It seems likely that the new administration will drastically change the Medicaid program, and as more adjustments are made within the administration, the possibilities for change are coming to light. The Trump administration is exploring options to...National News
Last week, a bipartisan group of legislators introduced a bill that would cancel the 2.83% Medicare physician pay cut and instead boost pay by 2%. Provider groups and stakeholders from across the industry have voiced support for the bill.
The bill, "Medicare Patient Access and Practice Stabilization Act," would reverse the January 1...Top of The Day
People with mental health symptoms from low to middle-income households use mental healthcare less after aging into Medicare, according to a new study.
The study, conducted by researchers at the University of Southern California's Schaeffer Center sought to address growing concern about access to mental healthcare services under...National News
Over the weekend, President Donald Trump appeared ready to make good on his campaign promise to implement 25% tariffs on Canada and Mexico. Agreements with them to invest in border security have delayed the tariffs for at least a month, the medical community remains on high alert for the ramifications of future actions the president may...
Despite the efforts to dismantle any trace of the Biden administration elsewhere, the Trump administration intends to continue the Medicare drug price negotiation program, including the 15 drugs proposed for the second round of negotiations as one of President Joe Biden's last acts in office.
The Trump Centers for Medicare and...
At the direction of the Office of Personnel Management (OPM), the Department of Health and Human Services was asked to scrub its website of all references to diversity, equity and inclusion (DEI) and gender identity.
The OPM memo said it was implementing two of President Donald Trump's executive orders, "Defending Women from Gender...
Robert F. Kennedy, Jr. is one step closer to becoming the Secretary of the Department of Health and Human Services (HHS) after clearing the Republican-led Senate Finance Committee in a party-line vote.
Kennedy participated in two days of hearings last week -- the Senate Finance Committee on Wednesday followed by the Senate Health,...
With about 28.6 million members, including 12 million Medicaid lives, 4.4 million Marketplace members, and 4.8 million commercial enrollees, Centene beat its 2023 numbers; $2.7 billion in profit and $154 billion in revenue.
The insurer's biggest pocket of business is Medicaid; $84 billion in premium and service revenue in 2024....
Cigna's deal to sell its MA plans to Health Care Service Corporation is on track to close in the first quarter of 2025. The insurer recently reported its 2024 profits were down year over year (YOY) missing Wall Street expectations due to higher medical costs in its employer stop-loss insurance business. To recover lost profits, the...
Health Affairs pitched two reform strategies this week to limit the competitive advantage for Medicare Advantage (MA) plans that aggressively upcode - MedPAC estimated taxpayers overpaid MA plans by $50 billion in 2024. In other news this week, KFF found MA insurers made nearly 50 million prior authorization determinations in 2023...
With normal communications from CMS suspended, no January 2025 enrollment totals are available. Instead, The Hertel Report compiled end-of-year (EOY) Arizona Medicare Advantage enrollment totals and market penetration, as well as the agency's December 2024 dump of monetary sanctions against Elevance, Centene, and Humana, including plans...
In the Senate Finance committee confirmation hearing for the Department of Health and Human Services, anti-vaccine activist Robert F. Kennedy, Jr. (RFK) was championed by Republicans despite being unable to answer basic questions about his plans for Medicaid and other payer programs. He is expected to attend the Senate Health, Education,...
A new report from ProPublica found that at least 40 residents of sober living homes and treatment facilities in the Phoenix metro area died during the massive fraud scheme that exploited Indigenous people with substance use disorder.
The deaths were almost all attributed to drug and alcohol use between the spring of 2022 and the...
On Tuesday, the White House Office of Management and Budget issued a memorandum carrying out an executive order by President Donald Trump that immediately instituted a freeze in federal grant dispersals. The freeze temporarily disrupted state funding portals for Medicaid.
Despite promises from the administration that the pause would...
President Donald Trump began his second term with a flurry of executive orders targeting immigrants and workforce diversity, which directly threatens the stability of the long-term care industry.
The administration focused on diversity, equity and inclusion programs (DEI), marking them "illegal" and redefining them as a form of...
This month, Arizona Governor Katie Hobbs released several new initiatives in the proposed 2026 budget that funds critical programs and initiatives supporting people receiving Medicaid in the state.
The healthcare sector is Arizona’s primary job creation source, with an additional 27,000 jobs added as 2024 came to a close, ranking...
On Tuesday, President Donald Trump signed an executive order that threatens federal funding for providers that offer support for gender-affirming care for minors.
The president directed federal agencies to begin the process of withholding funding to institutions that provide gender therapies to anyone under the age of 19 and to...
Arizona State Superintendent of Public Instruction Tom Horne announced a partnership with mental healthcare provider Cartwheel to provide telehealth behavioral health services beginning March 1, 2025.
In a press release from the Arizona Department of Education, Horne explained that the service would allow rapid access to mental health...
A new analysis looked at the rates of claims denials among ACA Marketplace plans in 2023 and found that nearly one in five in-network claims and 37% of out-of-network claims were denied.
The denial rate varied from plan to plan with some plans reaching in-network denials of 54% and some as low as 1%. The KFF analysis also showed that...
Located at 7669 E. Pinnacle Peak Rd., Suite 220, in Scottsdale, the 10,415-square-foot facility includes acute and chronic condition care, geriatric care, immunizations, medication management, minor in-office procedures, newborn and pediatric care, on-site labs, routine physicals, sinus and respiratory care, well-child exams, well-woman...
President Donald Trump wasted no time after being sworn in on Monday to issue a sweeping executive order rolling back dozens of President Joe Biden's priorities. Republican lawmakers also have a number of healthcare program cuts, including the elimination of non-profit hospitals to fund the new administration's agenda.
The "initial...
As one of the last acts of President Joe Biden's term, the administration listed the prescription pharmaceuticals that would be included in the second round of the program that allows the Centers for Medicare and Medicaid Services (CMS) to negotiate what it pays for certain drugs.
The announcement was made earlier than the...
A new report from Georgetown University looks into the role played by Medicaid in rural healthcare delivery and finds that rural medical services rely on Medicaid funding.
The report found that non-Medicare eligible adults and children in rural areas were more likely than those in metro areas to use Medicaid or CHIP for their health...
As the Centers for Medicare and Medicaid Services (CMS) appeals a ruling that it recalculate UnitedHealthcare's Medicare Advantage Star Ratings, and another Medicare Advantage (MA) insurer has sued the agency over its quality ratings.
In November, Judge Jeremy Kernoodle ruled that the agency violated the Administrative Procedure Act...
In his first public remarks since the public murder of UnitedHealthcare (UHC) CEO Brian Thompson in December, UGH CEO Andrew Witty told investors during the fourth-quarter earnings call that the insurer is close to rolling out a new initiative to streamline prior authorizations.
Nearly all enrollees in Medicare Advantage are subject...