Managed Care Programs

State Medicaid programs are moving homecare reimbursement beyond hourly units toward skill- and acuity-based caregiver payment, a shift that could materially affect managed LTSS plans, Medicaid MCO network strategy, and VBC models that rely on in-home supports to reduce avoidable institutional care (MedCity News). At the same time, provider–payer friction is intensifying: hospital exits from Medicare Advantage networks continue, while physicians and insurers are pressing to reshape No Surprises Act arbitration rules—raising near-term contracting, margin, and out-of-network risk.