Payer

As more hospitals and health systems grow frustrated with Medicare Advantage plans, Ascension is among the organizations rethinking how — and whether — to continue participating. Delays in care, high denial rates and growing administrative burdens are prompting tougher contract…

Preventive care significantly improves health outcomes—cancer screening alone has added as many as 16 million years to people’s collective lifespans. Yet only about 5% of adults receive the screenings recommended for their risk factors.   That isn’t a gap. It’s a chasm.  Preventive care detects serious illnesses early, when treatment is most effective. With 90% of the nation’s $4.5 trillion in annual health care…

Nevada Medicaid is seeking proposals from insurers to offer a Coordination Only Dual Eligible Special Needs Plan. Proposals are due Feb. 17, with a contract expected to run from Jan. 1, 2027 through Dec. 31, 2030. The state may award…

Sidecar Health is bringing its fully insured health insurance product to Texas, according to a Jan. 22 news release. Sidecar said Texas is one of the largest employer markets in the U.S. According to recent survey data, about one-third of…

A federal judge has ruled that Luigi Mangione will not face the death penalty in the federal case stemming from the killing of UnitedHealthcare CEO Brian Thompson. On Jan. 30, U.S. District Judge Margaret Garnett dismissed two of the four…

CMS has issued a final rule that will end states’ ability to levy provider taxes to generate additional federal Medicaid matching funds, a financing mechanism the agency characterized as a “loophole.” The rule, effective April 3, implements changes included in…

Becker’s connected with 17 health plan leaders to learn how their organizations are shifting their priorities in response to continued medical cost trends and affordability concerns. Like what you see here? Join us at the Spring Payer Issues Roundtable in Chicago.…

Enhanced ACA premium tax credits expired Dec. 31, leaving millions of marketplace enrollees facing higher premiums in 2026. A bipartisan group of senators continues negotiating, and Republicans are preparing a “best and final” offer on a two-year extension with income…

Sen. Bernie Moreno, R-Ohio, said his party is preparing to make its “best and final offer” to extend the ACA enhanced tax credits, Politico reported Jan. 28.  Mr. Moreno has been a lead negotiator in a bipartisan effort in the…

Ten health technology companies have pledged more than $600 million in no-cost and discounted services to help states implement Medicaid work requirements. According to a Jan. 29 news release from CMS, the commitments support implementation of work, education and community-based…