Today's Top 20 Stories
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CMS publishes new guidance on Medicaid, CHIP coverage: 7 things to know
CMS is providing states new guidance to ensure states comply with required Medicaid services for children. -
OIG audits Humana, Aetna for Medicare Advantage overpayments: 10 things to know
Subsidiaries of Aetna and Humana received millions in Medicare Advantage overpayments in 2017 and 2018, the HHS Office of Inspector General alleged in audits published Sept. 25. -
16 payer headwinds to know
Payer executives are keeping a close eye on a shifting regulatory environment and ongoing provider shortages.
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Startup Medicare Advantage plan gets $140M
Startup Medicare Advantage plan Zing Health has raised $140 million in funding. -
Health systems back Centivo in $75M financing round
Centivo, a Buffalo, N.Y.-based health plan administrator for self-insured employers, has secured $75 million in equity and debt financing. -
10 providers seeking payer contracting talent
Ten providers recently posted job listings seeking leaders in payer contracting and relations. -
The biggest barrier to value-based success, per 1 exec
Resistance to change is the biggest barrier to value-based care, Monica Engel, senior vice president of Government Markets at Blue Cross Blue Shield of Minnesota, told Becker's.
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The lowest-rated health plans of 2024: NCQA
Of the 1,019 health plans rated by the NCQA in 2024, 13 received a rating of 2 stars or lower. -
How a 5-star Medicare Advantage plan approaches growth
Medicare Advantage plans "lacking substance" will not stand the test of time, Jordan Reigel, president of Essence Healthcare, told Becker's. -
CMS: States have 2 years to fix Medicaid renewal problems
States must be in full compliance with all of CMS' Medicaid renewal requirements by the end of 2026. -
UnitedHealthcare to add school-based mental health support in 14 states
UnitedHealthcare will provide mental healthcare to 1 million children in schools through a partnership with Hazel Health.
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The top GLP-1 challenge facing UPMC's health plan
Insurers, health systems, state health plans and self-funded employers are all grappling with how to cover the high cost of GLP-1 medications, with some large organizations limiting coverage or dropping benefits entirely in 2024. -
States with largest Medicaid enrollment declines
With Medicaid redeterminations complete in most states, Medicaid enrollment has decreased by 14.3% from March 2023, according to KFF. -
CVS Health sets quarterly dividend
CVS Health's board of directors approved a $0.665 per-share dividend to be paid Nov. 1. -
The best-rated commercial health plans in each state: NCQA
Three commercial plans received five-star ratings from the National Committee for Quality Assurance. -
How CareFirst guides AI startups
Healthworx, CareFirst Blue Cross Blue Shield's investment arm, aims to bridge the gap between an established insurer and scrappy startups, Managing Partner Doba Parushev said. -
Former payer exec: Older adults should avoid Medicare Advantage in 2025
During the upcoming annual enrollment period, seniors should opt for traditional Medicare over Medicare Advantage, according to seasoned healthcare executive Stacy Mays. -
Cigna to trim Medicare Advantage offerings in 8 states
Cigna Healthcare is exiting Medicare Advantage markets or making service area reductions in eight states for 2025, according to a Sept. 18 post from insurance brokerage firm Pinnacle Financial Services. -
States ranked by average monthly ACA subsidy per enrollee
West Virginia residents who receive health coverage on the ACA exchange receive the largest premium subsidies on average, while Minnesota residents receive the least, according to an analysis from KFF. -
Vance: Trump would make changes to ACA risk pools
Deregulating the individual insurance market would be part of former President Donald Trump's healthcare agenda in a second term, according to his running mate, Sen. JD Vance.
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