Medicaid & ACA Coverage
Expert articles and analysis related to medicaid & aca coverage.
AI Summary â Last 30 Days
In the past 30 days, significant movements in Medicaid and Medicare policy signal a structural shift towards value-based care amid regulatory uncertainties. CMS's ongoing efforts to combat fraud and abuse through the WISeR (Wasteful and Inappropriate Service Reduction) Model underscores a commitment to leveraging technology in prior authorization processes, while states are reportedly inching closer to implementing Medicaid work requirements, which may impact eligibility and access to care. Furthermore, as the Trump administration aligns its policies post-inauguration, the discussion around the role of "dark money" in Medicare Advantage payment rates is intensifying, potentially affecting accountability and transparency within value-based care frameworks, as highlighted by recent coverage of this phenomenon in the Becker's Payer Issues Newsletter.
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More
The One Big Beautiful Bill Act, enacted on July 4, 2025, established the first nationwide Medicaid work requirement, replacing prior state-specific Section 1115 demonstrations with a uniform federal s...
Amid fast-moving Medicaid changes, CMS vet offers providers and states advice
Hospitals and health systems are operating in a Medicaid environment defined by pressure, complexity and responsibility. Reimbursement remains constrained, administrative requirements continue to grow...
Minnesota sues CMS over Medicaid funding deferral
Minnesota Attorney General Keith Ellison and the Minnesota Department of Human Services have sued the Centers for Medicare and Medicaid Services and the Department of Health and Human Services for wit...
Health policy roundup: Minnesota sues over federal pause in Medicaid funding
Health policy roundup: Minnesota sues over federal pause in Medicaid funding  Advisory Board
CMS releases Medicaid billing data to expand fraud oversight
The Trump administrationâs ongoing push to address fraud in government healthcare programs includes the release of a massive data set showing Medicaid billing patterns of individual providers. With mo...
A Look at the Intersection of SNAP and Medicaid as States Implement Medicaid Work Requirements
This brief describes the intersection between Medicaid and SNAP and discusses how information from SNAP may be leveraged by states when implementing the new Medicaid work requirements.