2026 Medicaid Summit

Legislators, legislative staff and executive branch employees from across the country are invited to join us for the 2026 Medicaid Summit.

The 2026 Medicaid Summit is co-hosted by The Council of State Governments, the Massachusetts Developmental Disabilities Council, and CSG East. The lead sponsors of this summit are Co-Chairs of the Massachusetts Joint Committee on Children, Families and Persons with Disabilities, Representative Jay Livingstone and Senator Robyn Kennedy and Co-Chairs of the Massachusetts Joint Committee on Health Care Financing, Representative John Lawn and Senator Cindy Friedman. Massachusetts Senator Paul Mark is a co-sponsor and organizer of the summit.

The summit will be Tuesday, June 9 at the Massachusetts State House or online via Zoom beginning at 10:00 a.m. and concluding at 4:00 p.m. In-person space is limited; morning refreshments and limited lunch will be provided for in-person participants.

The future of Medicaid is undergoing a major transformation, with significant changes resulting from the "One Big Beautiful Bill Act" (OBBBA) enacted in July 2025. These reforms, taking effect between 2026 and 2028, constitute the largest overhaul in the program's history, focusing on restricting growth, implementing work requirements, and reducing federal spending by nearly a trillion dollars over a decade.

Agenda

Welcome

10:00 - 10:55 a.m.

Panel 1: Medicaid-funded Home and Community Based Services (HCBS) and the Direct Care Workforce

11:00 - 11:55 a.m.

Medicaid is more than a health insurance program – it is the largest provider of long-term services and supports (LTSS) in the United States. Home and Community-Based Services (HCBS) are a form of LTSS that enable people to live and engage in their communities, rather than institutional settings. The direct care workforce is essential to the delivery of HCBS. However, our current workforce is unable to meet current demand, let alone the growing need driven by an aging population and more people with disabilities living in the community.

Moderator: Nicole LeBlanc

Panelists: Dr. Joe Caldwell, Alixe Bonardi, Dorothy Hiersteiner

Panel 2: Implementation of H.R.1 and New Work Requirements

12:00 - 12:55 p.m.

Signed into law on July 4, 2025, H.R.1 (the One Big Beautiful Bill Act) cuts federal Medicaid spending by $1 trillion over the next ten years. In addition, states must implement new work requirements and more frequent redeterminations for Medicaid beneficiaries. This poses a challenge for state governments and threatens the established rights of people with disabilities to live, and receive services, in the most integrated community setting possible.

Moderator: Nicole LeBlanc

Panelists: Gelila Selassie, Elizabeth LaMontagne

Afternoon Break

1:00 - 1:25 p.m.

Panel 3: H.R.1 and State Budget Decision-Making

1:30 - 2:25 p.m.

The impending Medicaid cuts from H.R.1 will significantly impact state budgets. The legislation has already prompted states to consider tax code changes and make difficult choices on which Medicaid programs to retain and which they can no longer afford. This panel will highlight state budgetary impacts in 2026 and beyond.

Moderator: Sean Slone

Panelists: Wesley Tharpe, Andrew Badaracco

Panel 4: Rural Health Transformation

2:30 - 3:25 p.m.

H.R. 1 included the $50 billion Rural Health Transformation (RHT) Program, a major five-year initiative (2026-2030) aiming to revitalize rural healthcare delivery. It offers states, tribes, and territories funding for infrastructure, technology, and operational shifts to improve care access, while simultaneously navigating strict Medicaid reforms and
reduced federal funding. But even as states work to quickly implement the initiatives they proposed in order to gain access to RHT funds, concerns remain about the limitations states must navigate and whether the program can insulate rural health facilities from the challenges they have faced in recent years and the Medicaid cuts H.R. 1
will bring over the course of the next decade.

Moderator: Sean Slone

Panelists: Dr. Cody Mullen, Eliza Lake, Andrew Badaracco

Closing

3:30 - 4:00 p.m.

Panelist Bios

Andrew Badaracco

Andrew Badaracco is a Senior Healthcare Policy Consultant with the Milliman Indianapolis Health Practice. He brings more than 16 years of experience analyzing and evaluating Medicaid policy initiatives at both the federal and state levels, with deep expertise in payment policy, financing, access to care requirements, and fee-for-service methodologies. At Milliman, Andrew applies this expertise to support state Medicaid agencies and other stakeholders by analyzing federal and state statutes and regulations, identifying policy and operational risks, and advising on implementation strategies. His work focuses on developing legally compliant, practical policy solutions.

Prior to joining Milliman, Andrew spent 15 years at the Centers for Medicare & Medicaid Services (CMS), including serving as Deputy Director of the Division of Reimbursement Policy. In this role, he led the review and evaluation of proposed Medicaid initiatives, contributed to the development of federal regulations and sub-regulatory guidance, and assessed the legal and operational implications of policy changes. His work included direct responsibility for State Plan Amendments (SPAs), upper payment limit (UPL) demonstrations, and federal policy interpretation related to access to care and supplemental payment methodologies.

Alixe Bonardi

Alixe has over 30 years of experience with HCBS for people with disabilities. As the IDD team lead, she has grown the National Core Indicator’s (NCI) work, elevating participant voice and experience in state-level quality monitoring of HCBS for people with Intellectual and developmental disability. At HSRI, Alixe currently co-directs the Grassroots Project and supports the I/DD Counts initiative, both funded by the federal Administration for Community Living. She has led participant engagement efforts including community-based participatory research, community focus groups, and a grant-funded Citizen’s Jury project with people with IDD developing policy recommendations. She has served as principal investigator for several AHRQ-funded and CDC-funded research projects. Prior to joining HSRI, Alixe was the director of the Center for Developmental Disabilities Evaluation and Research at the University of Massachusetts Medical School’s E.K. Shriver Center. She has a Master of Health Administration from Suffolk University, a Master of Science in occupational therapy from Columbia University, and a Bachelor of Science in physiology from McGill University.

Joe Caldwell, PhD

Dr. Caldwell is Director of the Community Living Policy Center within the Lurie Institute for Disability Policy at Brandeis University. He has over 30 years of experience in the field of disability as a researcher, policy expert, and family member of a young adult with Down syndrome. His research primarily focuses on improving access to Medicaid Home and Community-Based Services, self-direction, and supports for family caregivers. Prior to Brandeis, he directed public policy at national aging and disability organizations and worked for the Senate Health, Education, Labor, and Pensions (HELP) Committee as a Kennedy Fellow.

Dorothy Hiersteiner

Dorothy Hiersteiner is a Research Associate and the Human Services Research Institute (HSRI) Co-Director for National Core Indicators® (NCI®), an effort that began in 1997 to develop indicators and benchmarks of performance across state human service systems. Dorothy also developed and currently directs the NCI State of the Workforce, IDD and AD surveys, used to help states collect data on the stability and quality of the workforce supporting adults with intellectual and developmental disabilities and the aging and physical disability population.

Dorothy’s skills in strategic planning and coordination of multiple partner collaborations are critical in her role as coordinator to NCI. Dorothy’s work with NCI also includes data management and data analysis, report writing and editing, and communications. She has contributed to numerous technical reports, data briefs, manuscripts, and training/TA materials. Dorothy is passionate about data, outcome measurement, evidence-based policy and social justice and uses these interests to guide her work with NCI.

Eliza Lake

Eliza Lake has been the Director Health Policy and Strategic Initiatives at the Massachusetts Executive Office of Health and Human Services since April 2024, and is responsible for overseeing a portfolio of inter-departmental health policy initiatives. Her role involves collaborating with agency heads and EOHHS leadership to advance aligned policy strategy, implementing new initiatives, and facilitating cross-agency coordination on issues as diverse as health equity, long-term supports and services, behavioral health, health care finance, and, most recently, rural health transformation. A native of Western Mass, where she manages her family farm in its third-generation, Eliza has recently been named as the Project Director for the Commonwealth’s Rural Health Transformation Program. Prior to returning to state service, for ten years Eliza was the CEO of Hilltown Community Health Center, a small FQHC that serves the rural Hilltowns of Western Mass and is the only provider of medical, dental, behavioral health, optometry, and community services for most of its service area. Previously, she worked as a consultant to state governments and non-profits in the area of long-term supports and services policy and served as the Director of Community Supports and Services at the Massachusetts Executive Office of Elder Affairs. She has a BA from Harvard University and an MSW from Boston University.

Nicole LeBlanc

Nicole LeBlanc is a policy assistant at HSRI. She currently works on the IDD Counts Health Data project, Disability Map It WITH Grant, social media campaigns, the Idaho SYSTEM Redesign team on top of presenting at conferences and making webinar summaries plain language. She spent more than 8 years at Green Mountain Self-Advocates as Advocacy Director supporting self-advocates in communicating with elected officials and improving healthcare access. Nicole completed internships with Administration on Intellectual and Developmental Disabilities and Association of University Centers on Disabilities, policy fellowships at the Autism Soc. Of America, NDRN. Nicole graduated from the Vermont LEND program as its first self-advocate graduate, and has consulted nationally on healthcare, employment, autism, dignity of risk, and person-centered planning. She has presented keynotes and webinars across the country and received the Steve Bartlett Award and David Joyce Advocate of the Year Award. Nicole currently works in policy, consulting, and disability employment initiatives while continuing to champion self-advocacy and systems change and believes "no one is too disabled to live and work in the community!" She is the author of Disability Employment Policy 101 & WHY Employment Matters TOOLKITS.

Elizabeth LaMontagne

Elizabeth LaMontagne is the Chief Operating Officer for MassHealth, where she oversees member eligibility policy and operations. During her tenure at MassHealth, she led the agency’s post-pandemic redeterminations effort and is currently implementing the new federal work and education requirements. Prior to MassHealth, she worked in private sector and government roles supporting strategy and operations.

Cody Mullen, PhD

Dr. Cody Mullen is a Clinical Professor of Public Health and Director of Professional Graduate Studies at Purdue University. He is also an Associate Director for the Center for Rural and Migrant Health. He holds a PhD in Health Policy and Management from the Indiana University Indianapolis Richard M. Fairbanks School of Public Health.

Dr. Mullen’s research focuses on the application of scientific and engineering principles and theoretical frameworks to examine trends, impact patient outcomes, and improve care coordination in the realm of health services and patient-centered outcomes research. His expertise lies in project development and execution in diverse acute care and outpatient settings, including rural, urban, and resource-constrained communities. He leads and executes a strong research portfolio as an independent investigator, specifically on vulnerable populations, including physically, mentally, or cognitively disabled individuals, as well as individuals living in rural communities or other health provider shortage areas.

He serves as on the Board of Directors of Wabash Center, The Arc of Indiana, and The Arc-National. He is a past board member of the National Rural Health Association.

Gelila Selassie

Gelila has been with Justice in Aging since 2020. Her work focuses on strengthening Medicaid, expanding access to Home and Community‑Based Services, and improving the quality of care for nursing home residents. She collaborates closely with national partners and local advocates to address systemic barriers, respond to emerging threats to Medicaid, and advance policies that support older adults’ rights, autonomy, and well‑being. Prior to Justice in Aging, Gelila worked in legal services in North Carolina as an Equal Justice Works Fellow. She received her BA from the University of South Carolina and her J.D. from Wake Forest University School of Law.

Sean Slone

Sean Slone is a public policy manager at the national headquarters of The Council of State Governments (CSG) in Lexington, Kentucky. In recent years, he has staffed projects on long-term care, mental health policy and the future of work and directed the organization’s Medicaid policy education programs. Previously, as CSG’s Director of Transportation & Infrastructure Policy, he spent a decade (2008-18) staffing the organization’s Transportation & Infrastructure Public Policy Committee, organizing transportation-related convenings in Washington, D.C. and around the country and writing for CSG publications. A journalist by training, his career also has included a decade as a producer for C-SPAN in Washington, D.C. and five years as a producer/reporter for Kentucky Educational Television, where he covered the Kentucky General Assembly. Sean is a graduate of Emerson College and Northwestern University’s Medill School of Journalism.

Wesley Tharpe

Wesley Tharpe is Senior Advisor for State Tax Policy at the Center on Budget and Policy Priorities (CBPP) in Washington, D.C. In this role, he leads the Center’s research and analyses of state revenue policies, trends, and opportunities, and collaborates closely with fellow researchers, advocates, and other internal and external stakeholders to help drive sound, equitable tax policy reform in the states. Prior to joining the Center as a Senior Policy Analyst in 2018, Tharpe served as Research Director at the Georgia Budget and Policy Institute, where he marshalled the organization’s policy agenda and for seven years coordinated with advocates, elected officials, and community partners on topics including tax reform, jobs and wages, and immigrant inclusion. A native of Fayetteville, Georgia, Tharpe holds a B.A. in Political Science and International Affairs from the University of Georgia and an M.A. in Public Policy from the Johns Hopkins University.