Medicaid & ACA Coverage

Over the last week, significant developments in Medicaid and ACA coverage highlight evolving state approaches and potential tensions for stakeholders in value-based care. Two states are inching closer to implementing work requirements for Medicaid, which could impact coverage and access for vulnerable populations, while ongoing litigation, such as the recent court ruling against Aetna regarding gender-affirming care, raises questions about payer responsibilities and care delivery within sustainable payment models. The KFF Medicaid Waiver Tracker indicates increasing state interest in utilizing Section 1115 waivers to explore innovative care strategies, pointing to a shifting landscape that will require CMS and payers to adapt swiftly to evolving policies and stakeholder expectations.