For Medicaid MCOs and state-contract bidders
A state contract you can actually staff.
Medicaid adequacy is written state by state, and the bar is moving: appointment wait-time standards and independent secret-shopper surveys are now federal requirements with dates attached.
No pitch. If it fits, the next step is a two-week diagnostic: fixed fee, no commitment past it.
Where it usually breaks
Sound familiar?
- Every state writes adequacy differently, and the RFP is already scored
- Behavioral health and LTSS breadth is thinner than the model assumed
- Wait-time standards and secret-shopper surveys are coming
- Directory accuracy is an enforcement exposure, not a chore
What we take off your plate
One team for the whole build.
- State-standard adequacy modeling
- Built to your state's actual rules, not a national template.
- Safety-net contracting
- FQHCs, behavioral health, and LTSS providers brought in and papered.
- Wait-time & survey readiness
- Appointment availability you can evidence when a surveyor calls.
- Provider data operations
- A directory that matches reality, and a cadence that keeps it there.
The plan
Three steps, with dates.
- 1
Diagnose
Your state's standards against your current network.
- 2
Build
Recruit, contract, credential. Tracked weekly.
- 3
Hand back
Procedures written and handed to your team.
What success looks like
- Adequacy demonstrable against state standards
- Wait-time and secret-shopper exposure closed before it's tested
- A directory your members and regulators can trust
Not sure where your build stands?
Eight questions, two minutes. See your weak spots and what we'd fix first. No email required.
From our playbook
What's changing in Medicaid networks.
- Regulatory · 14 min readThe Medicaid Access Rule: Wait-Time Standards Are ComingThe Medicaid Access Rule sets appointment wait-time standards, secret-shopper surveys, and a phased timeline that health plans and IPAs must prepare for now.Read it
- Playbook · 8 min readMedicaid managed care networks are not Medicare Advantage networksPlans entering Medicaid managed care from an MA background face a different adequacy framework, a different provider population, and a different compliance environment.Read it
- Regulatory · 14 min readBehavioral Health Network Adequacy: The New CMS StandardsBehavioral health network adequacy is now a first-class CMS standard. Here are the 2024-2026 rule changes and how to build a compliant network.Read it
- Operations · 8 min readContinuity and transition of care when a provider exitsWhen a provider leaves the network or a member is mid-treatment, continuity-of-care rules protect the patient. Learn the timelines and how to operationalize them.Read it
- Regulatory · 12 min readGhost networks: why provider directories lie — and how to fix yoursGhost networks break access and trigger enforcement. Learn why provider directories go stale, what CMS and the No Surprises Act require, and how to fix yours.Read it
- Operations · 6 min readRural providers require a different playbookThe standard outreach model was designed for suburban commercial networks. Rural providers have different economics, different leverage, and different reasons to say yes.Read it
- Contracting · 8 min readSingle Case Agreements: the release valve for network gapsA single case agreement covers one member when your network has a gap. How SCAs and letters of agreement work, how rates get set, and the compliance risks.Read it
- Regulatory · 8 min readDirectory accuracy isn't optional anymoreThe No Surprises Act, state penalties, and the operational discipline required to keep your directory honest.Read it
Talk to the founder
I've watched a lot of builds go quiet around week six. Usually it isn't strategy. It's that nobody owns the hard middle. Tell me where yours is stuck and I'll tell you straight whether we can help, and what I'd do first.
Dave Smith
Founder, Kearny Street Management
Building provider networks since 2002, for payers and for providers.
A 20-minute call. No pitch and no slides, just a straight read on where your build stands.