Managed Care Markets
Expert articles and analysis related to managed care markets.
AI Summary — Last 7 Days
Managed care markets are tightening across both Medicare and Medicaid: Humana is planning additional 2027 Medicare Advantage market exits affecting roughly 600,000 members, signaling continued benefit/geography pruning as plans manage Stars, risk adjustment, utilization, and margin pressure (Healthcare Finance). On the Medicaid side, Trump-era work requirements remain on track after a judge declined to pause implementation, while providers are pushing back on CMS implementation of OBBBA state-directed payment limits—raising coverage-continuity and supplemental-payment risks for health systems, Medicaid MCOs, and VBC contracts tied to vulnerable populations (Healthcare Dive).
Related Articles
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Why Medicaid is U.S. Healthcare’s Biggest Opportunity
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AMGA Urges CMS to Strengthen Safeguards Against Coverage Losses in Medicaid Community Engagement Rule
AMGA Urges CMS to Strengthen Safeguards Against Coverage Losses in Medicaid Community Engagement Rule AMGA.org
Comment Letter: Community Engagement Requirement for Certain Individuals - MACPAC - Advising Congress on Medicaid and CHIP Policy (.gov)
Comment Letter: Community Engagement Requirement for Certain Individuals MACPAC - Advising Congress on Medicaid and CHIP Policy (.gov)
NABH Responds to Medicaid Community Engagement Requirement Interim Final Rule
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AHA Comments on CMS Medicaid Community Engagement Requirements Interim Final Rule
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Middle-aged Women on the Medicaid Coverage Fringe
Women in this age group carry a substantial chronic disease burden, including diabetes, cardiovascular disease, and depression. Many manage multiple conditions that require continuous monitoring and m...
Indiana plans to cover GLP-1s for some Medicaid members under BALANCE model - beckerspayer.com
Indiana plans to cover GLP-1s for some Medicaid members under BALANCE model beckerspayer.com
Court denies Democrats’ move to pause Medicaid work requirements
Court denies Democrats’ move to pause Medicaid work requirements Modern Healthcare