The Rhode Island Executive Office of Health and Human Services proposed pulling back on Medicaid’s coverage of GLP-1s for weight loss, according to a budget document acquired by the Rhode Island Current. In April, the Trump administration said it will…
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CMS released Medicare Advantage star ratings on Oct. 9, showing an average score of 3.65 for 2026, compared to 3.92 last year. Plans were evaluated by the agency across 40 quality criteria spanning outcomes, experience, access, operations, and pharmacy. Plans…
West Virginia may have paid managed care organizations up to $32.4 million for ineligible Medicaid participants, according to an October audit report. The audit examined payments from 2019 to 2020 and was inspired by Louisiana audits involving Aetna. MCOs get…
The Medicare Part D market is entering 2026 amid a period of contraction and recalibration. Premiums are ticking down on average, but plan options are shrinking as major insurers reassess the profitability of standalone drug plans under the effects of…
California Gov. Gavin Newsom has signed a bill into law allowing the state’s Department of Managed Health Care to waive prior authorizations for services or prescriptions that payers approve at least 90% of the time. Senate Bill 306 also requires…
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Sixty-five percent of U.S. voters believe Democrats should accept a continuing resolution to end the government shutdown instead of holding out for extended ACA funds, according to a Harvard CAPS-Harris Poll. The survey ran Oct. 1-2, gathering results from 2,413…
The Maryland Department of Health is streamlining three Medicaid waiver programs overseen by the Developmental Disabilities Administration into a single program, according to an Oct. 6 news release. The unified waiver program aims to help those with intellectual and developmental…
It was Tuesday at 3pm, and Michael, a health plan compliance officer, paced around his office in frustration. A new state law mandated a fundamental change in reporting data related to claims reimbursement policies. The deadline was looming, and his…
The American Hospital Association critiqued the Medicare Payment Advisory Commission’s initial assessment of Medicare Advantage enrollment changes and its effect on hospital finances, according to an Oct. 3 letter from Molly Smith, AHA’s group vice president of public policy. MedPAC…
Sentara Health Plans will not offer Medicare Advantage, MA prescription drug HMO, or C-SNP plans in Virginia, North Carolina and Florida in 2026. “These products are no longer financially sustainable in the current environment. Industry-wide headwinds and market dynamics, including…