Republican Lawmakers Demand CMMI Prioritize Cost Savings, Transparency, and Rural Healthcare
Republican lawmakers on the House Ways and Means Committee have issued a forceful call for the Center for Medicare and Medicaid Innovation (CMMI) to realign its priorities under the Trump administration. In a letter sent to CMS Administrator Dr. Mehmet Oz and CMMI Director Abe Sutton, led by Committee Chairman Rep. Jason Smith (R-MO), the lawmakers expressed deep concerns about CMMI’s financial performance, lack of transparency, and focus on initiatives like health equity, which they argue deviate from its congressional mandate. The letter, dated April 28, 2025, urges CMMI to emphasize cost savings, enhance provider engagement, and address healthcare challenges in rural communities. This demand reflects broader Republican efforts to ensure fiscal responsibility in federal healthcare programs while improving care access for underserved populations.
Background on CMMI
Established under the Affordable Care Act in 2010, CMMI was designed to test innovative payment and care delivery models to reduce costs and improve quality in Medicare and Medicaid programs. The agency was granted significant flexibility to develop and implement demonstration projects, to identify scalable solutions that could lower federal healthcare spending without compromising patient outcomes. However, CMMI’s performance has been a point of contention, particularly among Republican lawmakers who have long questioned its effectiveness.
A 2023 Congressional Budget Office (CBO) report underscored these concerns, revealing that CMMI increased net federal spending by $5.4 billion during its first decade of operation. This figure has fueled criticism that the agency has failed to deliver on its core mission. Additionally, lawmakers have pointed to CMMI’s 2021 strategic refresh, which prioritized health equity and increased participation for rural providers, as evidence of a shift toward political priorities over fiscal responsibility. The strategic refresh aimed to address disparities in healthcare access and outcomes but was criticized for minimizing the importance of cost savings in model design.
Lawmakers’ Concerns
The letter from House Republicans highlights several key issues with CMMI’s operations. First, the lawmakers expressed frustration with the agency’s track record of developing payment models that have not consistently improved care quality or reduced costs. They argue that many of CMMI’s demonstrations have been costly and ineffective, placing an undue burden on taxpayers and providers alike. The CBO’s findings are a cornerstone of their critique, reinforcing the need for a fundamental shift in CMMI’s approach.
Second, the lawmakers accused CMMI of promoting a “political agenda” ahead of its congressional mandate. They specifically pointed to the agency’s focus on health equity, which they claim has overshadowed efforts to achieve cost savings. The 2021 strategic refresh, initiated under the Biden administration, outlined goals to advance equity by addressing social determinants of health and increasing participation among underserved providers, including those in rural areas. While these objectives aimed to improve access to care, the lawmakers contend that they diluted CMMI’s focus on fiscal discipline.
Finally, the letter emphasizes the need for greater transparency and provider engagement. An analysis by Avalere Health, published in April 2025, found that only half of the 18 CMMI models studied offered opportunities for public input during their design phase, often through rulemaking or requests for information. Lawmakers argue that this lack of engagement limits provider buy-in and hinders the development of effective models. They also called for clearer communication with providers when significant changes to demonstrations are proposed, ensuring that stakeholders are adequately informed and prepared.
Recent CMMI Actions and Republican Support
Under the Trump administration, CMMI has already taken steps to address some of these concerns. In March 2025, the agency announced the cancellation of four payment models and the halting of two demonstrations before their launch. These actions are projected to save nearly $750 million, a move that the lawmakers praised in their letter. “We were pleased to see CMMI recommit to the goal of pursuing payment models that will save money, including concluding or modifying existing models to achieve savings,” the lawmakers wrote.
The cancellations reflect a broader push by the Trump administration to streamline federal healthcare programs and eliminate initiatives deemed inefficient. The lawmakers view these actions as a step in the right direction but argue that more work is needed to ensure CMMI’s long-term success. They urged the agency to continue identifying and terminating underperforming models while developing new demonstrations that prioritize cost savings and care quality.
Focus on Rural Healthcare
A significant portion of the letter is dedicated to addressing healthcare challenges in rural communities, where residents face higher rates of chronic illness, limited access to providers, and financial pressures on local hospitals. The lawmakers noted the recent conclusion of the Pennsylvania Rural Health Model in December 2024, which provided participating hospitals with fixed payments to improve their financial stability regardless of patient volumes. The end of this model has left a gap in rural-focused initiatives, prompting lawmakers to call for new value-based models tailored to these communities.
“Improving rural health is a multi-faceted issue, and value-based models can provide flexibility and incentives to ensure access to vital health services,” the lawmakers wrote. They emphasized that rural residents are often sicker and have worse healthcare access compared to their urban counterparts, making targeted interventions critical. Potential solutions include models that incentivize care coordination, support telehealth expansion, or provide financial stability for rural providers. The lawmakers urged CMMI to pursue these solutions aggressively, leveraging its authority to test innovative approaches.
Transparency and Public Engagement
The letter also underscores the importance of transparency in CMMI’s operations. Lawmakers called for increased opportunities for public feedback during the design and development of payment models, arguing that stakeholder input is essential for creating effective and sustainable demonstrations. The Avalere Health analysis highlighted the limited avenues for public participation, with many models lacking formal mechanisms for comment until after their initial design phase. This approach, the lawmakers argue, risks alienating providers and undermining model success.
To address this issue, the lawmakers recommended that CMMI establish clear processes for soliciting and incorporating feedback from providers, patients, and other stakeholders. They also urged the agency to communicate more effectively with providers when making significant changes to existing models, ensuring that transitions are smooth and disruptions are minimized. These steps, they argue, will enhance trust in
CMMI’s Path Forward
The letter represents a broader Republican push to hold CMMI accountable for its financial and operational performance. By emphasizing cost savings, rural healthcare, and transparency, the lawmakers aim to steer the agency toward fulfilling its congressional mandate while addressing pressing healthcare challenges. The CMS has acknowledged the letter and plans to respond directly to the lawmakers, though no specific timeline for a response has been provided.
As CMMI navigates these demands, its ability to balance innovation with fiscal responsibility will be critical. The agency faces the challenge of developing models that achieve measurable cost savings while addressing complex issues like rural healthcare access and provider engagement. The Trump administration’s early actions suggest a willingness to make bold changes, but sustained progress will require careful planning and collaboration with stakeholders.
The lawmakers’ focus on rural healthcare also highlights a growing recognition of the unique challenges facing these communities. By prioritizing value-based models that support rural providers, CMMI has an opportunity to make meaningful improvements in access and outcomes. However, these efforts must be paired with rigorous evaluation to ensure that models deliver on their intended goals without adding to the federal deficit.
The House Ways and Means Committee’s letter to CMMI reflects a critical moment for the agency as it seeks to redefine its priorities under new leadership. Republican lawmakers have made clear their expectations for cost savings, transparency, and a renewed focus on rural healthcare. While CMMI’s recent actions have earned praise, the agency faces significant pressure to demonstrate tangible results.
