Medicaid Care Models
Expert articles and analysis related to medicaid care models.
AI Summary â Last 30 Days
Medicaid VBC activity is concentrating around state-based accountable care and waiver infrastructure: Medicaid ACOs are being positioned as vehicles for maternal health improvement through care coordination, quality measurement, and community-based supports, but leaders still face data-sharing, workforce, and attribution challenges that limit scalable impact (Milbank). At the same time, CMS is tightening operational and fiscal guardrails through prior authorization transparency requirements affecting Medicaid managed care plans and new Section 1115 budget-neutrality guidance, increasing pressure on states and MCOs to prove access, utilization management discipline, and measurable ROI in care model investments (SHVS). Indianaâs move to cover GLP-1 obesity drugs through the federal BALANCE Model signals a broader Medicaid test of high-cost therapeutics inside accountable payment frameworks, raising strategic questions for ACOs, MCOs, and states about pharmacy risk, outcomes tracking, and whether obesity treatment can be integrated into population-health contracting rather than treated as a pure cost trend.
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Analysis: At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits
An estimated $60 billion in federal Medicaid spending in 37 states (including the District of Columbia) would likely exceed new federal limits on state directed payments for hospital services once ful...
At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits
This analysis estimates the number of states impacted by and the amount of current federal spending on Medicaid state directed payments for hospital services that exceeds the new limits established by...
CMS ends Medicaid coverage of gender-affirming care for minors
Federal Medicaid funding no longer will be available to cover gender-affirming healthcare for minors, according to a CMS final rule issued Aug. 11. The rule blocks Medicaid and Childrenâs Health Insur...
Trump administration cuts Medicaid funding for youth gender-affirming care
CMS Administrator Dr. Mehmet Oz argues the rule will protect children from âirreversible harm.â LGBTQ+ advocates say itâs an attack on transgender youth.
Senate Medicaid hearing highlights the debate over federal spending cuts
Cuts to federal Medicaid spending are necessary to streamline the program and donât necessarily portend tough times for providers, conservative policymakers and analysts argued during a Senate hearing...
âWay off the reservationâ: Brookings researchers slam assumptions in CMS work requirements rule
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Ohio Medicaid Announces August 1, 2026 Statewide Expansion of Next Generation MyCare Program - open minds
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New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization - Office of Inspector General (.gov)
New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization  Office of Inspector...