Insights from the 2025 Annual Conference for the National Academy for State Health Policy 

Nearly 1,000 health policy leaders, policymakers, and policy experts from across the country gathered in sunny San Diego earlier this month for this year’s National Academy for State Health Policy (NASHP) annual conference. This year’s conference was aptly themed “Riding the Waves of State Health Policy,” a reference to the need of state health policymakers to be flexible and creative in uncertain and ever-changing policy environments. The conference covered a range of health policy topics, including addressing the complex behavioral health needs of young people, caregiving and home and community-based services, understanding and preparing for health insurance market shifts and consolidations, and navigating health care challenges in rural America, among others. The conference also celebrated the 60th anniversary of Medicaid and focused on the future of the program. Cheryl Robers, Director of the Virginia Department of Medical Assistance Services, reminded the audience that each state’s Medicaid program is reflective of that state’s values, culture, and safety net, and that everyone will have to work together to keep the program functioning successfully.  

Strengthening Access to Interventions for Youth with Complex Behavioral Health Needs 

This session highlighted innovative strategies from Michigan and Wisconsin to support youth with complex behavioral health needs. 

• Michigan leverages two Medicaid waivers—the Serious Emotional Disturbance (SED) Waiver and the Children’s Waiver Program—to provide intensive services for children with SED and intellectual and developmental disabilities (IDD). The state is also advancing cross-system collaboration among child welfare, juvenile justice, Medicaid, and behavioral health agencies.  

• Wisconsin has strengthened its youth mental health continuum by establishing three certified Youth Crisis Stabilization Facilities (YCSFs), which offer short-term, community-based care as part of the state’s Crisis Now model. These facilities are used by over 30 counties and serve as step-down options from higher levels of care. In July 2025, the state passed legislation mandating the creation of Psychiatric Residential Treatment Facilities (PRTFs) for youth under 21, with DHS initiating the rulemaking process.  

Key takeaways from the session: 

• Complex problems require multi-pronged and coordinated solutions. Youth with complex behavioral health needs often face challenges that span multiple domains. Addressing these complex needs effectively requires multi-pronged interventions that are not only clinically supported but also coordinated across systems.  

• State and local collaboration is fueling design and implementation of both novel and old-school policy options. Recognizing the urgency and complexity of these challenges, states and localities are working together to better serve youth with complex behavioral health needs and their families.  

• Medicaid plays a critical role as the backbone of funding for services that support youth with complex needs, but it cannot and should not be the sole source. While Medicaid dollars are essential, they are most effective when used to leverage additional resources and complementary policies.  

• Justice-involved youth often cycle between juvenile justice and child welfare systems, making it critical to ensure consistent and comprehensive behavioral health assessments across settings. Regardless of where a youth is located, whether in a detention facility, residential placement, or shelter, they should receive the same standardized assessment, administered appropriately and consistently across systems.  

What’s Next for Integrating Behavioral Health in Managed Care 

This session explored how states are using Medicaid managed care to improve access to mental health and substance use disorder services. As states move more towards addressing “whole person” care and coordinating behavioral health services, one of the looming questions is how to incentivize various actors to work together.  

• Ohio presented its OhioRISE (Resilience through Integrated Systems and Excellence) program, a specialized managed care model for youth ages 0-20 with multi-system needs. Unique to OhioRISE is a pay-for-performance structure that requires managed care organizations (MCOs) to collaborate and be evaluated against one another.  

• Kansas discussed challenges in connecting individuals with appropriate care post-incarceration due to paused Medicaid coverage. The state is implementing pay-for-performance incentives for MCOs and advancing the Certified Community Behavioral Health Clinic (CCBHC) model through legislation.  

• New Mexico is moving toward regionalized managed care and establishing a single credentialing system for MCOs to ensure uniformity. The state highlighted targeted oversight for children in state custody and is exploring ways for MCOs to reinvest in communities, particularly where Medicaid cannot fund infrastructure and opportunities, by partnering with various stakeholders.  

Key takeaways from the session:  

• Leverage MCO partnerships to improve integration. States are prioritizing requirements for care coordination, quality improvement and payment approaches in MCO contracting to advance behavioral and physical health integration. 

• Standardization may ease provider burdens. Aligning reporting, quality measures, and care coordination expectations across MCOs could help reduce administrative complexity for providers participating in behavioral health integration initiatives. 

• Value-based payments can reinforce priorities. At least half of states are incentivizing integrated care through payment approaches with plans and alternative payment models to providers. 

• Data sharing remains foundational. Identifying opportunities to support behavioral and physical health data exchange is critical to improving coordination and accountability. 

Charting the Course for Caregiving and Home and Community-Based Services 

This session tackled approaches to reducing reliance on institutional care and supporting unpaid caregivers to avoid burnout and reduce the need for other Medicaid services.  

Speakers from Illinois, Wisconsin, and Georgia spoke to their states’ challenges with supporting caregivers and offering HCBS.  

• Georgia spoke to using the Bakas Caregiving Outcomes Scale (BCOS) to gather data for return on investment (ROI) analysis & quality improvement. 

• Illinois highlighted the use of Tailored Caregiver Assessment and Referral Tool (TCARE) by all Area Agencies on Aging (AAAs) to assess burnout risk and generate custom care plans. The state also established a caregiver portal via legislation and has relied on Trualta as an online educational service to connect caregivers with events and online discussion groups.  

• Wisconsin indicated that the volume of participants who have completed respite care training programs signals workforce interest, in addition to unmet caregiver needs. The state also highlighted an HR CareKit project that gives employers tools to support working caregivers.  

Key takeaways from the session:  

• States are using evidence-based measures to better understand caregivers’ needs and refine their support services accordingly, as well as to demonstrate the value of these services. The programs that gained traction and additional funding did so through data collection and clearly presenting findings and effectiveness to policymakers.  

• States are incorporating family caregiving supports into multisector plans on aging/State Plans on Aging. The sustainability of states’ aging infrastructure depends on strengthening the informal care system and requires agencies to embed caregiver supports within broader aging and health strategies.  

• States are supporting and developing caregiver coalitions, interagency partnerships, and cross-organizational collaboratives. Some next steps discussed include AAAs working with managed care for Medicare/Medicaid programs. 

Health Insurance Market Stability, Sustainability, and Shifts 

This session featured a presentation from the American Academy of Actuaries, a nonpartisan organization that sets professional standards and serves as the public policy voice for actuaries in the U.S. The presenter outlined a framework for health insurance market stability, built around three key pillars: 

• Adequate Enrollment: Ensuring a large enough pool to spread risk and stabilize premiums. 

• Balanced Risk Pool: Including both high- and low-risk individuals to prevent adverse selection. 

• Predictable Regulatory Framework: Maintaining consistent rules to support fair competition and prevent market fragmentation. 

Policy strategies that can be used to strengthen these pillars include: 

• Expanding market size (e.g., merging markets) 

• Affordability initiatives (e.g., premium tax credits, cost-sharing subsidies) 

• Risk mitigation programs (e.g., reinsurance, high-risk pools) 

• Uniform market rules (e.g., rate review, solvency standards) 

• Transparency requirements to support informed consumer choice 

Key takeaways from the session: 

• Health insurance markets across states are facing mounting pressures due to a combination of rising health care costs, evolving consumer needs, and rapidly changing federal policies. These factors are contributing to volatility in premium rates, insurer participation, and coverage options-particularly in the individual and small group markets. 

• States are actively exploring a range of policy levers to stabilize their markets to improve affordability. These include reinsurance programs public option proposals, enhanced rate review processes, and expanded eligibility or subsidies through Medicaid and marketplace coverage. 

• Balancing short-term responsiveness with long-term sustainability is critical. States must address immediate challenges – such as insurer exits or premium spikes-while also laying the groundwork for durable reforms that promote competition, equity, and access. 

• Cross-sector collaboration and federal-state alignment are key success factors. States that engage stakeholder early and align their strategies with CMS guidance are better positioned to implement effective and sustainable reforms.