Washington County currently has several open SUD solicitations/Letters of Interest, all posted August 21 and opening September 4:

• Residential SUD Treatment — Washington County LOI, opens Sept. 4 at 2 PM.

• Substance Use Disorder Residential Capacity — separate capacity solicitation, opens Sept. 4 at 4 PM.

• Supported Capacity for Dependent Children Whose Parents Are in Residential SUD Treatment — opens Sept. 4 at 4 PM.

• Outpatient and/or Intensive Outpatient SUD Treatment — opens Sept. 4 at 4 PM.

WHO I’D HIRE

FULL SCORECARDS HERE

VIDEO CHAPTERS + SOURCES

00:00 — Funding Does Not Automatically Create Capacity
San Bernardino adult residential procurement · 18-bed youth shelter contract

00:39 — The Oregon Addiction-Treatment Procurement Test
Washington County addiction-treatment system · Clackamas County Recovery Campus

03:18 — How PULL Scores Fundability

04:16 — CODA: Operating County-Built Capacity
Beaverton Recovery Center capacity and investment · CODA’s Beaverton Recovery Center · CODA annual reports

05:59 — Fora Health: Adding Beds and Improving Throughput
Fora’s 70-bed residential program · 76-bed Recovery Campus · 46-bed recovery-housing project · Youth-program closure

08:07 — Recovery Works NW: Activating Supply
Clackamas County’s $236,075 start-up agreement · Oregon Health Authority facility overview · Recovery Works NW detox program

09:58 — Boulder Care: Capacity Without Another Building
Umpqua Health performance-based contract · Independent PHTI assessment · Boulder’s payer model

11:40 — LifeWorks NW: Specialized but Unavailable Capacity
LifeWorks residential programs and Mountaindale status · Washington County dependent-children capacity solicitation

13:04 — The Five Capacity Plays

14:01 — What I Would Ask Before Awarding the Contract

14:40 — What I’m Watching Next
Washington County’s current procurement opportunity

TEN YEARS IN SOCIAL CARE

Ten years ago, healthcare was just learning to pay for social care; how did a handful of industry shapers turn unfamiliar services into models healthcare could buy, measure and renew? I’m posting a video on Tuesday for paid subscribers on these orgs and what their strategies teach us about making the next wave of spending safer.

Subscribe now

Washington County currently has several open SUD solicitations/Letters of Interest, all posted August 21 and opening September 4:

• Residential SUD Treatment — Washington County LOI, opens Sept. 4 at 2 PM.

• Substance Use Disorder Residential Capacity — separate capacity solicitation, opens Sept. 4 at 4 PM.

• Supported Capacity for Dependent Children Whose Parents Are in Residential SUD Treatment — opens Sept. 4 at 4 PM.

• Outpatient and/or Intensive Outpatient SUD Treatment — opens Sept. 4 at 4 PM.

WHO I’D HIRE

FULL SCORECARDS HERE

VIDEO CHAPTERS + SOURCES

00:00 — Funding Does Not Automatically Create Capacity
San Bernardino adult residential procurement · 18-bed youth shelter contract

00:39 — The Oregon Addiction-Treatment Procurement Test
Washington County addiction-treatment system · Clackamas County Recovery Campus

03:18 — How PULL Scores Fundability

04:16 — CODA: Operating County-Built Capacity
Beaverton Recovery Center capacity and investment · CODA’s Beaverton Recovery Center · CODA annual reports

05:59 — Fora Health: Adding Beds and Improving Throughput
Fora’s 70-bed residential program · 76-bed Recovery Campus · 46-bed recovery-housing project · Youth-program closure

08:07 — Recovery Works NW: Activating Supply
Clackamas County’s $236,075 start-up agreement · Oregon Health Authority facility overview · Recovery Works NW detox program

09:58 — Boulder Care: Capacity Without Another Building
Umpqua Health performance-based contract · Independent PHTI assessment · Boulder’s payer model

11:40 — LifeWorks NW: Specialized but Unavailable Capacity
LifeWorks residential programs and Mountaindale status · Washington County dependent-children capacity solicitation

13:04 — The Five Capacity Plays

14:01 — What I Would Ask Before Awarding the Contract

14:40 — What I’m Watching Next
Washington County’s current procurement opportunity

TEN YEARS IN SOCIAL CARE

Ten years ago, healthcare was just learning to pay for social care; how did a handful of industry shapers turn unfamiliar services into models healthcare could buy, measure and renew? I’m posting a video on Tuesday for paid subscribers on these orgs and what their strategies teach us about making the next wave of spending safer.

Subscribe now

Current designation: Exact buyer fit; capacity currently offline
Capacity type: Women-and-children residential SUD treatment
Best use: Family-preserving residential treatment
Important limit: Reopening requirements and operating economics remain unresolved
Last evaluated: August 2026

THE PULL VERDICT

The model allows mothers to enter residential substance-use treatment without separating from their children. Mountaindale is temporarily closed, and the cost and timeline required to bring that capacity back remain unclear.

LifeWorks NW’s Mountaindale program scored 17/31 under PULL

↳ METHODOLOGY

Mountaindale is exceptionally well matched to the problem Washington County is trying to solve.

Parents can need residential substance-use treatment while their dependent children also need a safe, supported place to stay. A traditional residential program may require the parent and child to separate, creating another barrier to entering or remaining in treatment.

Mountaindale was designed around that exact constraint. It allows mothers to receive residential treatment while their children remain with them.

But the relevant facility is temporarily closed for renovations.

That means Mountaindale currently offers strong model alignment without confirmed usable capacity. Its public information does not establish the number of beds expected to reopen, the reopening date, renovation cost, staffing plan or reimbursement needed to sustain the service.

WHAT MOUNTAINDALE IS DESIGNED TO ADD

When operating, Mountaindale can provide:

• Residential substance-use treatment for mothers

• A supported living arrangement for dependent children

• Treatment without mandatory parent-child separation

• A pathway for parents who might otherwise delay or decline residential care

• Family-centered recovery support

• A direct response to Washington County’s identified family-capacity gap

LifeWorks also operates another residential program for women and children. That provides some evidence that the organization understands this specialized service model.

WHAT MOUNTAINDALE DOES NOT CURRENTLY ADD

While the facility remains closed, it does not provide:

• Confirmed open beds

• A documented number of staffed beds

• An available placement for current referrals

• A public reopening date

• Verified current reimbursement

• Proven post-renovation operating capacity

This distinction is essential.

A program can be perfectly designed for the buyer’s problem and still provide no usable capacity today.

PAID SUBSCRIBERS: Continue for the complete score breakdown, reopening test, purchasing questions and the conditions that would change Mountaindale’s rating.

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Current designation: Proven operator; expansion economics unresolved
Capacity type: Residential treatment and recovery continuum
Best use: Expanding higher-acuity residential and step-down capacity
Important limit: Per-bed economics and rate adequacy remain incomplete
Last evaluated: August 2026

THE PULL VERDICT

Demand is proven. Delivery is proven. Another 76-bed campus is underway. The remaining question is whether reimbursement and staffing can sustain the additional capacity.

Fora Health scored 23/31 under PULL

↳ METHODOLOGY

Fora is not promising that it will eventually create residential capacity. It already operates 70 adult residential beds and primarily serves Medicaid-covered patients.

The demand is equally clear. Fora has reported that patients can wait months for residential treatment. Clackamas County has also selected Fora to develop and operate a new 76-bed recovery campus.

That gives Fora one of the strongest combinations of proven demand, operating experience and expansion capability in this Vendor Watch.

The unresolved issue is economic durability.

Residential treatment requires buildings, continuous staffing and reimbursement that keeps pace with patient acuity. Fora’s previous youth-program closure demonstrates what can happen when reimbursement, referrals, labor and clinical complexity stop balancing even when the underlying service remains badly needed.

WHAT FORA ADDS

Fora currently provides:

• Seventy adult residential treatment beds

• A residential population that is approximately 82% Medicaid-covered

• Treatment for people with substance-use and co-occurring behavioral-health needs

• A broader continuum that includes withdrawal management, outpatient care and recovery support

• Operating experience with facility-based treatment

• Development and operating capacity for a new 76-bed Clackamas County recovery campus

• A 46-bed recovery-housing expansion that could improve step-down flow

Fora therefore contributes more than theoretical or licensed capacity. It has operating beds, patients receiving care and a public expansion pathway

.

WHAT REMAINS UNKNOWN

The public record does not clearly show:

• Current reimbursement per bed-day or treatment episode

• Fully loaded operating cost per bed

• Direct-care and clinical labor costs

• Break-even occupancy

• Daily staffed and available beds

• Referral acceptance and rejection rates

• Whether recovery housing shortens residential stays

• Whether the expanded continuum reduces emergency or inpatient spending

• Whether current Medicaid rates are sufficient for the acuity being treated

• How the new campus will avoid the pressures that contributed to the youth-program closure

Fora has established that it can build and operate capacity. The next question is whether each additional bed can remain financially and operationally usable.

PAID SUBSCRIBERS: Continue for the complete score breakdown, purchasing fit, evidence gaps, buyer questions and the conditions that would change Fora’s rating.

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Current designation: Strong payer-ready outpatient capacity
Capacity type: Distributed virtual OUD treatment
Best use: Same-day treatment access, rural reach and ongoing outpatient care
Important limit: Higher-acuity capacity relief remains unproven
Last evaluated: August 2026

THE PULL VERDICT

Boulder Care’s virtual OUD treatment can expand outpatient access without building another facility. It should not be counted as a replacement for residential or withdrawal-management capacity.

Boulder Care scored 24/31 under PULL

↳ METHODOLOGY

Boulder has one of the strongest fundability packages in this Vendor Watch. It has Medicaid and commercial-payer relationships, performance-based contracting experience, low facility exposure and unusually strong public evidence.

But Boulder solves a different capacity problem from CODA, Fora Health or Recovery Works NW.

Boulder can help more people start medication-based OUD treatment without traveling to a facility. It does not directly create detox beds, residential beds or 24-hour supervised treatment.

WHAT BOULDER ADDS

Boulder can expand treatment without purchasing real estate or constructing a residential facility.

Its virtual model may help:

• Medicaid members begin treatment sooner

• Rural patients reach clinicians

• Patients continue medication-based treatment

• Payers extend OUD services across a wider geography

• Health systems create an outpatient pathway before or after facility-based care

WHAT BOULDER DOES NOT ADD

Boulder does not directly add:

• Detox beds

• Residential treatment beds

• Twenty-four-hour supervision

• A physical placement for patients who cannot be treated safely at home

• Proven relief for residential waitlists

That distinction matters in this Vendor Watch. A model can be highly fundable without supplying the type of capacity currently in shortest supply.

PAID SUBSCRIBERS: Continue for the complete score breakdown, purchasing fit, evidence gaps, buyer questions and the conditions that would change Boulder’s rating.

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Current designation: Operating capacity; financial durability unclear
Capacity type: Medically monitored withdrawal management
Best use: Local detox access and hospital or crisis diversion
Important limit: Ongoing reimbursement and break-even economics remain unclear
Last evaluated: August 2026

THE PULL VERDICT

Clackamas County helped fund the workforce needed to open a defined detox service. The public record still does not show whether reimbursement can reliably sustain it.

Recovery Works NW scored 20/31 under PULL

↳ METHODOLOGY

Recovery Works has one of the clearest capacity-creation stories in this Vendor Watch.

Clackamas County lacked local withdrawal-management capacity. Public funding helped Recovery Works recruit the workers needed to activate a 16-bed, medically monitored detox program.

The facility is now operating. That is more concrete than a referral network, future construction plan or untested access promise.

But opening beds and sustaining beds are two different achievements.

The public record does not yet show occupancy, current staffing levels, Medicaid reimbursement, operating cost or the utilization needed to break even. We can see that capacity was created. We cannot yet see whether the economics will keep all 16 beds available.

WHAT RECOVERY WORKS ADDS

Recovery Works provides:

• Sixteen defined detox beds

• Twenty-four-hour medically monitored care

• A local withdrawal-management option for Clackamas County

• Access for OHP-covered and publicly supported patients

• A possible alternative to emergency-department or inpatient treatment

• A clear service unit that buyers can count, staff and purchase

The program was expected to support approximately 1,200 treatments annually and increase Portland-area detox capacity by approximately 18%.

Those were capacity projections. Actual utilization and completed treatment volume still need to be verified.

WHAT REMAINS UNKNOWN

The public record does not clearly show:

• How many beds are staffed and usable each day

• Current occupancy

• How often referrals are accepted or declined

• Medicaid reimbursement per stay

• Total operating cost

• Nursing and management labor costs

• The occupancy needed to break even

• Whether the program reduces emergency or inpatient spending

• Whether start-up funding created a financially self-sustaining service

Recovery Works therefore proves that public funding can activate beds. It does not yet prove that the regular payment system can keep those beds open.

PAID SUBSCRIBERS: Continue for the complete score breakdown, purchasing fit, evidence gaps, buyer questions and the conditions that would change Recovery Works’ rating.

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THE PULL VERDICT

CODA now operates the residential and withdrawal-management capacity Washington County said it was missing. The public record still does not show what another comparable expansion would cost to operate.

CODA scored 24/31 under PULL

↳ METHODOLOGY

CODA is probably the strongest direct answer to the capacity problem anchoring this Vendor Watch.

Washington County identified a specific shortage: it lacked publicly funded withdrawal-management capacity and had limited residential treatment capacity.

The county’s approximately $62.3 million CATT investment created the broader physical campus. CODA then staffed and activated the residential and withdrawal-management services inside it.

CODA’s Beaverton Recovery Center can provide as many as 48 residential beds, alongside withdrawal-management capacity. The organization treated 3,740 patients in 2025, including 654 residential patients.

This is not planned or hypothetical capacity. The facility is operating, the workforce was expanded and patients are receiving care.

The unresolved question is whether the model can be financially repeated.

The public record does not establish CODA’s current reimbursement, operating cost, cost per bed-day or the occupancy needed to break even. The first campus proves that government and an experienced operator can create capacity together. It does not yet tell another purchaser what the next comparable expansion would require.

WHAT CODA ADDS

CODA provides:

• Up to 48 residential treatment beds at the Beaverton Recovery Center

• Withdrawal-management capacity

• Publicly funded treatment access

• An experienced substance-use treatment operator

• A working county-provider operating relationship

• Documented service volume

• A direct response to Washington County’s identified bed shortage

Activating the Beaverton Recovery Center required CODA to hire dozens of workers and increased the organization’s size by roughly one-third.

That makes CODA an unusually useful capacity case. We can see the building, operating partner, workforce expansion and patient volume.

WHAT REMAINS UNKNOWN

The public record does not clearly show:

• CODA’s reimbursement per bed-day or treatment episode

• Fully loaded operating cost

• Direct-care and clinical labor expense

• Break-even occupancy

• Average daily staffed and available beds

• Referral acceptance and rejection rates

• Cost attributable specifically to CODA’s program

• Organization-specific emergency or inpatient savings

• The capital and operating support required to reproduce the model

• Whether the same expansion could work without a comparable county investment

CODA has proven that the model can operate. Purchasers still cannot calculate the price of producing the next usable bed.

PAID SUBSCRIBERS: Continue for the complete score breakdown, replication test, purchasing questions and the conditions that would change CODA’s rating.

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San Bernadino County needed a new operator for an 18-bed temporary shelter serving high-risk youth under a no-reject/no-eject model. It received zero proposals.

The county responded by adding $1.13 million and six months to Family Assistance Program’s incumbent contract, preserving the beds while it searches for another solution.

While it may be a classic case of system inertia, we can also see it as a test of whether public purchasing models can actually support the capacity they expect providers to supply.

This week has added 16 social care capital records since the last edition, now amounting up to 94 records and $3.72 billion in all-time disclosed pipeline. The 2026 cohort rose from $2.21 billion to $2.42 billion.

The most valuable movement came from older calls that finally reached a verdict: awards named, deals closed, one procurement ended without an award and a completed aquisition produced a major leadership transition.

COMING SOON!

Ten years ago, healthcare was just learning to pay for social care; how did a handful of industry shapers turn unfamiliar services into models healthcare could buy, measure and renew? I’m posting a video next week for paid subscribers on these orgs and what can their strategies teach us about making the next wave of spending safer.

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AT A GLANCE

Six forms of conversion in this week’s ledger:

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The rest of San Bernardino’s activity followed the same logic: extend community providers that cannot easily be replaced, commit capital to a housing and recuperative-care campus, and change reimbursement rules so behavioral-health organizations can draw payment through a more workable structure. The county was purchasing continuity and trying to exert more control over what survives the next contracting cycle.

That pattern runs through this week’s procurement story. Federal behavioral-health funding entered award review. Maryland began designing a Medicaid nutrition market. Maine moved closer to an eligibility system that will require far more frequent outreach, verification and navigation. The week’s senior hiring activity clustered around the people expected to decide where healthcare dollars go, prove that they worked and examine the operating models underneath them.

Of the $3.5 billion in disclosed pipeline activity tracked by PULL in 2026 so far, roughly nine of every ten dollars sit in navigation and engagement, rural infrastructure or behavioral health. These are the systems that determine whether people reach care, whether providers remain available and whether services can be financed reliably enough to continue. This week’s moves show what that concentration looks like on the ground: public purchasers are paying to preserve capacity now while redesigning the mechanisms that will control it later.

PULL tracks social-care purchasing so healthcare leaders know what deserves their attention, diligence, and money and what needs more evidence.

2026 DASHBOARD

$3.5B in social care spend tracked (so far)

Here’s how it all breaks down:

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Health systems and health plans have several ways to expand it: add clinicians, extend clinician panels, open treatment slots, improve placement, or move more patients through existing infrastructure.

Each approach produces a different unit of capacity.

For this Vendor Watch, PULL screened seven newer behavioral-health companies against one question:

How much additional usable capacity can this model create for a healthcare buyer?

The companies fell into three lanes:

Create: add new clinical or service supply.

Unlock: make existing supply easier to find and use.

Multiply: increase the number of patients existing clinicians and infrastructure can serve.

The strongest evidence we found was in multiplication: technology helping existing behavioral-health resources serve more patients.

The screen narrowed seven companies to two worth a buyer meeting now, one suited to a targeted pilot, and four that need more evidence before advancing.

NEW SIGNAL:

Utah Is Building Its Rural-Health Market Around Four Lead Entities

Utah anticipates selecting one organization to administer a rural-health consortium, one to build its statewide data model, one to operationalize a clinically integrated network and one to run its first Community Care Hub. The four will sit over five-year program ceilings totaling as much as $389.8 million. The emerging opportunity is the lead-entity position between the state and fragmented rural supply.

Across PULL’s radar, roughly 10 of 26 spending records in 2026—representing about $166.5 million in disclosed opportunity—fund some portion of the operating backbone around care: navigation, coordination, administration, billing readiness, workforce, data or hub management. Private capital is also flowing toward companies occupying these infrastructure positions, while recent provider closures are shifting capacity elsewhere in the system. Utah brings those signals together. Its RHTP procurements place unusually large funding opportunities around administration, data infrastructure, value-based-care development and community-provider coordination, with several structured around a single lead entity.

DASHBOARD:

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IN THIS EDITION: Track four treatment contractions, follow $5.6M in financing, compare two capacity strategies, track shifting leadership mandates, find five senior openings.

A behavioral-health network can look complete in a spreadsheet and feel different at 9 p.m., when a member needs a staffed bed. [ASK ME HOW I KNOW]

The distance between listed capacity and usable care is becoming one of the market’s most consequential measurements.

This week gives that distance a shape. Facility-based services contracted across four states. New financing surfaced for higher-acuity outpatient care and infrastructure that helps community providers enter value-based contracts. Public purchasers are trying to build beds, stabilize workforces and turn authorized services into delivered care.

Each move raises the same practical question: Which models can translate funding, contracts and clinical intent into care that is available when someone needs it?

That question is influencing what gets financed, what governments procure and the mandates given to behavioral-health leaders. For health plans, investors and operators, details such as staffed capacity, reimbursement, admissions and accountability now provide meaningful downside protection. They also produce a more humane measure of market performance: whether a person can receive the right care at the right time.

This week, $5.6M in financing surfaced for higher-acuity outpatient care and FQHC contracting infrastructure, while Recovery Works stopped accepting new patients and withdrew inpatient detox + residential treatment across Kentucky.

And it’s not the only one.

DASHBOARD

Capital is definitely not leaving behavioral health, but sorting among delivery models. Some of the most expensive, labor-intensive 24/7 capacity is struggling to survive that sorting.

Nearly $1B in disclosed social-care-related capital and purchasing activity tracked in 2026.

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In this edition: A $10M capital trace with $740K in modeled value, resolution accountability chain, payment integrity math, the value of admin capacity & capital allocation, a reality check from North Carolina, attribution guardrails, a capital-accountability dashboard, provider performance logic, five questions every buyer should ask, Unite Us’s acquisition trajectory, thesis validation signals, and a capital reallocation test.

Last week, Unite Us acquired Vircho Health.

Unite Us already had substantial infrastructure for screening, referrals, coordination, payments and reporting. Its current payer product promises actionable insights into member needs and health outcomes, while recent statewide work combines closed-loop referrals, payments, interoperability and outcomes reporting. Vircho adds deeper service verification, organization-level performance measurement, financial accountability and network analytics.

This acquisition brings to light a new kind of question in social care procurement:

How much of your social care budget can you actually trace from authorization to resolution?

CRUNCH OF THE WEEK: WHAT IS VISIBILITY ACTUALLY WORTH?

A $10M budget can still leave a lot unexplained. In this scenario, about $4M.

Imagine a health plan authorizes $10M/year for food, transportation, housing, navigation and other social-care services. The plan may know how much it authorized, the number of referrals made, and what providers invoiced but those are not the same thing as knowing what happened.

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On August 4, the Arizona Health Care Cost Containment System released RFP YH27-0001 for the Arizona Long Term Care System Elderly and Physically Disabled program.

Proposals are due September 24, 2026. The contract becomes statewide in October 2027.

Long-term care is one of healthcare’s messiest purchases: county networks, labor shortages, case-management rules, subcontractors, encounters, capitation and clinical risk all collide inside it. This RFP cuts through that complexity with one practical question:

Can this vendor turn authorized care into care that actually arrives?

AHCCCS requires bidders to find and address gaps between approved service plans and actual delivery, including caregiver no-shows, missed appointments, transportation failures and missed social services. That requirement changes who has leverage. A large directory is no longer enough. Bidders need workers who can accept cases, hours that can be filled, placements that are actually open and operating data that proves the service occurred.

This is my attempt at showing which Arizona operators are best positioned to meet that need, the evidence that puts them there and the proof that could still knock them out. For buyers, it narrows a sprawling market to the few calls worth making first. For operators, it shows which capabilities have become commercially valuable before the award is decided.

The larger signal travels well beyond Arizona and long-term care: healthcare is beginning to treat the distance between access promised and care delivered as a financial risk.

THE MARKET CALL

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Editorial and disclosure note: ModifyHealth and Joybus provided the meals featured in this episode at no cost. Neither companies paid for or control this analysis. The Joy Bus and ModifyHealth are discussed as examples of different service architectures, not ranked against one another. Vendor observations are based on a site visit, personal product experience and publicly available information; they are not substitutes for clinical, legal, security or procurement diligence. Financial examples are illustrative scenarios and should not be interpreted as guaranteed savings or universal Food as Medicine ROI.

I used AI to help me with the podcast thumbnail, formatting and generating some of the diagrams in the video.

[HEY DIETITIANS: QUICK QUESTION, WHAT DO MTMS ACTUALLY DO FOR REGULAR PEOPLE?]

CHAPTERS & REFERENCES (LINKS)

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Health plans are often asked to pay twice for social care. First: turn a fragmented set of community organizations into something healthcare can actually buy. Find providers, test capacity, define coverage, connect data, create referral and billing workflows, negotiate contracts, monitor performance and decide what counts as success. THEN, pay for the service. The first bill is easy to miss because it rarely appears as a service price. It appears as months of staff time, consulting, integration, legal review, provider onboarding, failed referrals, readiness payments and evaluation. A $100 service can require a 6-7 figure market-building project before the first member receives it. That is one reason social care can look economically weak even when the underlying service is useful. Fund the service means funding the market in many cases.

Across several states, RHTP dollars are being directed toward community care hubs, regional conveners, community health workers, food supply chains, provider networks, shared data, referral infrastructure, administration, evaluation and payment-model design. This creates a kind of second-dollar advantage: Public capital pays the part of the cost of making a fragmented service market usable. The next healthcare buyer can enter later through infrastructure that already exists and spend more of its first dollar on the service itself.

While RHTP isn’t social care revenue it may be something more useful to the next buyer: a public subsidy for the fixed costs that have made social care hard to purchase.

If this works, lessons learned could change social care from a series of isolated pilots into something closer to a functioning procurement market. If those assets become functional, accessible and durable, a healthcare organization entering later won’t have to start from zero, which can shorten implementation, reduce duplicated spending and allow the buyer to place a smaller, more bounded first bet. For now, RHTP gives us places to watch for a different financing model.

I’m treating four state programs as competing hypotheses about how a $50 billion federal investment could make social care easier and less expensive to buy. Each offers a simple way to assess whether public funding could remove a costly implementation burden vs just moving it somewhere else. For leaders accountable for rural access, utilization, network adequacy, care transitions, workforce productivity, or value-based performance, that answer can make your next investment smaller, faster, and defensible, as well as reveal which models across all 50 states are worth replicating.

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SETUP

Social-care adjacent opportunities in RHTP generally fall into six setup functions:

• Aggregation

• Capacity

• Integration

• Admin

• Evidence

• Payment design

These are fixed or semi-fixed costs. Once built, more than one buyer or service line may be able to use them. That’s the source of the advantage.

WHAT PROBLEMS ARE STATES USING RHTP FUNDS TO SOLVE?

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References:

00:00:22- https://www.tpg.com/news-and-insights/tpg-partners-with-findhelp-to-expand-access-to-essential-services-for-underserved-populations

00:03:09 - https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/healthy-opportunities-pilots#Caremanagers-5220

00:03:31- https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/nccare360

00:03:44- https://www.dhcs.ca.gov/wp-content/uploads/2026/06/DHCS-1915b-Annual-Report-on-ILOS-STC-B20-2026-1.pdf

00:03:59- https://www.dhcs.ca.gov/calaim-transforming-medi-cal/closed-loop-referral-clr-frequently-asked-questions/

00:04:11- https://www.dhcs.ca.gov/calaim-transforming-medi-cal/calaim-providing-access-and-transforming-health-initiative/

00:04:22- https://hfs.illinois.gov/content/dam/soi/en/web/hfs/info/procure/shcnnofo06032026.pdf

00:04:33- [PAGE 3] - https://hfs.illinois.gov/content/dam/soi/en/web/hfs/info/procure/shcnnofo06032026.pdf

00:05:35- https://investors.ehab.com/news/news-details/2026/Enhabit-Completes-Previously-Announced-Acquisition-by-Kinderhook-Industries-to-Become-a-Private-Company/default.aspx

00:05:45- https://www.healthcaredive.com/news/private-equity-firm-closes-11b-take-private-deal-of-home-health-and-hospi/812938/

00:06:01- https://www.nourish.com/blog/nourish-announces-series-c

00:06:10- https://abry.com/news-article/abry-partners-closes-780-million-oversubscribed-continuation-vehicle-for-centauri-health-solutions/

00:06:21-https://www.prnewswire.com/news-releases/upside-lands-20m-series-a-to-solve-the-us-housing-crisis-for-healthcare-302810401.html

00:07:21- https://investors.molinahealthcare.com/static-files/b930ad46-3af0-4454-a216-a1221d3612ea

https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2026/unh-q2-2026-remarks.pdf

https://share.google/iZRj35VE1MCWAyZEl

00:07:28- https://investor.hcahealthcare.com/news/news-details/2026/HCA-Healthcare-Reports-Second-Quarter-2026-Results/default.aspx

00:08:24- https://www.ncdhhs.gov/hop-evaluation/download?attachment

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Cigna expanded its AI-enabled personalized care management programs to identify and engage 20% more customers with emerging, complex or chronic needs, including behavioral health conditions and high-risk pregnancy. More than 1,250 Cigna clinicians provide navigation, coordinate among providers and connect customers with additional resources. Cigna estimates average savings of $2k annually for engaged customers and $200M for 3+ years.

VENDOR WATCH

ACL announced the Phase 1 winners of its Health at Home Challenge. They can now advance to the implementation-focused second phase, and each of the competition’s 3 phases offers as much as $2M. ACL’s stated objective is to achieve community-clinical integration for as many as one million dually eligible and near-dually eligible Medicare beneficiaries.

I’ll be answering questions from paid subscribers for the Midyear Social Care Market Briefing tomorrow.

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Illinois Social Health Care Network NOFO

Illinois is offering $8M annually to select one statewide entity to build a Medicaid-ready network of CBOs delivering HRSN/social-health services. The award range is $5M-$8M, applications closed yesterday, and at least $3M in FY27 must flow as capacity-building subgrants to CBOs. New York, North Carolina, California and Oregon have similar structures but Illinois is seeking one statewide intermediary as opposed to regional divisions.

There are also new openings adjacent to the buildout now:

1. Illinois Public Health Institute (also very plausible for the statewide lead as a systems convener) is hiring a Project Manager of the Chicago Community Information Exchange, a Senior Program Manager of Community & Healthcare Integration, and a Program Manager of Health & Housing Strategy.

2. AgeOptions is hiring a Program Specialist in Information & Benefits.

3. HCSC/BCBS Illinois is hiring a Government Programs Care Manager III.

4. HCSC is also hiring a Sr. Project Manager touching Medicaid Market/Value Improvement Projects.

5. Housing Action Illinois is hiring various Corps positions for housing CBO capacity-building roles across the state.

NOTEBOOK

Inbox me your questions now for the Midyear Social Care Market Briefing on Friday, July 24. I’ll review the biggest procurement, policy, investment, and market signals from the first half of 2026 and what they mean for the rest of the year. I’ll also answer questions from paid subscribers.

Also, here’s a podcast episode to save before your next social care vendor pitch, pilot decision or investment review. Learn a clear way to judge social care programs beyond mission statements. Especially useful for health plan leaders, investors and operators evaluating food, housing, transportation or other social care models. I unpack the framework with Omar Haq, an actuary with 30+ years in managed care who previously led analytics at a $20B+ Medicaid payer.

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Food, housing, transportation, navigation, and community partnerships are now entering the same approval rooms as medical management, quality strategy, vendor procurement, and budget defense. A program may have a strong mission and a real population need, but the buying decision still depends on whether it can answer the questions required to move capital.

This video gives you a fast way to find the weak point.

In four minutes, you can test whether a program has the financial case, clinical targeting, contract alignment, vendor maturity, compliance basis, workflow ownership, measurement plan, and strategic timing required for approval, renewal, or scale.

Use it on one program currently being funded, debated, renewed, or delayed.

Ask: which answer is weakest today?

That answer tells you where the buying case needs work before more budget, staff time, or political capital gets spent.

The eight questions:

1. Is this a defensible investment?

2. Which patients should receive it?

3. Who captures the value?

4. Can we buy it like an enterprise service?

5. Can we defend it?

6. Who owns the workflow?

7. Can we prove it worked?

8. Why now?

Forward this to the person responsible for turning social care interest into a fundable decision.

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San Diego advanced a community-care contract worth as much as $29.6 million over five years. The selected contractor will coordinate outreach, navigation, peer support, housing assistance, Medi-Cal-billab…

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