State HIT Connect 2026: A Recap

Every year, leaders in state and federal government, technology, and policy come together to discuss the most pressing issues facing state agencies and share key learnings, strategies, and solutions to help address them. States play a crucial role in healthcare transformation, and the State Healthcare IT Connect conference is a perfect opportunity to hear directly from the people who are responsible for making that transformation happen. We went to New Orleans to do just that—and now that we’re back, here are some of the key takeaways from State HIT Connect 2026.

Compliance Alone Isn’t Enough

The implementation deadlines for CMS-0057-F are less than nine months away, and given the relatively short timeframe, many organizations have opted for a compliance-first approach to meeting the rule’s requirements. As many state leaders noted at State HIT Connect, however, compliance at this point is table stakes. The challenge they’re facing now is finding value beyond compliance.

Government and commercial payers made significant investments in interoperability to comply with CMS-9115-F; unfortunately, many have yet to see a meaningful return on that investment. A common refrain from conference attendees was that CMS-0057-F solutions must build on the investments they made to comply with CMS-9115-F, not replace them.

We also heard that the deadlines for CMS-0057-F have instilled an appropriate sense of urgency to invest in interoperability; however, that urgency has too often led to piecemeal solutions that meet compliance but don’t add value. Integrating these disparate systems to make better use of shared data is one way state agencies can maximize the value of their investments and continue to build on their established interoperability foundation.

Providers & Prior Authorization: An Ongoing Challenge

Since the burden of compliance with CMS-0057-F requirements falls entirely on payers, providers haven’t had to pay as much attention to the rule or its deadlines. According to the leaders we spoke to, that’s creating a problem: providers have little visibility into CMS-0057-F and don’t see its potential value, which has made it difficult to find providers who are willing to help states test their newly-implemented systems.

What many providers don’t realize, however, is that CMS-0057-F can help alleviate one of the most significant administrative burdens they face: prior authorization. State leaders shared with us that due to the perceived unnecessary time and expense it entails and its potential to delay treatment, many of their provider partners would prefer to do away with prior authorization entirely. Ironically, a significant portion of those delays may be caused by providers themselves.

State Medicaid leaders noted that providers frequently submit prior authorization requests even if they’re not needed; one leader told us that as many as 50% of the requests they receive are unnecessary. This ultimately means more requests for payers to sift through and, ultimately, delays responses and treatment. Providers, for their part, would likely contend that submitting an unnecessary prior authorization request is faster and more efficient than delaying treatment while waiting to hear if prior authorization is required.

Amid this conflict, one thing is clear: for CMS-0057-F to have the intended impact, provider buy-in is crucial—and payers can help secure it by helping provider partners understand how investing in interoperability will ultimately support smoother operations and better patient care. Having been named Best in KLAS® for CMS Payer Interoperability in 2023, 2024, and 2026, Edifecs is ideally positioned to help payers build a sustainable and strategic interoperability infrastructure. Our Unified Interoperability Gateway supports compliance with all areas of CMS-0057-F from interoperability to prior authorization and consent management.

Increasing Focus on Payment Accuracy & Integrity

Interoperability was naturally the big topic of conversation at State HIT Connect 2026, but state leaders are also concerned about payment accuracy and integrity. These concerns are driven by numerous high-profile examples of fraud, waste, and abuse, as well as recent CMS reporting that found the improper Medicaid payment rate for fiscal year 2025 was 6.12%, up from 5.09% in fiscal year 2024.

Most improper payments (77.17% in fiscal year 2025) were due to insufficient documentation, not fraud, but the uptick in improper payments has state leaders taking notice. And once the final implementation deadlines for CMS-0057-F have passed, government payers will continue to prioritize finding new ways to stop improper payments sooner in the claim cycle.

That increased focus is particularly welcome news for us. By joining forces with Cotiviti, Edifecs’ industry-leading data interoperability platform is now complemented by cutting-edge payment integrity solutions in addition to our prior authorization and consent management solutions. Currently in use by over 100 payers—including 23 of the top 25 national payers—Cotiviti’s prospective and retrospective Payment Accuracy solutions prevented or corrected more than $10 billion in errors in 2025 alone. That can mean millions (or more) in reduced improper payments for a single payer.

To learn more about how we can support your organization’s needs, get in touch with our team today!