States must enforce Medicaid work requirements by January 1, 2027, but the Centers for Medicare and Medicaid Services (CMS) have yet to issue guidance for compliance for states eager to start planning its implementation.
The One Big Beautiful Bill Act (OBBBA) cuts nearly $1 trillion in Medicaid spending over a decade in part by adding...National News
Several insurers lowered investors' expectations after an underwhelming second quarter. Financial analysts have noted that fiscal setbacks are rapidly becoming endemic to the health insurance sector.
On Tuesday, UnitedHealth Group revised its financial projections for the remainder of the year and will now project less than half of...
First quarter of 2024 results are in across the insurance industry, with UnitedHealth Group (UHG) pulling out ahead for shareholders despite a costly cyberattack shaking up subsidiary activities.
The repeated attacks against Change Healthcare left UHG with an approximate $1.2 billion loss, with the cyberattack directly costing the...
Medicaid managed care, as it varies state-to-state, is a complex and dynamic umbrella of care delivery. The National Association of Medicaid Directors (NAMD) published an in-depth explainer on Medicaid managed care to illuminate the program's intricacies.
Medicaid agencies contract with managed care organizations (MCOs), usually...Arizona News
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will truncate the timeline for prior authorization processes to 72 hours for people who receive health coverage from insurers participating in Medicare Advantage, Medicaid managed care, or the Affordable Care Act exchange.
The CMS...
An investigation in the JAMA Health Forum suggests that integrated managed care (IMC) organizations, which are Medicaid managed care programs that are required to pay for behavioral health services, have yet to demonstrate positive changes in the quality of health services.
The study used data from the state of Washington's staggered...National News
The National Conference of State Legislatures (NCSL), a nonpartisan association for sitting state legislators, which seeks to educate legislators on procedures, state flexibilities and standards of conduct, published the second installation in an ongoing series on Medicaid Managed Care (MMC) programs.
The report, "The Life Cycle of...Arizona News
As regulators make efforts to rein in prior authorization delays and denials by private insurers and Medicare Advantage (MA) plans, Medicare and Medicaid managed care organizations (MCOs) are also garnering scrutiny over denials and network adequacy.
A new consumer survey from Kaiser Family Foundation (KFF) found that roughly 60% of...
Amid a national mental health crisis affecting the very old and very young alike, a new study shows that enrolled in Medicare Advantage are far less likely to have access to psychiatric care than beneficiaries of other government-coordinated plans.
The study, which was published in Health Affairs, looked at a novel data set that...
This week, the Medicaid and CHIP Payment and Access Commission (MACPAC) published an issue brief on regulations from the Centers for Medicare and Medicaid Services (CMS) on Medicaid managed care and directed payment arrangements.
The directed payment option is used by few states in order to require managed care organizations (MCOs) to...National News
In the Kaiser Family Foundation's analysis, 2021 Medicare Advantage earned the highest per-person, average gross margin of $1,730 per enrollee in 2021, similar to the pre-pandemic years 2018 and 2019 and more than double the gross margins reported across the individual, group and Medicaid managed care markets. Medical Loss Ratios (MLR)...Arizona News
It's the time of year for insurers to file their fourth quarter (Q4) earnings reports for 2022. This week, Molina, Kaiser Permanente and Oscar Health posted financial metrics.
Oscar Health beat the odds in 2022 by improving its medical loss ratio from 88.9% in 2021 to 85.3%, Modern Healthcare reports. But the healthtech company still...CMS Rules
Medicaid contracted managed-care organizations (MCOs) can spend up to 5 cents of every premium dollar on SDOH needs. The new guidance says Medicaid MCOs can also reduce health disparities and address unmet health-related social needs such as housing instability and nutrition insecurity by adopting in lieu of services and settings (ILOS)...National News
The Centers for Medicare and Medicaid Services (CMS) published a proposed rule which would require Medicare Advantage, Medicaid managed care organizations, Affordable Care Act (ACA) plans, and state Medicaid agencies to implement electronic prior authorization systems by 2026.
The proposed rule updates requirements for certain payers...National News
This week, the Center for Medicare hinted at new value-based approaches to palliative care; health equity takes precedence in the national conversation on rural payment models; and value-based contracts are analyzed for their ability to mitigate drug costs.
The Medicare Shared Savings Program (MSSP) is now ten years old, and with it...
A new report from Health Affairs indicates Medicaid managed care enrollees who are members of racial and ethnic minority groups have historically worse care experiences than White enrollees. Data from the report adds to the growing list of evidence that the equity gap in healthcare is growing – and will continue to do so until...
This week, COVID-19 continues to impact the data collection and maintenance of Medicare Advantage and Medicaid Managed Care programs. MedPAC reasserts its findings that Medicare Advantage costs the government more than fee-for-service and Oklahoma asks "is now really the time to be privatizing Medicaid?"
Medicare Advantage
The...Arizona News
This week in commercial health insurance news, a study suggests there could be new ways to innovate cost savings for employers, commercial payers are pushing surgery centers over hospitals, and how utilization during COVID-19 is affecting profits for insurance companies. Also, a Kaiser study demonstrates that tying insurance...National News
A paper released this week in the National Bureau of Economic Research suggested that enhanced payer-focused cost-control methods for Medicaid managed care plans did not influence spending reductions for those payers.
The study looked at the second largest Medicaid Managed Care (MMC) market in the country, New York City where ten...
