Delaware is putting shared infrastructure to work.
Delaware is investing $50 million over five years through its Rural Health Transformation Program to deploy Smart Health Network, starting with prior authorization. The work combines shared infrastructure with organized implementation across public programs, health plans, providers and technology partners.
Other states can reuse the network and implementation approach while addressing their own systems, requirements and funding decisions.
What is being implemented
Medical prior authorization is the first major implementation. Participating organizations are connecting their systems, testing requests and responses, and organizing the provider support needed to make those exchanges useful.
What others can reuse
Reuse the common network, open-source connection software, common participation framework, relevant testing work and lessons from provider adoption. Each state still has local implementation work, but it does not need to rebuild the underlying network.
What has been demonstrated
July 13, 2026 — Delaware Launch & Connectathon: synthetic end-to-end prior-authorization testing, with 14 organizations connected to the shared test environment. July recap →
October 14, 2026 — Virtual Prior Authorization Connectathon, held with state satellite sites on synthetic data. Participation and tested-configuration results will be posted once confirmed by the testing team. October recap →
Convening milestones to date: July 20, Insurance Commissioner Navarro convened the state’s payers; July 30, Surgeon General Hockstein presented the model to 40 state Medicaid directors; August 7, the model was presented to the CEOs of 45 state hospital associations; August 14, the Delaware Healthcare Association brought the major health systems and Epic together; August 31, the first market-readiness session with 53 participants; September 3, presentation to the 12-state Northeast Zone insurance commissioners; September 9, the first Cut Paperwork, Not Care | State Leaders Roundtable with participants from 11 states, now meeting monthly. Attendance records the convening work; working exchange is demonstrated at the testing events above.
What happens next
Future milestones are targets for accepted workflows, not universal availability.
| When | Shared work |
|---|---|
| September 28 | Held — Action Forum · Progress to January: test results, updates and blockers, with Rhyme and Microsoft presenting. |
| October 14 | Held — Virtual Prior Authorization Connectathon: synthetic end-to-end testing. Recap on the Connectathon page. |
| October 26 | Next up — Action Forum: defects, remediation and reusable patterns. |
| November 30 | Action Forum: production readiness and contingencies. |
| December 1 | Limited production begins for accepted medical prior-authorization workflows. |
| January 1, 2027 | Production milestone: activate additional pathways as ready. |
Contact the team for participation details and schedule updates. Synthetic testing is open between sessions.
Build on the implementation and the funding approach.
Delaware’s experience can help other states scope provider adoption and additional Medicaid-wide operating services. Review the program materials, define the work your state needs and develop the applicable funding request. The $50 million five-year initiative is distinct from the state’s broader Rural Health Transformation award.
Historical sources: Original state announcement → · July event recap → · Axios coverage →
Last updated: October 2026