Medicare & Medicaid Programs
Expert articles and analysis related to medicare & medicaid programs.
AI Summary — Last 30 Days
CMS under the Trump administration is simultaneously tightening Medicare Advantage economics and expanding mandatory/advanced episode and ACO-style models, signaling a shift toward more explicit payment discipline across both plans and providers. The 2027 MA rate process is being framed as an effort to curb plans’ “unfair payment advantage” over traditional Medicare, while CJR-X, TEAM-related policy, and the LEAD/ACCESS models push hospitals, specialists, and primary care ACOs toward more downside-risk, data-driven population management and episode accountability (HFMA on MA payment policy; [Aledade on LEAD](https://news.google.com/rss/articles/CBMiggFBVV95cUxQMjMwak1tRDRZS2lVam5pcXNYd2IxVS1ROWpGYXdGS2RYQUZwNUNYSExIZ092Z092bFMyV0dfNld0QV9rbG5GZnNkbmxXWENPQVZwUWxKbkF6Z09pWHg0NHdVdkJHUmpuS2luVUZNREZHdGdMNGxsTmk1SjRmSndHMnpR0gGSAUFVX3lxTE9malNfWV9oZ21sNExDTmhJUExHWX
Related Articles
CMS’s Medicaid state-directed payment rule would expand limits beyond hospitals
CMS’s proposed rule on Medicaid state-directed payments (SDPs) would implement limits authorized by the One Big Beautiful Bill Act (OBBBA) while applying restrictions to a broader swath of Medicaid, i...
Trump administration proposes crackdown on Medicaid state-directed payments
The proposed rule codifies cuts outlined in the GOP’s “One Big Beautiful Bill,” but also takes other steps to restrict supplemental Medicaid payments. The CMS said it would save the federal government...
Understanding Medicaid Cost Sharing and Policy Changes from the 2025 Reconciliation Law
This brief explains current Medicaid cost sharing rules and changes made to cost sharing rules by the 2025 reconciliation law, reports on cost sharing amounts states currently impose on ACA expansion ...
CMS to cap state Medicaid payments to save $775B: 7 things to know
CMS to cap state Medicaid payments to save $775B: 7 things to know Becker's Payer Issues
CMS to cap state Medicaid payments to save $775B: 7 things to know
Justice Department can question former Elevance exec in Medicare Advantage fraud case, judge rules
The site-neutral payment shift: What every ASC leader needs to watch
CMS’ 2026 Hospital Outpatient Prospective Payment System rule moves Medicare further toward site-neutral payment, as part of an effort to narrow long-standing payment gaps between hospital outpatient ...
Transitions to Adult Medicaid Coverage for Children and Youth with Special Health Care Needs - MACPAC - Advising Congress on Medicaid and CHIP Policy (.gov)
Transitions to Adult Medicaid Coverage for Children and Youth with Special Health Care Needs MACPAC - Advising Congress on Medicaid and CHIP Policy (.gov)
Lawmakers mull Medicare physician pay reform to tamp down consolidation
Physician pay hasn’t kept up with the costs of providing care, pushing independent practices to sell to health systems and likely increasing costs, witnesses said during a House subcommittee hearing W...
STAT+: Elevance executive ordered to testify in Medicare Advantage fraud case
The DOJ alleges Elevance fraudulently billed the government for inaccurate medical diagnoses.