Why It Matters
Maryland’s Health Services Cost Review Commission, the only state agency in the nation with authority to regulate hospital rates across all insurance payers, is entering a critical transition period. The appointment of Kevin Sexton to lead the commission comes as the state negotiates a new federal agreement that will significantly curtail its rate-setting powers starting in 2028.
What Happened
The Moore administration announced Thursday that Sexton, former president and CEO of Holy Cross Health, has been nominated to chair the Health Services Cost Review Commission. Sexton will serve as interim appointee until the legislature convenes in January, when he will require Senate approval for a four-year term.
Sexton replaces Joshua Sharfstein, who stepped down from the position in July after serving a single term. The nomination reflects Sexton’s extensive background in both hospital operations and healthcare policy. He served as president and CEO of Holy Cross Hospital, which operates facilities in Silver Spring, Gaithersburg, Germantown, and other locations, from 1998 to 2018. During his tenure, he oversaw strategic restructuring that established the Holy Cross Health Network, which manages community health centers and prenatal care facilities for uninsured patients.
Sexton previously served on the commission itself, beginning his tenure in 2003 and later serving as vice chair for six years starting in 2005. More recently, he joined the Primary Care Coalition in 2019 and was selected to chair its board of directors in 2024.
Governor Wes Moore told the Maryland Matters Sexton “brings the strong leadership abilities, effective communication skills, and expertise needed to successfully empower our communities to achieve health and well-being at this transformative time for healthcare in Maryland.”
Sexton acknowledged the challenge ahead, stating, “I look forward to working with my fellow commissioners, our dedicated staff, and all of our stakeholders to manage this transition and move forward in a way that benefits all Marylanders.”
By the Numbers
2003 — Year Sexton first appointed to HSCRC
2005–2011 — Years Sexton served as HSCRC vice chair
1998–2018 — Duration of Sexton’s tenure as Holy Cross Hospital president and CEO
More than 40 years — Length of Maryland’s state authority to regulate Medicare hospital costs before the new agreement
2028 — Year state authority to set Medicare rates expires under the new model
Zoom Out
Maryland has maintained unique regulatory authority over hospital pricing for more than four decades, a distinction no other state possesses. The commission’s power extends across all insurance categories—private insurance, Medicaid, and Medicare—giving the state leverage to contain healthcare costs statewide.
That authority is now contracting. The state’s previous agreement, called the Total Cost of Care system, expired at the end of 2025. It has been replaced by the AHEAD model, or Achieving Healthcare Efficiency through Accountable Design, which took two years of negotiation between two federal administrations to finalize.
State officials signed the initial agreement with the Biden administration in 2024. However, the Trump administration decided early last year to renegotiate terms. Under AHEAD, Maryland will retain some rate-setting authority but will lose its ability to set Medicare rates beginning in 2028. The new model emphasizes improvements in community health and competition rather than state price controls.
What’s Next
Sexton’s appointment will be submitted to the Maryland Senate for confirmation when the legislature reconvenes in January. His leadership during the transition from Total Cost of Care to the AHEAD model will be central to managing the shift in the state’s healthcare regulatory framework and ensuring continuity in rate-setting policy during a period of significant federal and state-level change.