HT4M Membership Application

  • HT4M Member Information

  • Join the HT4M Community!

    Membership with Health Tech for Medicaid (HT4M) provides unparalleled opportunities for networking, collaboration, and access to exclusive events and resources. Our members play a vital role in advancing healthcare equity and innovation in the Medicaid space.

    Membership fee: $5,000 annually.

    We understand that the cost of membership may be a consideration. We offer flexible payment plans to accommodate your needs. Reach out to us at info@ht4m.org for more information.

    Join us today and become part of a dynamic community dedicated to driving transformative change in Medicaid!

  • About Your CEO/Founder

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  • Please list an additional marketing person we should contact with any information we may have to disseminate. This person may be a direct report, a colleague, an Admin, etc.

  • About Your Company

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  • What type of business is your company?*

  • Health Technology Startup Follow Up Questions

  • What Type of Innovation is your Company Bringing To Medicaid?*

  • Select All Client Segments Applicable To Your Revenue Model:*

  • Follow Up Questions For Non-VC Backed Entrepreneurs

  • My company is:*

  • What Type of Innovation is your Company Bringing To Medicaid?*

  • Select All Client Segments Applicable To Your Revenue Model:*

  • Follow Up Questions for Health Plan Members

  • Is your health plan owned by a parent company?*

  • What type of Medicaid innovation products have been identifies as current or near-future needs for your plan?*

  • Does your health system have an innovation office, government relations staff, or someone who works with start-ups, RFP cycles, or state Medicaid? We want to help leverage your membership by connecting these people with HT4M staff. Please provide their information below.

  • Follow Up Questions for Health Systems & Providers

  • My organization is:*

  • What type of Medicaid innovation products have been identified as current or near-future needs for your organization?*

  • Does your health system have an innovation office, government relations staff, or someone who works with start-ups, RFP cycles, or state Medicaid? We want to help leverage your membership by connecting these people with HT4M staff. Please provide their information below.

  • Follow up For Non-Profit Organizations

  • Follow Up For Consultants

  • Are you a former State Medicaid Director?*

  • Follow Up For Investors, Venture Capitalists, and/or Funds

  • Date of your most recent fund announcement:*
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  • Do you currently invest in health technology startups?*
  • Are you planning to announce a new fund in the next 12 months? [This information will be kept confidential and is for record keeping only]*

  • Please list an additional person who should receive our invitations, updates, opportunities and emails. This person may be a colleague, a direct report, an Admin, etc.

  • Help Us Serve You

  • What events and resources would be most useful to you?*

  • States where your organization currently operations: [This information is kept confidential but helps us better serve our members with targeted programming]:*
  • States where you plan to establish a footprint in the next 18 months [This information is kept confidential but helps us better serve our members with targeted programming]:*

  • Membership Dues

    Membership dues are $5,000. Member registration will not be completed until dues have been received.
  • I plan to pay my dues (directions will be sent with invoice):*
  • I would like to pay my dues:*
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  • By signing below, I certify that my organization will and is able to pay our annual membership dues. 

  • Should be Empty: