OPINION:
As state legislatures convene across the country, the implications of H.R. 1, the “One Big Beautiful Bill Act,” are no longer theoretical. Rural Health Transformation (RHT) funding is moving from promise to implementation. Medicaid community engagement requirements are shifting from debate to operational reality. Expectations around measurable outcomes and program integrity are rising.
For state leaders, this is not simply a funding cycle. It is a defining infrastructure moment.
The decisions made this year will determine whether time-limited federal dollars deliver a short-term boost to fragmented systems or establish the foundation for long-term fiscal discipline, stronger communities and durable self-sufficiency.
Too often, RHT funding and Medicaid mandates are treated as separate challenges requiring separate tools. One platform for compliance; another for care coordination; and another for reporting. This approach reinforces the very fragmentation that drives waste, inefficiency and poor outcomes in the first place.
The real opportunity is bigger.
Repairing fragmentation in rural health
States can use this moment to build not only connected systems but also intelligent infrastructure: a shared digital ecosystem that unites agencies, providers and community organizations around a single, accountable source of truth.
For decades, rural health and human services have operated in silos. Medicaid agencies, workforce departments, housing authorities, clinics and community-based organizations often serve the same residents without visibility into one another’s efforts. Even when organizations sit in the same building, their systems do not communicate.
This is a failure of technology, but it leads to a failure of care.
When systems cannot see across programs, states cannot allocate resources strategically. Service gaps go undetected until they escalate into high-cost crises. Verification processes become manual and duplicative. Return on investment is estimated, not demonstrated.
RHT funding offers a rare chance to correct this structural weakness. When used to build shared infrastructure, states can connect health care providers, workforce partners and social service organizations into a coordinated network. We have already seen what happens when sectors align around common data and accountability.
In communities that have implemented coordinated referral networks, emergency department utilization drops, preventable costs decline and residents receive the services they need faster. Addressing nonmedical barriers to health including housing instability, food insecurity and transportation produces measurable clinical and financial results. These are not abstract social theories. They are operational realities backed by data.
But the next chapter goes further.
One infrastructure, multiple mandates
We are entering a phase in which public infrastructure does more than store and transmit data. Modern platforms can reason across it. With the responsible application of artificial intelligence, states can move from reactive administration to predictive governance.
This shift is especially relevant in Medicaid. Instead of discovering after the fact that a resident lost coverage due to incomplete engagement documentation, intelligent systems can flag likely verification gaps in advance and coordinate with workforce or community partners to resolve them. Rather than waiting for housing instability to manifest in repeated emergency department visits, predictive analytics can identify high-risk individuals earlier and prioritize intervention.
This is not about replacing public servants. It is about equipping them.
Agentic AI systems capable of orchestrating multistep processes within defined guardrails can reduce administrative burden by automating verification workflows, cross-referencing trusted data sources and surfacing inconsistencies in real time. Compliance becomes embedded in the design of the system rather than layered on through audits and manual checks.
For states, that means stronger program integrity, lower improper payment risk and reduced overhead.
For residents, it means fewer redundant forms, fewer delays and clearer pathways to stability.
The same intelligent infrastructure that supports care coordination can also support Medicaid community engagement requirements. Verification should not require a new procurement cycle every time federal policy shifts. When workforce participation, education enrollment, volunteer service and health care engagement data flow through a shared ecosystem, reporting becomes a byproduct of normal operations rather than a parallel bureaucracy.
Just as importantly, intelligent infrastructure allows leaders to see across programs.
Medicaid spending does not exist in isolation from housing instability. Workforce participation is not disconnected from access to transportation or child care. When agencies operate within one coordinated network, states can analyze how interventions in one program affect costs in another. Budget decisions become informed by longitudinal evidence rather than annual snapshots.
That is the difference between managing programs and governing outcomes.
Governing for durability, not the moment
Some states will use RHT dollars to purchase point solutions tailored to current requirements. Those systems may satisfy immediate mandates, but they will need to be replaced when policies evolve.
Others will treat this as a structural inflection point.
They will invest in adaptable infrastructure that can support health care coordination today, community engagement verification tomorrow, and future federal priorities yet to be defined. They will embed accountability directly into workflows. They will reduce fragmentation across vendors and agencies. And they will position themselves to measure and prove the return on public investment.
The goal for 2026 should not be compliance alone. It should be durability.
If states seize this moment, they can move beyond managing crises and toward engineering pathways to self-sufficiency. They can reduce waste while strengthening support for those who truly need it. They can connect government agencies and community partners into a unified, accountable system designed to help residents stabilize, work and thrive.
The next generation of public infrastructure will not merely connect systems; it will think across them.
States that recognize this and build accordingly will comply with federal mandates; but what’s more, they will own their outcomes.
• Taylor Justice is co-founder and CEO of Unite Us.
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