Managed Care & Medicaid
Expert articles and analysis related to managed care & medicaid.
AI Summary — Last 30 Days
Managed care is tightening its grip on public coverage: Medicare Advantage now covers 55% of eligible Medicare beneficiaries in 2026, while CBO projections after the 2025 reconciliation law point to materially lower future Medicaid enrollment and federal spending—raising stakes for health systems, ACOs, and Medicaid plans around attribution, risk adjustment, supplemental benefits, and uncompensated-care exposure (KFF MA enrollment update; KFF Medicaid projections). At the same time, CMS under the Trump administration is pressing ahead on the ACCESS Model and interoperability/prior authorization modernization, while OIG scrutiny of high MA prior-auth denial rates for LTACH and inpatient rehab intensifies the tension between utilization management, post-acute access, and VBC performance accountability. For VBC leaders, the strategic imperative is shifting from simply contracting into MA/Medicaid risk to building defensible capabilities in behavioral health integration, home-based/post-acute steering, data exchange, and denial management as public programs become more managed, more constrained, and more administratively demanding.
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Missed Opportunities: Using Medicaid Section 1115 Projects to Improve the Health of Medicaid and Medicare Beneficiaries | Milbank Quarterly | Milbank Memorial Fund
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Medi-Cal in the H.R. 1 Era: Resources for the Field
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States face tough budget decisions as Medicaid cuts mount
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