Medicare & CMS Programs
Expert articles and analysis related to medicare & cms programs.
AI Summary — Last 30 Days
CMS is pushing Medicare VBC in two directions at once: expanding/iterating mandatory and specialty models such as CJR-X, TEAM, Kidney Care Choices, ACCESS, and the new LEAD ACO design, while also tightening scrutiny of Medicare Advantage payment levels and coding-driven plan advantages—raising the stakes for providers deciding between MA contracting, MSSP/ACO participation, and episodic risk (HFMA on MA payment changes). At the same time, congressional resistance to the WISER Medicare AI prior authorization pilot signals that automation in utilization management will face political and beneficiary-access constraints, even as CMMI under Director Abe Sutton leans into data, technology, and model redesign to improve savings and quality (Healthcare Dive on WISER pushback). For health systems and ACOs, the strategic throughline is clear: CMS is continuing to migrate accountability into more condition-specific and episode-based models, but success will depend on stronger analytics, post-acute management, specialist alignment, and a careful read of where federal policymakers draw the line between efficiency, access, and administrative burden.
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In April, CMS published its annual Medicare Advantage (MA) rate announcement for 2027.a For most years in recent memory, this would be a routine event, accompanied by no small amount of headshaking fr...
Federal Medicaid Work Requirements: What States Should Know | Aurrera Health Group
The Medical Frailty Exemption from Medicaid Work Requirements: Key Issues to Watch for in Upcoming CMS Guidance
This brief describes early state plans to operationalize the medical frailty exemption for Medicaid work requirements and identifies key issues and questions states are facing, some of which may be an...
CMS Targets State Payment Loopholes to Strengthen Medicaid Integrity
Arkansas Medicaid Waiver Renewal Request Would Reinstate Work Requirements For 212,000 ARHOME Beneficiaries - open minds
Arkansas Medicaid Waiver Renewal Request Would Reinstate Work Requirements For 212,000 ARHOME Beneficiaries open minds
How The New Medicare Home Care Framework Could Reshape The Industry
News Briefs: CMS proposes a modest increase to hospital inpatient payments for FY27
CMS projects an average Medicare inpatient payment increase of 2.4%, totaling $1.4 billion industrywide, when the new fiscal year begins Oct. 1. The update, described in a proposed rule for inpatient ...
Medicare Advantage Out-of-Pocket Limits: Variation and Trends
This brief analyzes out-of-pocket limits in Medicare Advantage plans in 2026, variation by plan type, the distribution of enrollees facing different out-of-pocket limits, and trends over time.