CMS Launches MAHA ELEVATE

A New Approach to Chronic Disease Prevention in Medicare

The American health care system faces an escalating crisis that demands a fundamental rethinking of how we approach patient care. In 2022, approximately 45% of people with Medicare had four or more chronic conditions, while beneficiaries with chronic diseases accounted for nearly 90% of total health care spending. These statistics reveal a system primarily designed to treat symptoms and manage diseases after they develop rather than prevent them from occurring in the first place.

The current reactive model of care has created an unsustainable trajectory. Health care costs continue to rise while population health outcomes remain stagnant or decline. For decades, policymakers and clinicians have recognized that lifestyle factors (i.e., diet, physical activity, sleep, stress, and social connection) play a fundamental role in the development and progression of chronic conditions. Yet the traditional Medicare program has offered limited coverage for interventions addressing these root causes. The current system of health care finance funds diagnosis and treatment using medicines and procedures rather than prevention or intervention using behavioral modification and the promotion of healthy diet and lifestyles. That is not to say that many physicians and clinics have incorporated these interventions into their treatment programs, but it is not common practice.

This is primarily due to the structure of how primary care visits are funded. Time typically does not allow for clinics to robustly offer these programs. And, similarly, they have not been emphasized in medical school, historically.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center has now launched the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model to address this gap. This initiative represents a significant departure from conventional Medicare coverage by investing in whole-person care approaches that target the behaviors and lifestyle choices underlying chronic disease.

Lifestyle medicine has been growing over the prior decade and this is now an opportunity, or an attempt, to align payment.

Can this model start the systemization of lifestyle medicine approaches to chronic disease? Or, will this model enter the graveyard of other ineffective models at CMMI?

Model Design and Structure

MAHA ELEVATE is the first CMS Innovation Center model to focus specifically on proactive, holistic, patient-centered functional or lifestyle medicine approaches as a complement to conventional care. The program will fund up to 30 cooperative agreements with a total budget of approximately $100 million over a three-year performance period. This funding will support organizations in delivering evidence-based interventions not currently covered (they probably are covered to an extent, but not explicitly) by Original Medicare while simultaneously collecting quality and cost data to inform future coverage decisions.

The model’s design reflects a critical distinction: these interventions are intended to support, not replace, the medical care Medicare beneficiaries receive from their providers. MAHA ELEVATE intends to combines psychological, nutritional, and physical interventions along with self-care strategies to address the whole person rather than treating individual diseases in isolation (this is a good goal). The critical focus areas include nutrition, physical activity, sleep, stress management, harmful substance avoidance, and social connection.

All proposals submitted to the program must incorporate either nutrition or physical activity as core components of their intervention design. Additionally, CMS has reserved three awards specifically for interventions addressing dementia, acknowledging the growing burden of cognitive decline in the aging Medicare population and the potential role of lifestyle factors in prevention and management.

Eligible Organizations and Requirements

CMS has opened eligibility to a broad range of organizations that either provide whole-person functional or lifestyle medicine services directly to patients or partner with other organizations to deliver these services. Eligible applicants include private medical practices, health systems and accountable care organizations, academic institutions, functional and lifestyle medicine centers, Federally Qualified Health Centers, Rural Health Clinics, community-based organizations, state and local governments, Indian Health Service programs, and senior living communities.

To be selected, applicants must demonstrate that their interventions are safe and effective for the target population and supported by peer-reviewed literature. Organizations must also show experience with data collection or demonstrate the ability to accurately collect and report data with appropriate beneficiary safeguards.

Notably, while individual organizations may submit multiple proposals and potentially receive multiple awards, each proposed intervention must be substantially distinct from others submitted.

Goals and Expected Outcomes

MAHA ELEVATE establishes three primary objectives. First, the model aims to create a novel U.S. evidence base within Original Medicare featuring cost and quality data on the effectiveness of whole-person functional or lifestyle medicine approaches. This includes psychological, nutritional, and physical interventions that have shown promise but lack the rigorous cost-effectiveness data needed for broader Medicare coverage determinations.

Second, the model seeks to empower patients to take control of their health through lifestyle changes. Preventive measures begin with giving people the tools and support to build healthy practices they can sustain outside of clinicians’ offices. This patient activation approach recognizes that meaningful health improvement requires behavioral change that extends beyond the clinical encounter.

Third, MAHA ELEVATE aims to prevent illness and promote wellness through novel approaches that support behavior changes aimed at improving health or slowing and reversing disease progression. Over time, this prevention-focused strategy is expected to produce a healthier population and lower health care costs. In theory, the model is attempting to shift Medicare from a system that pays for sickness to one that invests in health.

Implementation Timeline

CMS will award cooperative agreements in two rounds for two separate cohorts. The first round will launch on September 1, 2026, with a Notice of Funding Opportunity scheduled for release in early 2026. A second cohort will begin in 2027. Awardees in both cohorts will work directly with CMS to create plans for data collection, quality measurement, beneficiary recruitment, and cost containment throughout their three-year performance periods.

The cooperative agreement structure allows CMS and awardees to collaborate closely on implementation and evaluation. This differs from traditional demonstration projects by creating a partnership model where both parties share responsibility for achieving outcomes.

The interventions tested through MAHA ELEVATE will ultimately inform future Original Medicare coverage determinations and potential future Innovation Center models designed to improve beneficiary health and reduce costs. This means that if certain interventions demonstrate empirical success, they may be entered into permanent coverage within the entire Medicare program. Typically, this means that they save money from utilization avoidance and they produce equivalent or better quality outcomes, which is aligned with the CMMI statutory authorities to scale a model per legislation.

Patient Safety and Protections

CMS has embedded strong safeguards to protect beneficiary safety and choice throughout the MAHA ELEVATE model. Beginning with the application process, proposals including interventions with evidence of harm or substantial risk of harm will be excluded from consideration. CMS will monitor recipient programs for patient safety concerns during implementation and may disenroll recipients who fail to meet quality or safety standards.

Importantly, participation in MAHA ELEVATE does not change Medicare benefits, coverage, or beneficiary rights. Patients keep all standard Medicare protections and can continue to see any Original Medicare provider. The program is entirely voluntary, and all recipients must comply with Health Insurance Portability and Accountability Act privacy and security requirements for beneficiary health information.

Strategic Significance

MAHA ELEVATE represents more than an incremental policy adjustment. The model signals a potential transformation in how Medicare approaches population health. By testing whole-person care approaches that address root causes rather than symptoms, the model could catalyze a broader shift toward proactive, prevention-focused health care delivery. Medicare is often a proving ground for new innovations in care delivery, so success may also spill over into the commercial insurance and Medicaid markets.

The model also acknowledges what research has long suggested: that addressing the social, behavioral, and environmental determinants of health may be as important as clinical interventions in improving outcomes for Medicare beneficiaries with multiple chronic conditions. As the program moves toward its 2026 launch, healthcare organizations focused on lifestyle and functional medicine approaches now have a pathway to demonstrate their value within the Medicare system.

Additional Resources

For more information about the MAHA ELEVATE Model, visit the CMS Innovation Center website at cms.gov/priorities/innovation/innovation-models/maha-elevate or contact the MAHA ELEVATE team at mahaelevate@cms.hhs.gov. Organizations interested in applying should subscribe to the MAHA ELEVATE listserv for updates on the Notice of Funding Opportunity expected in early 2026.