Capture Intelligence:
FY2027 Federal Health Budget

What it funds

The vehicle through which VA pays for veteran care delivered in the private sector. The FY2027 Medical Community Care account sits at $56.2 billion — up $8.1 billion (17%) from FY2026 enacted. That single account now represents approximately 44% of all VA care delivery. The IDIQ ceiling of approximately $700 billion over ten years is the statutory maximum required to hold projected volume legally — not a spending projection. Verified — VA FY2027 Budget in Brief, April 3, 2026; GAO-26-108943

What changed

Two new mechanisms enter the contract that do not exist in the current CCN:

• Value-based payments. Episode-based payments begin with lower-extremity joint replacements (hips and knees). VA CFO Richard Topping testified before the House VA Committee (January 2026) that at least three additional VBP models will be added over the performance period. Critically: future alternative payment model designs will be proposed by TOPR awardees. The organization that proposes the next cardiac or oncology episode model shapes the contract's economics for its full run. Verified — House VA Committee testimony, January 2026
• Utilization management. New oversight requirements cover ED visits, inpatient admissions, concurrent hospital reviews, and high-cost drug administration. Requires clinical decision support at the point of authorization. The current contract has no such requirement. Any organization operating in care navigation or utilization review under the existing CCN is operating under different rules on day one of the new contract.

Competitive landscape

Incumbents: Optum Health (East and South regions), TriWest Healthcare Alliance (West region). Neither position is automatic — this is a new contract with new capability requirements that the current structure does not require incumbents to hold.

The Corporate Experience gating factor. Up to three references are permitted. Across all three references, the proposal must collectively demonstrate all three of the following or it is rated Unacceptable:

• Implementation of a network across multiple states
• Program management of a service across multiple states
• IT Integration with a client system across multiple states

Missing any single factor across all three references = Unacceptable rating. Binary. This structure forces teaming between traditional healthcare payers (Implementation strength) and systems integrators (IT Integration strength). Solo proposals from either category are exposed.

MOSA structure with No-Bid provision. A No-Bid is a compliant response to a task order. A specialized firm in network analytics, utilization review, rural telehealth, or clinical AI can win a bench position and wait for the matching task order without being penalized for passing on full-region awards.

Timeline

Response deadline was extended to April 3, 2026 (from the original March 16). Proposals submitted. Industry tracker timeline: IDIQ award August 2026; oral presentations October 2026; Regional TOPR awards January 2027. Verified — HigherGov 36C10G26R0003, March 20, 2026; Paradigm Seniors VA RFP Resource Center

CCN Dental closed April 3, 2026. Awards pending. See archive once available.

What it funds

Oracle Health's prime contract for EHRM. The $2.768 billion covers sustainment of 19 currently live VA sites; 26 new go-lives planned in FY2027; help desk, training, and data hosting; and preparation of 28 FY2028-targeted sites. Verified — VA FY2027 Budget in Brief

The Michigan go-live

Four sites went live simultaneously on April 11, 2026: Ann Arbor, Battle Creek, Detroit, and Saginaw. All four completed go-live on schedule with no system-wide outages or OIG-reportable patient safety incidents identified in open sources through mid-May 2026, marking the first Federal EHR deployment since the 2023 operational pause. Ann Arbor and Detroit are Level 1A complex facilities — the highest classification in the VA system. No Oracle EHR deployment has previously attempted this complexity level. This was the first multi-site simultaneous deployment in the program's history. Verified — VA press releases; Healthcare IT News December 2025; Congress.gov hearing record; open-source monitoring through 2026-05-15

On March 4, 2026 — three weeks before the Michigan window — the Oracle federal EHR went down from 8:37 AM to 2:05 PM Eastern (nearly six hours) across all six live VA sites, 26 community clinics, and installations serving DoD and the Coast Guard. Cause: database performance issue. Verified — Fierce Healthcare, March 2026

The 30% appropriation withhold

Congress withheld 30% of EHRM's FY2026 appropriation — approximately $1.02 billion — pending statutory conditions by July 1, 2026:

• Updated lifecycle cost estimate
• Facility-by-facility deployment schedule through full deployment
• Staffing projections for the EHRM PMO through full deployment
• Certification of 4 consecutive incident-free site deployments
• Certification that existing sites met baseline performance metrics

Status (as of May 18, 2026): The September 2025 VA lifecycle estimate ($37.2B) has been delivered to Congress but not yet reviewed by GAO. Secretary Collins testified April 30, 2026 that the Michigan rollout "has been phenomenal." Certification language remains undefined; certification has not been issued. Verified — MeriTalk, Nov 13 2025 and April 6 2026; FedScoop, April 30 2026

FY27 budget context: VA FY27 budget requests $4.24 billion for EHRM — an $840M increase over FY26 enacted, with 26 new site deployments planned in FY27. Verified — MeriTalk, April 6 2026

June 2026 wave: 4 Ohio/Kentucky sites (Chillicothe, Cincinnati ×2, Dayton). Chillicothe VAMC confirmed go-live June 6, 2026. Verified — DigitalVA deployment schedule, updated May 14, 2026

Structural problem with the cost estimate condition. Three lifecycle estimates exist: VA 2019 ($16.1B — GAO called it severely incomplete), IDA October 2022 ($49.8B: $32.7B implementation + $17.1B sustainment), and VA September 2025 ($37.2B, delivered by Deputy Secretary Paul Lawrence to Congress December 15, 2025). GAO's position as of December 2025: all three are outdated. GAO had not received the VA's September 2025 revision at the time of the hearing. GAO Director Carol Harris stated: "We have not received that estimate, so I would ask the department to provide that to us so we can review it." Verified — GAO-26-108812; House VA Subcommittee, December 15, 2025

Definitional problem with the go-live condition. The withhold language requires certification of deployments "without delays or patient harm." No quantitative threshold defines delay. No threshold defines patient harm. Certification rests on the Secretary's judgment. Context: VA OIG found 149 instances of patient harm at Spokane, 826 major performance incidents across the first five live sites, and a veteran's death linked to scheduling failures at Columbus. All of those sites were certified as go-lives. Verified — VA OIG reports July 2022, September 2024, March 2024

The program picture

Total EHRM obligations through Q2 FY2025: $13.84 billion. After Michigan completes, fewer than one in six VA medical centers will be live (~23 of 170). GAO-26-108812 (December 2025): 16 of 18 prior recommendations unimplemented. Twelve carry priority status. GAO Director Harris told Congress completing all remaining sites on the contract timeline is "impossible." Contract expires May 2028. Full deployment runs to end of FY2031. Verified — GAO-26-108812

GAO-25-108091 user survey (September 2024): 75% of current EHRM users disagree the system enables efficient care. 13% believe it makes the VA efficient. 58% say it increased patient safety risks. These numbers come from sites already live. Verified — GAO-25-108091

What it funds

Devices, cloud infrastructure, network interfaces, and identity management supporting the active deployment wave. This account is separate from the Oracle EHR prime contract and flows through independent contracting vehicles. Covers current live sites and 26 new FY2027 go-lives, with positioning for 28 FY2028-targeted sites. Verified — VA FY2027 Budget in Brief

What changed

Scale. As the deployment accelerates from 19 live sites to approximately 45 by end of FY2027, infrastructure requirements scale with every wave. Each new go-live requires device provisioning, network configuration, identity management integration, and data migration support that the Oracle prime contract does not cover.

What it funds

The EHRM Integration Office (EHRM-IO) program management office — the entity responsible for overseeing 170 total VA medical centers, a $37–49 billion lifecycle cost range, and an active GAO high-risk designation. Verified — VA FY2027 Budget in Brief

The staffing gap

313 positions authorized. Approximately 250 filled. The program then lost 24 additional staff to probationary firings and deferred resignation offers in early 2026. The functional vacancy rate heading into the most intensive deployment phase in the program's history exceeds 20% — at the precise moment the PMO is simultaneously managing the July 1 Congressional deadline, a four-site simultaneous go-live at the highest complexity level ever attempted, and 16 open GAO recommendations. Verified — Congressional testimony, February 2025 and early 2026 (note: 250 filled and 24 losses are from separate testimony timepoints; current fill rate is lower than 250)

What this means operationally

Program management functions the PMO cannot staff internally become contractor work. Michigan goes live this month and the PMO is demonstrably understaffed for it. Functions most likely to be contracted: acquisition support, data governance, quality assurance, deployment coordination, and Congressional reporting support.

What it funds

VA's total FY2027 IT request is $12.2 billion — a 62% increase over FY2026 per Federal News Network analysis. Of that, $4.24 billion is EHRM. The remaining non-EHRM IT covers cybersecurity, financial management modernization, scheduling systems, community care billing, interoperable health records, and digital mental health platforms. The budget specifically allocates $1.3 billion targeting high-impact healthcare delivery capabilities: scheduling and referral processes, community care billing expansion, and interoperable health records. Verified — Federal News Network April 6, 2026; VA FY2027 Budget in Brief

Active programs within this account

Ambient Scribe IDIQ (36C10B26R0006). A five-year IDIQ for ambient AI documentation at VA. Proposals closed April 3, 2026. Awards pending. The prior contract (36C10B26C0025) went to Rise8 and Thoughtworks at $4.9 million. Foreign influence concerns related to Thoughtworks were flagged; VA OIG was actively soliciting outside input on this question at time of publication. Verified — SAM.gov; contract record 36C10B26C0025

Cybersecurity — MITRE Assessment Remediation. Under the Strengthening VA Cybersecurity Act of 2022, VA contracted MITRE to assess five key VA systems. GAO-26-107980 (December 2025) confirmed the assessment addressed requirements and VA's remediation plan generally met the standard. The plan includes a cost estimate and implementation timelines. Remediation work is active across identity management, zero trust architecture, and incident response. Verified — GAO-26-107980

Community care billing. With $8.1 billion routed outside the VA system in FY2027, billing infrastructure is under volume pressure the system was not built for. The budget explicitly calls out billing expansion. Organizations with network billing, payment integrity, or claims processing capability should be tracking this.

What it funds

The largest single account in the VA budget. Covers direct care delivery at VA medical facilities — the clinical environment where AI tools, diagnostics, and scheduling systems operate. The FY2027 request explicitly names ambient scribe, clinical AI, and diagnostics as priority investment areas. Verified — VA FY2027 Budget in Brief

What's happening inside this account

The 17% growth in community care creates a knock-on effect on Medical Services: VA facilities see increased clinical complexity among patients who remain in direct care (lower-acuity patients route to community care more readily), while the referral authorization and triage function — 39.6 million referrals since the June 2019 MISSION Act launch — requires clinical decision support infrastructure to manage at volume. Verified — VA BiB for referral count, attributed to MISSION Act community care program

The Ambient Scribe IDIQ (36C10B26R0006) funded through this account closed April 6, 2026. Awards expected Summer 2026. See dedicated row #s26 below. Mental health residential rehabilitation (MHRRTP) expansion — a figure flagged for verification — will be addressed in Part 2 of this budget series.

FY27 AI funding: The FY27 budget proposes $47.8M for Decision Intelligence and Automation (+10.9% over FY26 enacted), with AI Infrastructure solution as primary driver. Verified — Nextgov, April 7, 2026

What it funds

Construction, renovation, and infrastructure at VA medical facilities. Covers major and minor construction, non-recurring maintenance, and leases. Up 6.7% over FY2026. Verified — VA FY2027 Budget in Brief

The strategic dynamic

The community care workforce-substitution model creates a counterintuitive facility investment pattern. Patients routed to community care are largely those where VA capacity was the constraint — meaning the remaining VA direct care volume skews toward higher complexity, specialty, and behavioral health cases that the community network cannot readily absorb. Facility investment will prioritize modernization, specialty capacity, and right-sizing over general expansion.

The FY2028 advance appropriations request ($138.2 billion in medical programs + $53.8 billion in Toxic Exposures Fund advances) is what long-cycle contractors are planning against — not FY2027. Verified — VA FY2027 Budget in Brief

FY26 NRM injection (operative now)

VA announced $596M in Q2 FY26 NRM obligations out of a record $4.8B FY26 NRM total — $795M for infrastructure repairs, $255M specifically for EHRM prep, $13M for building systems. Active EHRM infrastructure construction RFP for Philadelphia VAMC (36C77626R0063_1) posted April 14–29, 2026, SDVOSB set-aside, $20–50M. Verified — VA News, May 11, 2026

What it is

In December 2023, then-Deputy Secretary of Defense Kathleen Hicks issued a memorandum directing DHA to reattract at least 7% of available care from the private sector back to MTFs by December 31, 2026. The FY2025 NDAA (P.L. 118-159) subsequently encoded the staffing requirements to support the mandate, requiring each MTF to establish medical personnel requirements capable of achieving that shift. Verified — CRS IN12595; CRS IF13108; P.L. 118-159

The operational context

The Military Health System currently purchases more than 65% of total care for its 9.4 million beneficiaries through private sector contracts — primarily TriWest Healthcare Alliance (West Region, effective January 1, 2025) and Humana Military (East Region). Applied against the FY2026 MHS budget of approximately $64 billion, a 7% shift in private sector volume represents a directional signal of roughly $2.9 billion redirecting from managed care support contractors to MTF direct delivery. Analytical — MMT calculation from CRS data

The mandate is a reversal of a decade-long policy that reduced MTF staffing. GAO found that DHA "didn't have the staff to meet its estimated needs" for its management construct and "still doesn't know how many staff it needs." MTFs are chronically understaffed heading into a mandate to absorb more volume. Verified — CRS IN12595

The T-5 TRICARE transition (HealthNet to TriWest, effective January 1, 2025) has been complicated by referral delays, call center backlogs, and portal failures affecting over 1.5 million beneficiaries who moved from East to West Region. DHA has issued multiple policy waivers to manage access. An Inspector General review of the transition was directed by the FY2026 NDAA House report. Corroborated — MOAA documentation; Military.com

What MTFs need to absorb volume

To achieve 7% reattraction, MTFs need capacity they currently lack: scheduling systems that can handle increased appointment volume, telehealth infrastructure to extend clinical reach beyond facility walls, ambient documentation to make provider time more efficient, and clinical staffing to see patients. These are contractor opportunities.

What happened

On April 10–11, 2025, Defense Secretary Pete Hegseth signed a memorandum terminating $5.1 billion in DoD contracts. Within that total, he specifically cited: "DHA contracts for consulting services from Accenture, Deloitte, Booz Allen, and other firms that can be performed by our civilian workforce" — saving the department $1.8 billion. Verified — Washington Technology April 12, 2025; Nextgov/FCW April 12, 2025; Hegseth memorandum

GovTribe three-year prior obligation data at DHA: Booz Allen Hamilton, $345 million; Deloitte, $264 million; Accenture, $66 million. These are prior obligation figures across a three-year window — not the terminated contract values. Corroborated — GovTribe data via Washington Technology and Nextgov/FCW

What "in-sourcing" actually means

The Hegseth memo directed DoD and DOGE to prepare within 30 days a plan to in-source IT consulting and management services to the civilian workforce. The practical constraint: the federal civilian workforce available to absorb this work was simultaneously subject to reduction-in-force actions across the department. Work that cannot be absorbed internally will be re-competed — most likely in smaller, more performance-specific statements of work than the broad advisory vehicles that were terminated.

The support gap

Programs covered by the terminated DHA consulting contracts include EHRM program management support, MHS GENESIS sustainment advisory, and DHA IT portfolio management. Those programs are still running. The gap creates demand for specialized task orders rather than broad management consulting capability. Organizations with specific DHA program knowledge and documented performance metrics are better positioned for the replacement work than generalist consulting shops.

What changed on April 1

Federal Register 2026-06284 (April 1, 2026) transferred ONC's AI, data, and CTO functions to HHS OCIO. ONC's standalone name was restored. ONC confirmed its programs and priorities are unchanged. The structural change: where governance authority sits is different. That change is already in effect. ONC programs — TEFCA, USCDI, and information blocking — remain intact per an ONC spokesperson confirmation following the April 3 effective date. Verified — Federal Register 2026-06284

The scale of what TEFCA now manages

As of February 2026, TEFCA exchanged nearly 500 million health records across 14,214 organizations through 81,000 unique connections across eight QHINs. In January 2025, the exchange volume was 10 million records. That is a 50-fold increase in thirteen months. This infrastructure is not theoretical — it is running at scale. Verified — ONC/healthit.gov

Before April 1, the policy authority governing information blocking and the IT contract authority governing QHIN operations reported to different principals. They now report to the same principal — the HHS CIO. This matters for contracts: the authority writing QHIN technical requirements and the authority holding QHIN contracts are now unified.

The HTI-5 rule

HTI-5 Final Rule published. The HealthIT.gov HTI Rules page classifies HTI-5 as Final Rule as of April 29, 2026. The rule removes 34 of 60 ONC Health IT Certification criteria, eliminates AI "model card" transparency requirements, codifies AI/automated processes as "access" under the information blocking rules, and removes the TEFCA manner exception — making QHIN participation the de-facto information-blocking compliance baseline. Most removals are effective immediately; remaining criteria changes (including family health history and C-CDA transitions of care) are effective January 1, 2027. Verified — HealthIT.gov HTI Rules page, updated April 29, 2026

HHS consolidated from more than 40 separate IT departments under this reorganization. The OCIO is now the single decision-making authority for health IT standards, QHIN contracts, and information blocking enforcement. Corroborated — Federal News Network

What it is

The Agentic AI-Enabled Cardiovascular Care Transformation (ADVOCATE) program aims to produce the first FDA-authorized clinical agentic AI providing 24/7 specialty care for cardiovascular disease — the leading cause of death in the U.S., responsible for more than 200,000 preventable deaths annually. Nearly half of U.S. counties have no practicing cardiologist. Full proposals were due April 1, 2026 — the window is closed. Awards expected June 2026. Verified — ARPA-H.gov; STAT News January 2026

Three Technical Areas

• TA1: Patient-facing CVD agent. Autonomous AI for clinical reasoning, care navigation, and autonomous medical actions (medication adjustments, appointment scheduling). Connects to EHR, integrates with wearables. Available 24/7. Designed for FDA authorization for a specific intended use (heart failure management). Will almost certainly be proprietary technology.
• TA2: Supervisory agent. Disease-agnostic. Real-time monitoring, auditability, and control of clinical AI agents. ARPA-H has explicitly noted it would prefer this to be open source. This is the oversight architecture — it can scale beyond cardiovascular AI to any clinical agentic deployment. The organization that wins TA2 owns the oversight layer for every subsequent clinical agentic AI in healthcare, including potential DoD and VA deployments.
• TA3: Health system integration. Recruiting and partnering with health systems that will co-develop and deploy the technology in real clinical settings. These are deployment partners, not technology developers.

Program structure

Phase 1A: 12 months (development and prototype validation). Phase 1B: 12 months (independent V&V). Down-select. Phase 2: 15 months (large-scale real-world scalability). Total: 39 months. ARPA-H funds through Other Transaction Agreements — not contracts, grants, or cooperative agreements. Teaming is expected to be necessary. Solo proposals from a single organization are unlikely to cover all three TAs. ARPA-H is piloting secure LLMs to assist with initial solution summary review — a signal about how the agency intends to scale evaluation capacity going forward. Verified — ARPA-H.gov; STAT News January 2026; Fierce Healthcare January 2026

No clinical agentic AI has received FDA authorization as of this writing. ADVOCATE is designed to create that authorization pathway. The organization that first navigates it — and the health systems that deploy it — establish the clinical, regulatory, and reimbursement precedent for every agentic AI deployment in healthcare that follows.

What is proposed

The FY2027 HHS discretionary request proposes collapsing 28 HHS divisions to 15 through a new Administration for a Healthy America (AHA). The AHA would absorb: OASH, HRSA, SAMHSA, ATSDR, and NIOSH. The proposal also calls for a $5 billion reduction to NIH and elimination of NIMHD, the Fogarty International Center, and NCCIH. ARPA-H is zeroed in the proposal. Verified as proposed — HHS FY2027 Budget in Brief

Congressional history

Senator Susan Collins (April 3, 2026): Congress had "decisively rejected these particular cuts last year." The record supports her. For FY2026, Congress enacted approximately FY2025 funding levels across most contested HHS lines. NIH remained whole. ARPA-H was funded. Defense received $10.6 billion above the Pentagon's own request. The same Congress is now voting on FY2027. Full consolidation as proposed is unlikely to pass. Verified — CRS R48891; Collins statement April 3, 2026

What changed since Issue 1

AHA (Administration for a Healthy America) appears in the HHS FY27 budget request as an existing entity but Congress has not appropriated AHA funding or authorized the merger. FY26 enacted appropriations (signed February 2026) kept SAMHSA at approximately FY25 discretionary level. Treat HRSA and SAMHSA legacy vehicles as viable until Congress acts; monitor whether new task orders route via legacy vehicles or AHA channels. Verified — Filter Magazine, April 13, 2026

Why act now regardless

Partial restructuring, administrative consolidation without full legislative action, and de facto priority shifts within agencies are possible without a statutory vote. HRSA and SAMHSA program funding and contracting authority can shift even if the organizational chart does not change. Organizations holding vehicles scoped to individual agencies need to model what happens to those vehicles if the reporting structure changes — that is a contract language question, not a legislative one.

The executive order

President Trump signed Executive Order 14398, "Addressing DEI Discrimination by Federal Contractors," on March 26, 2026. This is categorically different from prior anti-DEI executive actions. Earlier orders (EO 14151 and EO 14173, January 2025) were policy directives. This one creates an enforceable contract clause with direct legal consequences for contractors and all subcontractor tiers. Verified — EO 14398; DLA Piper; Morgan Lewis; Holland & Knight

The FAR Council issued implementing guidance on April 17, 2026, creating clause 52.222-90 with insertion required in new solicitations by April 24 and modifications to existing contracts by July 24; a federal lawsuit (NADOHE v. Trump, No. 8:26-cv-01532, D. Md., filed April 20) is pending, with no TRO or preliminary injunction reported as of mid-May 2026. Verified — FAR Council implementing guidance, April 17, 2026; PACER docket No. 8:26-cv-01532 through 2026-05-15

The mandatory clause — six binding elements

By April 25, 2026, all federal agencies must insert the following clause into all covered contracts, modifications, and subcontracts at every tier:

• The contractor will not engage in any racially discriminatory DEI activities.
• The contractor will furnish all information and reports, including access to books, records, and accounts, for compliance verification.
• In the event of noncompliance, the contract may be canceled, terminated, or suspended in whole or in part.
• The contractor or subcontractor may be declared ineligible for further government contracts.
• The contractor will report any subcontractor's "known or reasonably knowable" violations and take remedial action directed by the agency.
• The contractor recognizes that compliance is material to the Government's payment decisions for purposes of section 3729(b)(4) of title 31, United States Code (False Claims Act).

Verified — EO 14398 clause text

What "racially discriminatory DEI activities" means

The EO defines the term as: disparate treatment based on race or ethnicity in recruitment, employment (hiring, promotions), contracting (vendor agreements), program participation, or allocation of resources. "Program participation" includes membership in or access to training programs, mentoring, leadership development, educational opportunities, clubs, and associations sponsored by the contractor. The EO does not address sex-based discrimination. Verified — EO 14398

The False Claims Act exposure

The clause's explicit statement that compliance is "material to the Government's payment decisions" eliminates one of the most common FCA defenses — that the violated requirement was not material to the government's decision to pay. A contractor that submits a payment claim while knowingly maintaining a prohibited program faces treble damages (three times the contract value), civil penalties, and potential debarment. DOJ has stated its intent to aggressively pursue FCA enforcement. Qui tam whistleblowers — including employees — can initiate actions independently. Verified — Winston & Strawn; DLA Piper; EO 14398

Implementation deadlines

Note: There is a timing gap — agencies must insert the clause before the FAR Council issues interim guidance. Consult legal counsel on how your specific contracting agency is interpreting the April 25 requirement.

What to do before April 25

• Audit internal programs under legal privilege. Review mentorship programs, ERGs, leadership development tracks, supplier diversity initiatives, and hiring processes for any eligibility criteria based on race or ethnicity.
• Update subcontractor agreements. The clause flows to every tier. Begin incorporating the clause into subcontractor agreements now and establish a monitoring system for "known or reasonably knowable" violations.
• Check for jurisdictional conflicts. Some state equal opportunity laws may conflict with the federal clause. Assess the compliance conflict before April 25.
• Document any program changes. If you modify or terminate any program in response to this EO, document the basis and process. FCA qui tam actions frequently originate from employees who observed the change.

Signal

The prime systems integrator model is gone. The DHMSM Program Office retains direct decision authority, supported by three separately contracted functions: Technical Integration, Product Management, and Human-Centered Design. None carries the authority over program direction and vendor management a prime SI would have held.

Solution vendors now hold direct FAR-based contracts. Oracle Health Millennium, Health Data Intelligence, and Patient Portal are Best of Suite. Philips eCare and Amwell are Best of Breed. Converge, Solventum Health Information Systems, and Henry Schein Dentrix complete the current vendor portfolio. OCI hosting constraint lifted — solution vendors can now host in their own cloud environments provided they meet DHA performance, security, and cost standards. Verified

Immediate action

Deployment Solutions RFP (HT003826RE001) posted April 6, 2026. Proposals due April 15, 2026, 12:00 PM EDT. Multiple-award IDIQ, $300 million shared ceiling. Price is not an evaluation factor. Government awards to every technically acceptable offeror.

OCI lockout clause locks awardees out of all DHMS work for the duration of the contract plus 12 months. Read the OCI clause before you bid. Firms that want task order access without foreclosing HCDS must make that decision now. Verified

What it funds

Enterprise application and desktop virtualization lifecycle support across the MHS footprint. CPFF, 1 base + 4 option years. $250 million. Verified

Competitive landscape

SPINVI is the confirmed incumbent — an 8(a) firm acquired by Core4ce in January 2023. Recompete is expected April 2026 with award November 2026. SeaPort-NxG vehicle required. Small business set-aside — teaming decisions and 8(a) positioning should be finalized now. Verified

What it is

Enterprise technology planning and risk management. OT prototype mechanism — 10 U.S.C. § 4022, not a traditional FAR acquisition. Each award valued $1.5-2.2 million. Verified

What it funds

Inventory of up to 80 DHA data systems. VAULTIS framework. Automated ML metadata harvesting. Part of DHA Data and Innovation Strategy launched March 2026. $34 million, WOSB set-aside. Posted December 22, 2025. Verified

Status (May 2026)

Responses closed January 9, 2026. The GAO protest filed by BDR Solutions, LLC (File B-424295.1) was dismissed March 30, 2026, suggesting award proceeded. Winner has not been publicly announced as of May 18, 2026. Verified — OrangeSlices / GAO docket, March 30, 2026

Phase 2 is the live opportunity. See signal #s27 (DHA EDC Phase 2 / FY26-30 Data Strategy Implementation) for the multi-year follow-on.

What it is

MHS Information Platform currently runs on a 1+ petabyte AWS GovCloud environment. EIDS PMO managing 10 active contracts; manpower assessment underway to consolidate. This is the highest-growth functional area in DHA IT. Corroborated

SpinSys-Diné bridge contract (HT003824C0005) expired January 25, 2026 at $54.1M total value. Koniag IT Systems was awarded a $94M DHA EIDS AWS IDIQ on June 4, 2025 (firm fixed-price, 1 base + 3 option years) for cloud/compute/storage. Verified — HigherGov HT003824C0005; OrangeSlices, June 4 2025

ESS Next Sources Sought (TBD-8675309) posted March 26, 2026; responses due April 9, 2026 — market research for the next enterprise software services vehicle supporting EIDS, DHMSM, JOMIS, and FEHRM. Verified — HigherGov ESS Next, March 26 2026

What it funds

$370 million across 52 condition areas. All 7 PRMRP FY26 funding opportunity announcements were released May 8, 2026 (CDMRP page updated May 14). Access through eBRAP, then Grants.gov CFDA 12.420. Platform Clinical Translation Award funds up to $15 million per award ($8M guaranteed FY26 funds). Pre-proposal is the invitation-only gating step. Verified — CDMRP PRMRP funding page, updated May 14, 2026

Active deadlines (FY26)

• Discovery & Research Advancement Awards: pre-app (LOI) due July 16, 2026 · full app July 30, 2026
• Platform Clinical Translation, Clinical Trial, Impact Awards: pre-proposal due July 23, 2026 · full app September 22, 2026
• Technology / Therapeutic Development Award: pre-app July 23, 2026 · full app August 6, 2026

FY2027 funding context

The FY2027 CDMRP total will be set by House appropriators in mid-April markup, not by this budget. The FY2026 award cycle is running now. Verified

What it funds

$165 million across 20 cancer types. Pre-announcement February 20, 2026. All 14 additional programs have live pre-announcements at cdmrp.health.mil. Each program has its own timeline and mechanism structure. Verified

FY26 Prostate Cancer Research Program (PCRP) pre-announcement released April 24, 2026. Award mechanisms: Exploration-Hypothesis Award, Idea Development Award, Translational Research Partnership Award, Physician Research Training Award. FY26 PRCRP topic areas explicitly exclude breast, kidney, lung, melanoma, ovarian, pancreatic, prostate, and rare cancers (those route to separate programs). Verified — CDMRP PCRP pre-announcement, April 24, 2026

Additional programs

• TBI/PH — Traumatic Brain Injury / Psychological Health
• Combat Readiness — Military medical readiness research
• Joint Warfighter — Joint operational medicine
• Military Burn — Burn treatment and recovery
• Toxic Exposures — Environmental and occupational exposures
• Breast Cancer, Ovarian Cancer, MS, Parkinson's, ALS, Lupus — Disease-specific research
• Spinal Cord Injury, Hearing Restoration, Vision — Injury rehabilitation

The funding context you need

P.L. 119-4 cut CDMRP by 57% in FY2025 — from $1.51 billion to $650 million. FY2026 restored it to $1.27 billion. That level is still 16% below FY2024. Research timelines interrupted by a one-year cut cannot be recovered by a funding restoration alone. Congressional advocacy during the FY2027 markup (mid-April) is the only mechanism to restore the FY2024 funding level. Verified

What it covers

Primary acquisition pathway for all OPMED PMO programs. Covers blood products (cryopreserved platelets, cold-stored plasma), deployed diagnostics (man-portable molecular systems), CPG implementation requirements, and force health protection programs. Continuous submissions accepted through September 30, 2027. Verified

Active programs in pipeline

• CLPH-511 (Cellphire Therapeutics): $29.25M contract W81XWH20C0030. FDA Fast Track granted March 2025. CRYPTICS Phase 2/3 trial stopped early for efficacy April 2025. Five-year shelf life at ≤-65°C. Procurement requirements follow.
• Man-Portable Diagnostic System: Cepheid GeneXpert Omni validated at Balikatan 25 in Philippines. Tropical fever panel tested in field conditions.
• En-route blood delivery: Updated operational guidance published December 2025 covering aerial delivery of fresh and stored blood products. Requirement generation underway.

What it is

Infrastructure engineering support task order through NIWC Atlantic. $129.6 million. Six original bidders on current vehicle. Expiring FY2026. Recompete expected to draw significant interest given scope. Corroborated

Incumbent + follow-on

Incumbent Core4ce TO N6523621F3030 has potential end date September 2, 2026 (83% complete, $42.2M funded backlog). NIWC Atlantic forecast shows follow-on DHIA II (LSUBP00010-0134, ≥$100M, SeaPort-NxG) with RFP targeted December 2026 — bridge gap risk is real. Verified — HigherGov N6523621F3030, June 17, 2025; NIWC Atlantic SBIOI Forecast, July 16, 2025

Portfolio breakdown

What the portfolio reveals

Kunsan AB is the first INDOPACOM DHA MILCON entry — there was no INDOPACOM DHA medical construction in FY2026. Geographic pivot confirmed. Lakenheath and Rhine ORB are continuing increments on multi-year authorized builds — no reduction in commitment, natural increment progression. Fort Wainwright follows ARCTIC EDGE 26 exercise validation. Jacksonville SARP signals behavioral health and addiction treatment are inside the lethality framework. Verified — C-1 FY2027 confirmed

What it is

The FY26-30 DHA Data Strategy was signed and released March 11, 2026 with five Lines of Effort: (1) Strengthen Data Roles; (2) Maximize Authoritative Data Sources; (3) Operationalize Data-as-a-Product; (4) Build Trust Through Data Quality; (5) Maintain Enterprise Data Catalog. On April 16, 2026, DHA CDAO published the operating companion Enabling Decision Advantage With Health Data — the strategy, governance, and request-process playbook for how DHA will consolidate data operations across more than 100 source systems. The EDC LOE is the direct successor authority for HT001126RE011 Phase 2 work. Verified — DHA.mil, March 11, 2026; DHA CDAO, April 16, 2026

The three things this document tells you

1. The buy is Data as a Product. Strategic Line of Effort #3 is explicit: transition to a reusable, outcome-driven DaaP model. Every funded data product must originate from an Authoritative Data Source, carry measurable SLAs, sit in the Enterprise Data Catalog, and follow a seven-step lifecycle from Discover through Retire. Dataset-per-project work is off-strategy. Capabilities positioned as one-off integrations will be repackaged into Data Products or will lose to vendors that already frame them that way. Verified

2. The architecture is orchestration, not consolidation. The Data Orchestration Layer is described with a triple negative: Not a New Platform. Not a Cloud Service. Not a Replacement. It is a logical layer built on infrastructure services (monitoring, lineage, auditing, scheduler, bucket, GenAI hook), an Enterprise Data Product Registry, and an Enterprise Data Product Access tier enforcing sharing policies, classification and tagging, access control, authentication, and APIs across NIPR, SIPR, and COCOM consumers. Any pitch that leads with "we'll build you a new lake" is misreading the requirement. The buy favors API work, metadata harvesting, catalog tooling, identity management, governed data-sharing services, and contract-and-quality instrumentation. Verified

3. The timeline is near. A source annotation on the published briefing reads: "51 systems, less than 12 months — Space Force API Portal." That is the orchestration horizon and the reference architecture DHA CDAO is working against. The Space Force API portal is the published model for serving data products to downstream consumers through governed APIs rather than bulk replication. Corroborated — annotated source copy; single-source directional signal

Who you actually talk to

The strategy defines six data governance roles. For capture teams, two of them matter most:

• Data Domain Steward — day-to-day governance lead for a data domain (bed status, blood inventory, access to care, pharmacy, readiness, etc.). Owns definitions, metadata, business rules, and access criteria. This is where product shape gets decided.
• Data Steward Coordinator — facilitates cross-functional governance, leads forums, tracks decisions, manages change requests. This is the orchestration function — the human workflow the Orchestration Layer supports.

Pitching IT Data Custodians will route your capability into security and operations work. Pitching Data Domain Stewards and their Coordinators positions your capability as a Data Product. Those are different contract shapes and different ceiling values. Verified

How DHA accepts requests

Four pathways feed the DHA Global Support Center at gsc.health.mil:

1. GSC Online Services Portal — DHA personnel, DHA Network personnel, COCOMS liaisons. Route to: CDAO Triage.
2. Local ISC Routing — MTF personnel.
3. Data Request Catalog Form — flagged "coming soon." This is a small-dollar tech opportunity in the catalog implementation itself.
4. Email and phone — dha.jbsa.j-6.mbx.mhs-service-desk@health.mil or 1-800-600-9332. This is the external-partner pathway.

"CDAO Triage" is the routing label that gets requests into the seven-step Enterprise Measure Request Process. External-org data products (primes, SIs, research partners) trigger MOA, DSA, or DUA review plus DHA Agreements, Patient Privacy, and OGC approval before delivery. Verified

The GenAI gate

The strategy names six approved GenAI platforms. Only two are cleared for PHI and PII:

• Ask Sage (health.mil) — PHI/PII approved; tokens required; API available. Fewer models than the CUI tiers.
• Approved Cloud-native services — AWS Bedrock, AWS SageMaker, Azure AI Endpoint, deployed by approved developers inside DHA GovCloud.

Microsoft CoPilot is MED365-integrated and handles PHI/PII but sits in limited pilot with no API. CamoGPT, Ask Sage (Army), and GenAI.mil are CUI-only — useful for administrative, supply-chain, and policy work, not clinical content. Any GenAI capability touching PHI that is not on this list is classified as a reportable data breach and security violation. Clinical solicitations should be read against this list — not against general commercial AI availability. Verified

What this means for your pipeline

For vendors already in DHA data work: signal 18 (Enterprise Data Catalog, HT001126RE011, $34M, WOSB) is the first procurement instantiation of this strategy. Read it as a template — metadata harvesting, catalog integration, VAULTIS framework, and ADS lineage language will recur across follow-on actions. Position against the catalog, not against a replacement platform.

For vendors outside DHA: the three use cases published in this document (Bed Status from CAPMAN, Blood Inventory, Access to Care at 80–100M records and a 51-step pipeline) are the published templates for what "done" looks like. Capabilities that can be written as a reusable, versioned Data Product against those domains have a clearer path than capabilities positioned as custom integrations.

For GenAI vendors: if your clinical AI is not on the approved list and you cannot host inside DHA GovCloud, you are positioning for CUI-only work. Clinical decision support touching PHI requires Ask Sage integration or cloud-native deployment. Those are distinct procurement paths and distinct teaming partners.

For proposal teams: evaluators reading technical volumes on DHA data and AI solicitations through at least FY2028 will be trained on this playbook. Technical approaches that use the language of DaaP, ADS, federated governance, metadata foundation, and orchestration-layer consumption will read as on-strategy. Approaches that describe ingest pipelines, data lakes, and custom ETL will read as off-strategy regardless of technical merit.

What it funds

VA's Technology Acquisition Center (TAC New Jersey) issued solicitation 36C10B26R0006 March 20, 2026 with proposals due April 6, 2026. The IDIQ establishes a multi-vendor, multi-VISN ambient AI scribe capability with a $775.7M ceiling and 5-year ordering period, with up to 4,700,000 user-months of utilization. Verified — HigherGov 36C10B26R0006, April 2, 2026

Why the IDIQ doesn't end the competition

The contract structure envisions one task order per VISN (18 VISNs + possible additional TOs) — competition does not end at IDIQ award. Each VISN-level task order is a separate competitive event. Technical requirements: FedRAMP Moderate authorization, integration with VistA/CPRS and Oracle Health EHR, real-time note generation, and specialty-specific documentation.

Strategic context

VA's AI strategy commits to scaling ambient scribe across all 170 VAMCs. The FY27 budget allocates $47.8M for Decision Intelligence and Automation (+10.9%). Existing pilots at VA Providence (March 24, 2026), Kansas City (April 2026), and at least 12 other sites under Knowtex's $15M contract create technical past performance. Kansas City pilot: 18 providers, all want to continue; 1–2 hours/day saved per provider. Verified — VA News Kansas City, April 18, 2026

Competitive landscape

FedRAMP-authorized ambient AI vendors — Knowtex, Nuance/Microsoft, Ambience, Suki, DeepScribe — are the likely prime competitors.

What it funds

The DHA FY26-30 Data Strategy (signed and released March 11, 2026) mandates an Enterprise Data Catalog as standing LOE 5: integration with all key data systems for continuous metadata refresh; metadata-first governance; metadata quality indicators; and connection of EDC metadata to operational and analytical systems. HT001126RE011 was a 1-year, $34M scoping/prototype contract covering only 80 systems. Phase 2 must implement the EDC across the full DHA data estate (hundreds of systems). Verified — DHA.mil, March 11, 2026; DHA FY26-30 Data Strategy PDF

The near-term driver

CDAO Jesus Caban's Orchestration Layer mandate (~51 systems orchestrated to the Space Force API Portal reference within 12 months) is the implementation forcing function. The GAO protest dismissal (BDR Solutions, B-424295.1, March 30, 2026) means HT001126RE011 award likely proceeded, establishing a Phase 1 incumbent. Verified — OrangeSlices / GAO docket, March 30, 2026

Competitive landscape

WOSB/SB set-aside likely to continue. Firms with DHA data pedigree (EIDS PMO support teams, VAULTIS framework implementers) and Enterprise Data Catalog COTS deployment partners (Collibra, Alation, Microsoft Purview) are natural competitors. Solicitation estimated Q3-Q4 FY26 based on HT001126RE011 performance period ending January 29, 2027.

What it funds

DHA posted Special Notice HT003826X0000 on March 18, 2026 — the first public signal of the formal procurement process for the MHS GENESIS HCDS recompete — with an August 30, 2026 industry input deadline. This is the follow-on to the current HCDS contract supporting MHS GENESIS, the DoD's Federal EHR deployed at 10 Army, Navy, Air Force, and Coast Guard MTFs with expansion underway. Verified — FederalCompass HT003826X0000, April 13, 2026

Draft contract strategy

From Industry Days (November 2025 and March 2026), the draft strategy emphasizes: (1) leveraging the commercial ecosystem to maintain technology relevance, (2) tighter VA/DoD interoperability, (3) value-based EHR contractor compensation (outcomes, not consumption), and (4) preserving best-in-class deployment methodologies from the current Oracle Health contract. The Deployment Solutions IDIQ (HT003826RE001, $300M — see #s29) separates deployment services from the EHR platform itself, creating two distinct competitive streams.

Competitive landscape

Oracle Health holds the current HCDS platform contract but the government has explicitly designed for competitive replacement. Epic, Cerner (Oracle), and potentially AWS/Microsoft healthcare cloud platforms are potential offerors. For capture teams, the 2026 opportunity is the Deployment Solutions IDIQ; the HCDS platform recompete is a 12-18 month pipeline investment. Verified — Washington Technology, April 8, 2026

What it funds

DHA posted HT003826RE001 April 6, 2026 (final amendment April 13, 2026 extended close to April 21). $300M IDIQ for site preparation, deployment, training, change management, and post-installation support across all DHMS products — MHS GENESIS, operational medicine systems, JOMIS. 1 base + 4 option years. Verified — Washington Technology, April 8, 2026

The unusual evaluation structure

DHA will award to every technically acceptable offeror — effectively an open IDIQ vehicle for qualified firms — with price not an evaluation factor. Evaluation focuses on a two-scenario EHR deployment challenge: OCONUS accredited medical center + operational medicine scenario for EUCOM/INDOPACOM. Verified

The named OCI contractors

Five named government support contractors appear in the OCI clause — proposers must state whether access is granted: Andrew Morgan Consulting, Boston Consulting Group, Greenlight Analytic, Monterey Consultants, Swing Tide. Verified — HigherGov HT003826RE001, April 17, 2026

What it funds

ARPA-H-SOL-26-142 issued January 13, 2026; solution summaries due February 27; full proposals due April 1, 2026. Targets the first FDA-authorized, agentic AI clinical system — an autonomous AI agent capable of adjusting medications, scheduling, diet, and prescriptions for heart failure and MI patients 24/7. Three technical areas: (TA1) patient-facing clinical AI agent; (TA2) supervisory safety agent; (TA3) health system integration and deployment. Verified — ARPA-H ADVOCATE program page; ARPA-H news release, January 13, 2026

The OT structure

Awards via Other Transaction Agreements, not traditional contracts or grants. Due to "exceptional interest," ARPA-H is piloting LLM-assisted review of solution summaries — the first known use of AI in federal health R&D proposal review at this scale. Verified

Teaming reality

Teaming between tech sector (clinical AI vendors), academic health systems, and medical device/pharma regulatory experts is virtually required per ARPA-H's own guidance. While the total program budget is undisclosed, GovCon intelligence estimates $100M+ over 4-5 years across multiple awardees.

What it is

HTI-5 Final Rule confirmed published (HealthIT.gov page classifies HTI-5 as Final Rule as of April 29, 2026). The rule removes 34 of 60 ONC Health IT Certification criteria, eliminates AI "model card" transparency requirements, defines AI/automated processes as "access" under information blocking, and removes the TEFCA manner exception — making QHIN participation de-facto mandatory for IB compliance. Verified — HealthIT.gov HTI Rules, updated April 29, 2026

Effective dates

Most removals are effective immediately upon publication. Remaining criteria changes (including family health history and C-CDA transitions of care) are effective January 1, 2027. The Jan 1, 2027 deadline for remaining criteria changes creates a 7-month sprint for large health systems.

The compliance services window (the opportunity)

1. EHR vendors must decertify removed criteria and re-certify revised criteria — creating developer services demand.
2. Health systems must re-assess information blocking compliance posture now that the TEFCA manner exception is eliminated.
3. QHIN participants see increased value as TEFCA becomes the compliance backstop.
4. Federal agencies deploying certified health IT (VA, DHA, IHS, CMS) must align vendor requirements with the new certification landscape — recertification services opportunity for federal capture teams.