The health insurance industry is facing a major downturn, driven by escalating issues in the Medicaid and ACA markets, as well as growing scrutiny of prior authorizations and pharmacy benefit managers, according to J. Mario Molina, MD, former CEO of…
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Nevada Gov. Joe Lombardo and the Nevada Department of Health and Human Services have announced the launch of the Nevada Health Authority, effective July 1. The NVHA consolidates the state’s Medicaid program, ACA exchange, and public employees’ benefits program under…
The COVID-19 pandemic cemented virtual care as a clinical mainstay. Now, health systems are shifting from survival mode to long-term strategy. But scaling telehealth sustainably demands more than new tech. It requires integrated staffing, standardized workflows and a sharp focus…
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Elevance Health has agreed to a $12.9 million settlement to resolve a class action lawsuit that accused the company of improperly denying coverage for residential treatment of mental health and substance use disorders. The lawsuit was originally filed in April…
Centene has pulled its earnings guidance for 2025, citing higher aggregate ACA market morbidity. In a July 1 regulatory filing, Centene said it received data from consulting firm Wakely indicating overall marketplace growth in 22 of its 29 marketplace states…
The affordability of employer-sponsored health insurance varies significantly by household income, according to a report from the Peterson-KFF Health System tracker. Average employer-sponsored insurance premiums have increased by 24% over the past five years, though deductibles have remained steady, according…
Ohio ended GLP-1 coverage for weight loss under its state employee health plan on July 1. Any current prior authorizations for medications will be honored until they expire, and GLP-1 medications prescribed for diabetes will continue to be covered. Several…
Representatives from Anthem Blue Cross Blue Shield and Columbia-based University of Missouri Health Care testified before a state committee on June 30 regarding a disagreement over reimbursement rates. Since April, MU Health Care’s physicians and facilities have been out of…
More than half of U.S. hospital facilities are over 50 years old, with $390 billion in deferred maintenance accumulating risk year over year. Aging HVAC, chillers and mechanical systems are more than operational headaches — they threaten care delivery and…
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Groups representing insurers are urging the House of Representatives to rollback steep Medicaid cuts passed by the Senate. The “One Big Beautiful Bill Act, a 1,000+ page budget reconciliation package, passed the Senate July 1. The Senate version would cut…