Network Adequacy
Expert articles and analysis related to network adequacy.
AI Summary — Last 7 Days
Network adequacy pressure is intensifying across Medicare Advantage and Medicaid as CMS scrutiny, provider access disputes, and workforce shortages converge: Elevance temporarily avoided an MA enrollment freeze, while hospitals and ASCs are escalating concerns that MA network narrowing and contract terminations are undermining beneficiary access and provider participation in risk-based arrangements. In Medicaid, states are preparing for 2025 reconciliation-law work requirement implementation amid budget shortfalls, with North Carolina offering an early view of how eligibility changes, medical-frailty exemptions, and administrative burden could affect coverage continuity and access for managed care and VBC populations (KFF; Wakely). The underlying delivery-system constraint is worsening: projected PCP and specialist shortages—including reports that nearly 70% of U.S. counties lack a GI—raise the stakes for ACOs, MA plans, and Medicaid MCOs that are accountable for access, quality, and total cost of care but increasingly lack sufficient local provider capacity.
Related Articles
Are Medicare Advantage plans dropping ASCs from their networks?
Are Medicare Advantage plans dropping ASCs from their networks?  Becker's ASC
Lexington Medical Center, Cigna reach agreement after months out of network
Lexington Medical Center, Cigna reach agreement after months out of network  Becker's Payer Issues
Nearly 70% of US counties lack a GI: 13 concerning workforce stats
Nearly 70% of US counties lack a GI: 13 concerning workforce stats  Becker's ASC
Access to Higher-Level Neonatal Care Depends on Where You Live
Access to Higher-Level Neonatal Care Depends on Where You Live  AcademyHealth
Tennessee: Primary Care Health Professional Shortage Areas If Family Physicians Were Withdrawn - American Academy of Family Physicians | AAFP
Tennessee: Primary Care Health Professional Shortage Areas If Family Physicians Were Withdrawn  American Academy of Family Physicians | AAFP
States with the highest, lowest PCP shortages in 2028
States with the highest, lowest PCP shortages in 2028Â Â Becker's Hospital Review
H1 secures $40M in funding for its AI healthcare provider directory
Provider-focused data company H1 has received a $40 million investment in a round led by CVS Health Ventures, the investment arm of CVS Health, which H1 has recently collaborated with on several proje...
‘We’ve seen some slippage’: Hospitals open a new front in the Medicare Advantage fight
‘We’ve seen some slippage’: Hospitals open a new front in the Medicare Advantage fight  Becker's Hospital Review
Week in Washington 05/28/26
Medicaid Regulation Watch: All eyes are on CMS as it prepares for the release of the Medicaid work requirements regulation. One of the key questions is what flexibilities states will have around the d...