What Is the ASPIRE Model?
The Centers for Medicare and Medicaid Services (CMS) has launched a bold new pediatric payment model. It is called ASPIRE — Accelerating State Pediatric Innovation Readiness and Effectiveness. Together, the program aims to transform how states deliver care to high-risk children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
CMS Administrator Mehmet Oz and CMMI Director Abe Sutton announced the initiative on March 24, 2026. Their goal is clear: replace a fragmented, fee-for-service system with integrated, value-based care that treats the whole child.
Why the Current System Falls Short
A Broken Patchwork of Care
Currently, Medicaid and CHIP together cover half of all American children with complex medical and behavioral needs. Yet the fee-for-service model fails these children consistently. Providers operate in silos. The family doctor does not talk to the physical therapist. Furthermore, the physical therapist rarely communicates with the behavioral health specialist. As a result, the burden of coordination falls entirely on parents.
Parents spend countless hours attending appointments, filling out forms, and repeating the same information to multiple providers. For many families, managing a child’s care feels like a second full-time job.
The Real Cost of Poor Coordination
The consequences of this fragmented system are serious. High-risk youth covered by Medicaid are 56% more likely to visit an emergency room than peers with private insurance. Moreover, they are 53% more likely to face hospital admission. Without early intervention, some children must leave school or move into institutional care settings entirely.
Research further shows that children with autism who receive early psychosocial and behavioral interventions before age two develop stronger social and communication skills as adults. Therefore, timely, coordinated care is not just helpful — it is essential.
How ASPIRE Works: A Whole-Child Approach
Connecting Physical Health, Behavioral Health, and Community Support
ASPIRE introduces a whole-child care model that links three critical pillars: physical health, behavioral health, and community support. Instead of isolated treatments, providers collaborate across disciplines. Consequently, care teams can identify warning signs early and deliver preventive interventions before conditions worsen.
Shifting Away from Fee-for-Service
Under ASPIRE, CMS moves away from fee-for-service payments that reward volume over quality. Instead, the model provides incentive payments to care teams that coordinate effectively, prioritize prevention, and show measurable improvements in health outcomes and efficiency.
A Single Point of Contact for Every Family
Additionally, ASPIRE assigns each enrolled family a dedicated care coordinator. This single point of contact focuses entirely on the child’s and family’s overall well-being. States participating in the program must also provide a 24/7 medical advice line staffed by licensed professionals. Parents can call any time to receive guidance, access health records, and manage their child’s conditions at home.
Funding and State Participation
$125 Million Investment Over Eight Years
CMS has set aside $125 million to fund the ASPIRE model. Up to five states will receive grants to test the program over an eight-year period. This timeline allows states to design, test, and refine care delivery systems tailored to their pediatric Medicaid populations.
States must submit applications, which CMS plans to begin accepting later in 2026. Therefore, state Medicaid agencies should begin preparing proposals now to participate in this historic initiative.
Building on the InCK Model
Lessons From Integrated Care for Kids
ASPIRE builds directly on the Integrated Care for Kids (InCK) Model, CMS’s earlier pediatric care initiative. InCK demonstrated that coordinated, whole-child care produces real results. One parent who participated in InCK shared that her son became “more sociable, creative, and engaged in sports” and “more aware of his health.”
However, ASPIRE goes further. It standardizes a more robust value-based payment framework for pediatric providers. This framework gives providers a clear path toward greater accountability and stronger rewards for delivering high-quality outcomes.
What This Means for Families
Less Paperwork, More Time for Life
For families of high-risk children, ASPIRE promises meaningful change. Specifically, it aims to reduce the time parents spend on redundant paperwork. It also accelerates progress toward health and functional goals. Furthermore, it gives families more time to focus on quality of life rather than healthcare logistics.
The program directly addresses four systemic failures in American pediatric healthcare: the focus on reaction over prevention, failure to treat the whole person, lack of care coordination, and financial incentives that reward expensive interventions rather than effective ones.
Next Steps for States
Apply and Prepare for a Whole-Child Future
ASPIRE will begin accepting state applications later this year. CMS views the program as a proof-of-concept for scaling whole-child, value-based care across millions of Medicaid-enrolled children nationwide. While the initial investment is limited to five states, the agency expects the model to inform broader Medicaid reform efforts in the future.
States that act early will help shape the next generation of pediatric care delivery in America — and give high-risk children a healthier, more independent future.
