Medicare & Medicaid Programs
Expert articles and analysis related to medicare & medicaid programs.
AI Summary — Last 30 Days
CMS is pushing Medicare VBC further into technology-enabled chronic disease management through the ACCESS Model, with recent coverage expansion to heart failure, COPD, substance use disorders, and tobacco use for spring 2027—signaling a longer runway for providers, vendors, and MA/ACO-aligned care teams to build remote monitoring, care coordination, and outcomes-tracking infrastructure despite skepticism about whether the payment economics will be sufficient (ACCESS expansion). In Medicaid, the strategic pressure is moving in two directions at once: Medicaid ACOs are being positioned as vehicles to improve maternal health quality and workforce-enabled access, while the 2025 reconciliation law’s eligibility, financing, and work-requirement changes create enrollment volatility and risk-adjustment challenges for safety-net VBC organizations (Medicaid changes). Across both programs, the looming prior authorization API deadline is forcing payers and providers to operationalize interoperability not as compliance plumbing but as a core VBC capability for reducing friction, managing utilization, and connecting care coordination to measurable clinical outcomes.
Related Articles
U.S. poised to boot legal immigrants from Medicaid, including refugees and sex-trafficking victims
Hundreds of thousands of immigrants with legal status, including refugees and sex-trafficking victims, are at risk of losing government health coverage starting Oct. 1.
CMS guidance details how states can apply the Medicaid medical frailty exemption
New guidance from CMS explains how states can operationalize the medical frailty exemption to the Medicaid work requirement. Per the guidance, the intent is for states to identify medically frail bene...
Medicaid tax rule goes beyond the statute, say hospitals
A proposed rule to implement provider tax provisions of the 2025 Medicaid overhaul would be far more restrictive than that law required, say hospital advocates. Hospitals raised those concerns in resp...
CMS and 37 States Pledge to Judge Medicaid Care by Whether Patients Get Healthier, Not Paperwork Checklists
CMS and 37 States Pledge to Judge Medicaid Care by Whether Patients Get Healthier, Not Paperwork Checklists Medical Daily
Early Medicaid Work Requirement Insights From Nebraska
This brief describes the verification process for Medicaid work requirements in Nebraska and examines early data on outcomes for individuals subject to work requirements.
5 governors push HHS to delay Medicaid work requirements
5 governors push HHS to delay Medicaid work requirements Becker's Payer Issues
5 governors push HHS to delay Medicaid work requirements
5 governors push HHS to delay Medicaid work requirements Becker's Payer Issues
US Poised To Boot Legal Immigrants From Medicaid, Including Refugees and Sex-Trafficking Victims
From newsletter: The Week in Brief: A Wrenching Choice for Dementia Patients’ Families The Week in Brief: A Wrenching Choice for Dementia Patients’ Families Plus: 100 nursing homes that face perilous ...
Attorney General James Announces Arrest of Queens Dentist Who Stole Over $300,000 from Medicaid - Office of Inspector General (.gov)
Attorney General James Announces Arrest of Queens Dentist Who Stole Over $300,000 from Medicaid Office of Inspector General (.gov)
US Poised To Boot Legal Immigrants From Medicaid, Including Refugees and Sex-Trafficking Victims
From newsletter: This Week: Medicaid Work Requirements - Early Insights from Two States This Week: Medicaid Work Requirements - Early Insights from Two States Plus, rural MAHA followers day Trump he...