Medicare & Medicaid Programs

Medicare and Medicaid VBC activity this week centered on operational execution: CMS’s ACCESS Model is drawing attention as a technology-enabled chronic disease and care-coordination model that ties population health infrastructure more directly to clinical outcomes, while payers and providers face a looming Jan. 1 prior authorization API deadline that could materially affect MA, Medicaid managed care, and ACO workflows if implementation remains uneven (Epic prior authorization analysis). At the same time, Medicaid stakeholders are preparing for eligibility and financing changes from the 2025 reconciliation law—including work requirements affecting millions—creating risk for coverage churn, attribution instability, and care-management disruption in Medicaid-focused VBC arrangements (KFF Medicaid changes update). The broader payer backdrop is tightening: Centene’s workforce reductions and improving Medicare outlook, Molina/Elevance earnings attention, and shrinking Medicare Advantage options in states like Minnesota all point to margin pressure driving benefit, network, and administrative changes that providers and ACOs will need to price into 2026 contracting and population health strategy.