ASPIRE (Accelerating State Pediatric Innovation Readiness and Effectiveness) Model

Background

Approximately half of all children and youth who have or are at risk for developing complex medical and behavioral needs are covered by Medicaid or CHIP. These children, youth, and their families often face a health care landscape that is at best challenging to navigate, and at worst inaccessible resulting in serious gaps in care, poor health outcomes, and higher need for services into adulthood.

ASPIRE aims to facilitate coordinated care for children and youth with medically and/or behaviorally complex conditions (high-risk) and children and youth with one or more risk factors for developing a complex condition (rising risk) who are covered by Medicaid and CHIP. Conditions may include behavioral health conditions, substance use disorders, chronic conditions, and certain physical, intellectual, and developmental disabilities.

Aims

ASPIRE aims to help children and youth live healthier lives. The model facilitates states in the adoption of coordinated care delivery that promotes whole-person, high-quality care for high- and rising-risk children and youth. This will improve their care experience, help them get the right care at the right time in less intensive settings, and enable better outcomes for children and  youth, as well as their families.

ASPIRE’s care model includes: 

• Delivery of supportive, wrap-around services for physical and/or behavioral health needs.
• Resources to help empower families and caregivers with information needed to partner in their children’s care.  
• Long-term planning to support health, productivity, and economic stability during the transition to adulthood.

CMS will select up to five (5) state Medicaid agencies (SMAs) to receive funding through Cooperative Agreements to implement ASPIRE. The NOFO will be available in 2026.

States will partner with organizations (“accountable entities”) responsible for managing total health care costs and improving care for the covered children and youth. Examples of accountable entities include:

• Managed Care Plans
• Accountable Care Organizations

These entities must partner with providers who have specialized experience delivering care for high - and rising-risk children and youth.

The CMS Innovation Center may also require states to use a portion of their Cooperative Agreement funding to strengthen care systems, for instance to build infrastructure and expand access to comprehensive wrap-around services.

How will states be selected to participate in ASPIRE?

CMS will release a Notice of Funding Opportunity (NOFO) in 2026 to solicit participation from up to 5 state Medicaid agencies (SMAs). Selected SMAs will enter into cooperative agreements, which will outline model expectations and requirements for allowable use of federal funds awarded to SMAs.

SMAs must demonstrate sufficient potential accountable entities in the state with the capacity to meet model requirements, or entities with the capability to meet model requirements during the pre-implementation phase.

More detailed evaluation criteria will be shared when the NOFO is released.

Does the ASPIRE Model place any limits on the type of care a child is eligible to receive?

No. ASPIRE does not set any limit on care.

ASPIRE provides the tools to support coordinated care to help children receive the right care at the right time and place. The total cost of care payment model introduces accountability for quality to ensure that care patterns support positive outcomes that matter for children and their families. 

• Journey Map
• Integrated Care for Kids Model