Managed Care & Coverage
Expert articles and analysis related to managed care & coverage.
AI Summary — Last 7 Days
CMS’s managed care agenda is tightening around Medicaid and Medicare Advantage: the Trump administration extended the GENEROUS Medicaid drug-pricing model application window amid strong manufacturer interest, while proposed 2028 HCBS quality measures signal a broader push to standardize Medicaid long-term services accountability and make quality performance more comparable for states, plans, and home-based care providers. At the same time, Medicare Advantage remains under pressure from both directions—CMS’s 2027 MA final rule adjusts consumer protections and plan obligations, while Aetna’s $117.7 million false-claims settlement reinforces continuing risk-adjustment and coding scrutiny for MA organizations and VBC partners. For ACOs, Medicaid MCOs, and provider groups, the pattern is clear: more opportunity to participate in payment models and benefit redesign, but with rising expectations around data quality, care management performance, and compliance infrastructure (GENEROUS deadline extension; MA consumer protection changes).
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Efforts by states to implement the Medicaid work requirement are intensifying, with hospitals likely to play a supporting administrative role when the requirement begins nationwide Jan. 1, 2027, based...
How states are planning to implement Medicaid work requirements: survey
Most states are planning to adopt less restrictive policies to verify compliance with work requirements mandated by the “Big Beautiful Bill,” but some are implementing the policies early or checking e...
Nebraska rolls out Medicaid work requirements, putting tens of thousands at risk of coverage losses
The Cornhusker State is the first to roll out work requirements under the GOP’s “Big Beautiful Bill,” well in advance of the law’s 2027 deadline. Between 20,000 and 40,000 people are expected to lose ...
CMS mandates state Medicaid directors to validate providers
Centers for Medicare & Medicaid Services Administrator Mehmet Oz has sent state Medicaid directors a letter mandating they submit a plan within 30 days on a two-year provider revalidation strategy.CMS...
Medicaid Managed Care Plan Alignment With State Substance Use Disorder Treatment Coverage Requirements | Milbank Quarterly | Milbank Memorial Fund
Medicaid is the largest payer of substance use disorder (SUD) treatment in the United States. Managed care plays an important role, administering benefits for more than 80% of Medicaid enrollees. Whil...
NBC News: Nebraska Rolls Out Medicaid Work Requirements, Putting Thousands At Risk Of Losing Coverage
From newsletter: First Edition: Monday, May 4, 2026 First Edition: Monday, May 4, 2026 Get your first pass at the day's top health care policy news. ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏...
Politico: Some Red States Expanded Medicaid Against Their Will. Now They're Trying To Shrink It With Work Rules
From newsletter: First Edition: Monday, May 4, 2026 First Edition: Monday, May 4, 2026 Get your first pass at the day's top health care policy news. ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏ ͏...
What Happens When Coverage Is Cut? Looking Backward and Forward From the One Big Beautiful Bill | Milbank Quarterly | Milbank Memorial Fund
The so-called One Big Beautiful Bill Act signed into law by President Trump on July 4, 2025 will cut $1 trillion from federal health care programs over the coming decade and cause 10 million individua...
5. 1st state enacts Medicaid work rules under HR 1
5. 1st state enacts Medicaid work rules under HR 1 - Becker's Hospital Review Becker's Hospital Review