States make the market. Delaware moved first.

Five steps to a launched market.

1 — Commit. A short-form commitment by September 30, 2026 reserves your state’s seat in the January cohort and locks Launch Participant pricing; full agreements execute by November 30, ahead of December production burn-in — a supervised live run in which a small cohort routes real transactions on production credentials for two to four weeks, so January 1 is a certainty, not a first attempt. Step 1 is a short-form commitment; the detailed legal, technical, and operating work follows behind it.

2 — Engage as a payer. Bring everyone the state insures — Medicaid fee-for-service, managed care, and the employee plan — onto the network on the same published terms as any insurer.

3 — Subsidize providers. The Provider Enablement Fund pays Certified Onboarding Partners to connect your providers, against verified go-lives; the money never flows through Smart Health Network — the state pays the people who do the work.

4 — Bring your records. The state’s official registries — licensure, Medicaid enrollment, exclusions, the insurance-department registry — anchor who’s trusted in its market.

5 — Catalyze the market. Your insurance commissioner convening the market’s carriers, and program management on your terms, with whoever you trust, running the launch cadence: recruitment, readiness, and your state’s satellite site of the October 14 national Connectathon.

The path, at a glance:

Engage as a payer

A state brings everyone it insures — Medicaid fee-for-service, Medicaid managed care, and the state employee plan — onto the network through one connection, on the same published national terms as any insurer, solely for the lives it insures. That supports the state’s January 1, 2027 prior-authorization compliance obligations, with the rest of the catalog following at no additional fee; public-health reporting, eligibility, and patient access ride the permanent free tier. The state funds its lives directly or directs its MCOs — its choice. And the state’s own book is typically a quarter or more of its market: the savings land in the state’s own costs first.

What it replaces

Everything the payer page describes, applied to the state’s own programs, and beyond that: MMIS custom interfaces, provider enrollment and provider-relations friction, and the quality and public-health reporting that today means paying people to pull data out of charts by hand. The displaced cost is modeled at roughly 14x the fee on hard dollars alone, and roughly 24x once third-party-liability recovery and the measured downstream savings are counted.

Provider adoption — the Provider Enablement Fund.

Your rural-health transformation dollars can fund the work of connecting your providers through a dedicated Provider Enablement Fund — a nameable line in your RHTP plan that pays Certified Onboarding Partners (your HIE, EHR vendors, revenue-cycle firms, regional integrators) against verified connection milestones. Providers pay nothing for funded onboarding. The fund never flows through Smart Health Network: the state pays whoever does the work, against verified go-lives — we publish the standards and certify the work.

Your records anchor the market’s trust.

The state brings what only it holds. The network verifies participants against the state’s official sources — Medicaid provider enrollment, professional licensure, facility licenses, the Medicaid exclusion list, and the insurance department’s carrier registry — supplied against a published specification. The state isn’t just funding its market; it is the authority the network defers to for who is licensed, enrolled, and excluded in it.

Market-making

The state’s commitment is what launches its market — starting with prior authorization on January 1. Medicare Advantage plans face the same federal interoperability requirements. Commercial payers face the join-or-build decision in a market that already works, and a pledge to streamline prior authorization the market now expects them to keep. And providers onboard on the rural-health funding into a network already running.

States with managed-care plans

The terms are identical; the state chooses who pays for its managed-care lives — directly on one master schedule (often the cleaner path, because a fee paid by the plans may return through future capitation rates, depending on the state’s rate-setting process), or each MCO signs its own participation schedule at published rates, with the same Launch Participant terms available.

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 go-live 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 goes live.