CMS updates AHEAD model: 6 things to know

By Alan Condon / September 2, 2025

CMS on Sept. 2 unveiled policy and operational updates to the Achieving Healthcare Efficiency through Accountable Design Model, a state total cost of care initiative launched in 2023 to curb spending, improve population health and advance health equity.

Six things to know:

1. The AHEAD Model will now conclude on Dec. 31, 2035. The extension is designed to give participating states additional time to implement reforms and demonstrate progress on total cost of care and quality goals.

2. Changes will begin across all cohorts in January 2026. These updates give states new tools to manage Medicare costs sustainably, while also aligning Medicaid and commercial payers under a single accountability framework, according to CMS.

3. For the first time, AHEAD will bring total cost of care accountability to all Original Medicare beneficiaries in participating regions, including those not aligned with other accountable care models. Geographic entities will operate under two-sided risk arrangements, with opportunities for shared savings or losses.

4. States must now implement at least two policies to promote choice and competition in healthcare markets. In addition, each state will develop a population health accountability plan to strengthen preventive care and chronic disease management. CMS will also require new transparency around state primary care investments and total cost of care targets.

5. Current participants include:

• Maryland and Vermont (Cohort 1)

• Connecticut and Hawaii (Cohort 2)

• New York (in five downstate counties: Bronx, Kings, Queens, Richmond and Westchester) and Rhode Island. 

6. States may receive up to $12 million over the first five to six years to support implementation activities. Funding will be distributed through an initial award and annual continuation awards. CMS said it designed the longer planning and testing period to give states time to prepare for care redesign and to allow early investments in primary care and care coordination to yield results.