As 2026 begins, Medicare and Medicaid are entering a new phase shaped by cost pressures, tighter oversight, and shifting expectations about transparency and accountability. The common thread is clear: safety net systems are being asked to do more, with less room for administrative inefficiency. In that environment, technology-enabled models are moving from “nice to have” to essential infrastructure.
On the Medicare side, the biggest policy story is the rollout of major updates to Medicare Advantage (MA) and Part D rules for 2026. CMS finalized changes designed to reign in the kinds of plan behaviors that have drawn scrutiny in recent years, particularly around prior authorization and appeals. Among the most consequential provisions is a clarification that MA plans must honor medical necessity determinations made during an approved prior authorization process. The goal is to prevent situations where a patient is approved for care, receives that care, and then faces barriers when follow-up services are needed.
CMS is also tightening requirements in the appeals process, including closing loopholes that critics say made it harder for beneficiaries to challenge coverage denials. These changes reflect an ongoing effort to reduce friction for seniors and people with disabilities who already navigate complex care pathways.
Meanwhile, Medicare Part D continues its post–Inflation Reduction Act evolution, with CMS expanding and refining the Medicare Prescription Payment Plan. This program lets beneficiaries spread prescription drug costs across the year instead of being hit with large, one-time bills. It is a shift that could improve adherence and reduce financial distress, particularly for people with high-cost chronic conditions.
But Medicare is only half the story. Medicaid, the backbone of the U.S. safety net, is also facing major policy and operational turbulence heading into 2026.
Just this week, the federal government announced it will eliminate a requirement for states to report certain Medicaid vaccination quality measures, including pediatric and prenatal immunization rates. Public health experts warn that removing those measures could reduce national visibility into vaccination coverage for populations Medicaid disproportionately serves, including nearly half of U.S. children.
At the same time, Medicaid privacy and trust are under pressure following a judge’s ruling that allows HHS to resume sharing limited Medicaid data with immigration enforcement officials in certain circumstances. Even with restrictions, advocates fear the policy could deter eligible patients from seeking emergency care, further straining safety net providers.
Taken together, these developments highlight why the safety net cannot rely on manual systems and fragmented workflows. The organizations serving Medicaid and dual-eligible populations are expected to deliver better outcomes while navigating a moving regulatory landscape. That is where technology-forward care models come in.
One example is Pair Team, which focuses on building what it calls “the safety net of the future” by supporting care teams and community organizations with AI-enabled tools. Pair Team’s technology is designed to help coordinate whole-person care, including benefits navigation and social needs support, areas that often determine whether a patient can actually follow a treatment plan.
As Medicare and Medicaid rules tighten and public expectations rise, the next version of the safety net will be defined by organizations that can adapt quickly and coordinate care seamlessly. In 2026, the policy direction is unmistakable: better oversight, more accountability, and stronger protections for patients. The systems that succeed will be the ones that pair mission with modern infrastructure.