and preventive care metrics.

Source: CMS data analysis + AI anomaly detection·Mar 2026

State Benchmarking

Texas vs. selected peers with median comparison

State
Enrollment
YoY Change
Per Enrollee
Managed Care
Quality Score
Expansion
TXTexas
5,842,0008.2%$7,450#292%
62
Not Expanded
CACalifornia
14,267,0006.1%$9,830#382%
71
Expanded
FLFlorida
5,183,00011.3%$6,920#188%
58
Not Expanded
NYNew York
7,892,0004.7%$12,150#478%
74
Expanded
Peer Median7,892,000$9,83082.0%71.0

Comparisons across expansion/non-expansion states require careful interpretation. Structural differences in eligibility rules and demographics affect all metrics.

Source: CMS/Medicaid.gov & KFF State Health Facts

Per-Enrollee Spending Breakdown

National FY2024 — per enrollee

Source: CMS MBES/CBES (CMS-64)

Risk & Opportunity Matrix

Improving
Stable
Deteriorating
Size = Impact

Ranked by Priority

Source: Accenture Intelligence Analysis·Mar 2026