What Is the ASPIRE Model?
The Centers for Medicare & Medicaid Services (CMS) has launched a bold new initiative to reshape how Medicaid serves children with complex health needs. On March 25, 2026, CMS announced the Accelerating State Pediatric Innovation Readiness and Effectiveness (ASPIRE) Model — a value-based payment pilot that will award up to five state Medicaid agencies a combined $125 million over ten years.
Specifically, the model targets youth up to 21 years old who have complex medical or behavioral health conditions, as well as those at risk of developing them. Furthermore, the program runs for eight years of active care coordination, with states applying for funding later in 2026.
Why Pediatric Medicaid Needs Reform
The Problem with Fee-for-Service
The existing fee-for-service (FFS) payment structure has long failed children with complex needs. Under FFS, providers receive payment for each individual service rather than for overall health outcomes. As a result, care becomes fragmented, reactive, and difficult to coordinate across physical and behavioral health systems.
CMS Administrator Mehmet Oz, M.D., and Deputy Administrator Abe Sutton highlighted these systemic gaps directly. They pointed to a healthcare system focused on reaction rather than prevention — one that consistently fails to treat the whole person and lacks financial incentives to do otherwise.
Who Does This Affect?
Medicaid and the Children’s Health Insurance Program (CHIP) together cover approximately half of all children in the U.S. with complex medical and behavioral health needs. Moreover, many of these children face overlapping challenges, including chronic illnesses, intellectual disabilities, substance use disorders, and developmental conditions.
Consequently, the burden on families is substantial — navigating multiple providers, repeating information, and managing paperwork without a unified point of contact.
How ASPIRE Funds Will Work
State Medicaid Agency Awards
Selected state Medicaid agencies will receive funds to coordinate physical health, behavioral health, and community support services over the eight-year program period. Additionally, CMS will provide incentive payments to care teams that deliver high-quality, coordinated care.
Wraparound Services and Infrastructure
Importantly, a portion of each state’s award must go toward building infrastructure or expanding access to wraparound services — community-based supports that address social determinants of health. These services will support long-term planning for health, productivity, and financial stability as children transition into adulthood.
Key Features of the ASPIRE Model
24/7 Medical Advice Line
One standout feature of ASPIRE is the required 24/7 advice line staffed by medical professionals. This line gives caregivers a single point of contact for all care-related questions and paperwork. As a result, families spend less time chasing answers across multiple providers and more time focused on their child’s well-being.
Targeted Conditions
The model covers a wide range of conditions, including:
- Behavioral health conditions
- Substance use disorders
- Chronic physical conditions
- Intellectual and developmental disabilities
Incentive-Driven Quality Improvements
Beyond coordinating care, ASPIRE uses financial incentives to motivate care teams toward preventive care and measurable quality improvements. Therefore, providers are rewarded not simply for volume of services but for meaningful health outcomes.
ASPIRE vs. the InCK Model
Building on an Existing Foundation
ASPIRE does not emerge in a vacuum. CMS already administers the Integrated Care for Kids (InCK) Model, a voluntary program launched in January 2020 that also targets children enrolled in Medicaid or CHIP with behavioral or complex health needs. Six states currently participate in InCK, which is set to expire at the end of 2026.
Key Differences
However, ASPIRE goes significantly further. While InCK provided a voluntary framework, ASPIRE standardizes a more robust value-based payment structure. It gives pediatric providers what Oz and Sutton describe as “an on-ramp to greater accountability and more substantial rewards for high-quality care.”
Notably, the Trump administration previously considered reducing InCK’s scope and terminated four other CMS Innovation Center models early. ASPIRE signals a continued — though restructured — federal commitment to value-based pediatric care.
What Comes Next
CMS will open the application process later in 2026, with up to five states eligible to participate. Those selected will gain access to substantial federal funding, technical support, and a structured framework for transforming pediatric care delivery within their Medicaid programs.
The ASPIRE model represents a meaningful shift — from reactive, siloed treatment toward proactive, whole-person care for America’s most vulnerable children. Ultimately, its success will depend on how effectively state agencies deploy these resources to build lasting care infrastructure and improve outcomes for children and families.
