Medicaid & Public Coverage
Expert articles and analysis related to medicaid & public coverage.
AI Summary ā Last 7 Days
This week saw continued turbulence in Medicaid and public coverage payment policy, as CMSās recently unveiled ACCESS Model payment rates drew criticism from stakeholders for falling below current reimbursement levels, intensifying pressure on providers already adapting to real-time repricing of physician enterprise and shifting site-of-care economics. At the same time, new CMS proposals would require Medicaid and other public payers to speed up and digitize prior authorization for prescription drugsāa move that could improve care access but places further operational demands on plans. Meanwhile, debates over coverage for high-cost drugs and home- and community-based services, including Californiaās Medi-Cal benefit design, signal growing tension between cost containment and equitable access for vulnerable populations.
Related Articles
4 Priorities for a Pivotal Moment in California Health Care
ANCOR Rebuts RFK Jr.ās Remarks On CDPAP, Home- And Community-Based Services
Health advocates warn Medi-Cal cuts to obesity drugs could worsen health disparities in California
Health advocates warn Medi-Cal cuts to obesity drugs could worsen health disparities in CaliforniaĀ Ā NBC Palm Springs
āA crisis in the makingā: Nebraska races to impose work requirements on Medicaid
āA crisis in the makingā: Nebraska races to impose work requirements on MedicaidĀ Ā Health Leaders Media
New Federal Medicaid Rules Require One Month of Work. Some States Demand More.
Starting next year, about 18.5 million adults will be subject to new Medicaid work rules in 42 states and Washington, D.C. Applicants must show theyāve been working for at least a month before receivi...
Medi-Cal Immigrant Enrollment Is Dropping. Researchers Point to Trumpās Policies.
A KFF Health News analysis found Medi-Cal lost almost 100,000 immigrants without legal status in the second half of 2025. California officials say itās not clear if immigrants are losing coverage fast...
The Medicaid SDP āFalse Plateau:ā Why Hospitals May See a Surge Before the Cliff
Recent guidance from the Centers for Medicare & Medicaid Services (CMS) on Medicaid State Directed Payments (SDPs) has been widely interpreted as a tightening of federal oversight. That interpretation...
Hospitals see danger to SDPs in fraud fight
Hospitals are worried that a coming Trump administration fraud-fighting effort will go after Medicaid state-directed payments (SDPs). The concern was raised by various hospital advocates responding to...
State Medicaid CoverageĀ of Certified Nurse Midwives
Learn how states use Medicaid reimbursement for certified nurse midwives to expand access to maternal care and improve perinatal outcomes. The post State Medicaid CoverageĀ of Certified Nurse Midwives ...
Reimagining Medicaid to safeguard Americaās children
Reimagining Medicaid to safeguard Americaās childrenĀ Ā Cornell Chronicle