States make the market. Delaware moved first.
January 1, 2027 is a compliance deadline. It can either create fifty new payer portals — or become the moment your state replaces fragmented administrative connections with one set of shared rails. Delaware chose the shared path first. Your state doesn’t have to start from scratch.
Why this matters
Every impacted payer will build or buy CMS-0057 capability. The state’s decision is whether those capabilities remain fragmented at the provider edge or become reachable through one shared path. The federal government sets payer obligations; payers build APIs; the state is the only actor positioned to point all of that mandatory motion toward a common destination. Compliance won’t solve the problem on its own — it will perpetuate it: more portals, more one-off integrations, more unfunded work pushed onto the practices least equipped to absorb it. Fragmented APIs are just fax machines in modern clothing — and miss the window, and the money gets spent anyway, on the fragmented version, which then hardens for years.
In a recorded Delaware prior-authorization call this spring, a physician — now the state’s Surgeon General — learned mid-appeal that the payer had never received his clinical note: “So it was denied without asking for additional information?”
The note wasn’t missing. The bridge was. The full story is in the playbook →
Every state is trying to solve the same problem:
- rural providers spending their time chasing paperwork instead of treating patients;
- Medicaid agencies paying for one-off interfaces that get rebuilt every few years;
- every federal requirement threatening to become another unfunded mandate;
- patients waiting because administrative systems cannot talk to one another.
January 1, 2027 can either accelerate that fragmentation — or become the moment your state replaces hundreds of one-off administrative connections with one shared set of rails. CMS-0057 is the next deadline. It does not have to become the next silo. Delaware chose the shared path — and this is not a big IT project: the network exists and is operating in synthetic-data testing. Your state doesn’t build this — it joins a network already operating in test.
Prior authorization isn’t the product. It’s the first transaction. The product is shared administrative rails.
What the state gets by joining
— that letting each payer implement CMS-0057 independently cannot deliver:
- One common connection path for providers across participating payers, instead of a portal and integration per payer
- A coordinated production launch on a common timeline, instead of disconnected payer deadlines
- Common participation, conformance, security, and accountability rules across the market
- Measurable, production-tracked administrative-burden results — compliance is the floor; relief is the goal
- Reusable infrastructure for later transactions and state affordability priorities
- A way to enable rural providers — without building a new state-owned platform or replacing core state systems
- A health-IT result constituents can directly see: a staged path to patient-visible prior-authorization status
What SHN is not: the state’s MMIS; a clinical data warehouse; a payer’s utilization-management engine; the maker of any coverage or medical-necessity decision; a replacement for an HIE or EHR; or a state registry or source system.
Why one national network beats fifty state hubs. National and multistate payers integrate once rather than state by state; EHR vendors and onboarding partners build to one specification across markets; published national terms replace bespoke contracting; state HIEs and vendors operate certified roles on the network rather than being displaced; and each state retains control of its funds, its programs, and its source data. A state-built hub solves one state’s fragmentation by adding one more incompatible network to the nation’s.
The Delaware pattern: four actions to a January launch cohort.
The state makes a nonbinding public commitment to the launch-cohort planning process — no contract, no expenditure — and names an executive sponsor and implementation lead.
Convene the state’s payers and providers around one shared path; point mandatory CMS-0057 motion at a common destination.
MCOs first (reusing the compliance work and existing contract leverage, as state law permits), then Medicaid FFS, then employee plans and other state books — keeping the systems the state has.
State-funded provider enablement, prioritizing rural providers and the referral partners that complete rural patients’ care journeys.
Two lanes: every state can Join, Activate, and Connect its plans; RHTP states can additionally fund Action 4 provider enablement. A public commitment by September 1 is the preferred target for January cohort planning — a planning marker, not an exclusion. The program contract applies to RHTP states only.
The full playbook — problem, answer, four actions, launch definition, economics, and appendices — is published: read it as a page → or download the PDF → · The Delaware evidence: announcements, results, targets, press →
The path, at a glance:
| When | What |
|---|---|
| Now | Signal intent · receive the commitment package |
| By Sept 1, 2026 | Public commitment for the January launch cohort |
| By Sept 30, 2026 | Program contract signed (RHTP states only) |
| Oct 14, 2026 | National CMS-0057 readiness Connectathon — your state hosts a satellite site |
| Oct–Dec | Onboarding at scale · rolling conformance green-lights |
| By Nov 30, 2026 | Participation agreements fully executed (production burn-in requires them) |
| December | Production burn-in |
| By Dec 31, 2026 | Pricing window closes — any 2026 signer holds Launch Participant terms into a later cohort |
| Jan 1, 2027 | Prior-authorization routing begins for launch participants |
| Jan 13, 2027 | Claims & Remittance Connectathon — the cadence repeats each release |
Cohort scope depends on executed payer, provider, and state-system participation agreements by November 30.
December runs supervised burn-in with production credentials and approved operating controls, using production or production-equivalent workflows as permitted by executed agreements — so January 1 is an operational launch, not a first attempt. Production credentials require executed agreements.
What joining the January cohort means
- Public commitment by September 1 — the preferred target for cohort planning, not an exclusion.
- Program contract or state-approved equivalent by September 30 (RHTP states only).
- Payer, provider, and state-system participation agreements by November 30.
- December supervised burn-in where ready.
- January 1 prior-authorization routing begins for launch participants.
No contract or funding is required to commit. Cohort scope depends on executed agreements, production credentials, and completed readiness checks.
January 2027 means, at minimum: the state — or its designated participant — has executed its participation agreement; designated launch payers’ endpoints are reachable through the network; the first named provider-payer cohort can transact prior authorization in production; a defined onboarding path exists for providers not yet integrated; additional payers, providers, and transaction types join continuously after launch. Launch is a beginning, not a saturation event.
How the program works — RHTP contracting and governance protections, the two-agreement structure, connecting state-sponsored plans and state systems, the Provider Enablement Program, and MCO payment options — is all in the playbook →
Delaware first, not Delaware only.
Delaware wrote shared, neutral infrastructure into its Rural Health Transformation plan and on July 6 launched the first statewide initiative — real-time insurance verification and prior authorization across the state, built with DHIN, the exchange Delaware already trusts. Every state after Delaware joins a network that already exists, and the same pattern — your HIE, your certified partners, your RHTP plan — is built to repeat. Joining requires no major capital investment beyond provider onboarding, which transformation funding can support: a state is not financing new infrastructure — it is joining an existing national utility with predictable operating costs. Read the announcement →
For state leaders: download the Delaware briefing — the case, the model, and the timeline, from the state that went first.
Download the Delaware briefing (PDF, 14 pages) →By Dr. Neil Hockstein, Chair, Delaware Health Care Commission. Shared with permission.Launch Participant terms
A state that signs in the 2026 window and certifies for production by December 31, 2027 holds the $0.25 rate through 2029 — the January 2027 launch cohort remains the market-making ask; the rate condition is the same certification gate every payer carries. The rate locks at signature; billing begins when the market launches.
The 2026 window closes December 31, and every state that follows joins a network that already exists. Delaware’s July 13 Launch & Connectathon drew 200+ participants and connected the first health plan; the national CMS-0057 readiness Connectathon on October 14 is open to every state — bring a team, run prior-authorization workflows on synthetic data, and leave with a concrete readiness artifact for state, payer, and federal-review discussions.
Per-transaction benchmarks are published third-party figures (CAQH Index; AMA survey data). Results vary by organization, starting cost, route migration, participation levels, and decommissioning timing; whether the network clears your fee is computed from your numbers in a working session, and each participant sees its own computed fee alongside displaced cost on its monthly network statement.
References to CMS, HHS, RHTP, or CMS-0057 describe federal programs and requirements. Smart Health Network is not endorsed by CMS or HHS. State participation and funding decisions remain with each state.