In a Feb. 9 exchange with The Topeka Capital-Journal, Democratic Gov. Laura Kelly of Kansas appeared to acknowledge her lame-duck status regarding her attempts to achieve Medicaid expansion for the state, a longtime key item of her administration’s platform. “There’s…
Payer
A University of Minnesota Medical School course formed in partnership with UnitedHealth Group will undergo revisions, the Minneapolis-based school confirmed to Becker’s Feb. 11. First taught in 2024, “Leadership and Value: A UnitedHealth Group-UMN Collaboration” is a fourth-year elective that…
Dallas-based Tenet Healthcare expects a 20% reduction in ACA exchange enrollment this year with the expiration of enhanced premium tax credits set to pressure hospital earnings and payer mix. The company is projecting adjusted EBITDA of up to $4.8 billion…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Baylor Scott & White Health, based in Dallas, seeks a director of payer…
Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo., have introduced legislation that would prohibit companies from simultaneously owning a health insurer or pharmacy benefit manager and a medical provider or management services organization, and would require companies in violation to…
Advertisement
The House Judiciary Committee issued subpoenas Feb. 9 to eight health insurers, seeking documents about potential fraud issues related to ACA marketplace subsidies. The subpoenas target Blue Shield of California, Centene, CVS Health, Elevance Health, GuideWell, Health Care Service Corp.,…
CMS unveiled a proposed rule Feb. 9 that would reshape the ACA marketplace for plan year 2027, expanding insurer flexibility on plan design, tightening eligibility verification, and re-introducing several program integrity measures that were blocked by a federal court last…
Montana has clawed back more than $23 million in fraudulent claims after PacificSource flagged more than 200 suspicious ACA enrollments tied to as much as $54.7 million in unjustified claims. A state investigation identified a scheme in which out-of-state individuals…
Alameda Alliance for Health, a county-organized Medicaid managed care plan serving more than 400,000 members in Alameda County, Calif., is bracing for a potential 40% to 45% reduction in membership over the next three years as federal Medicaid cuts and…
Alliance of Community Health Plans President and CEO Ceci Connolly sees momentum around risk adjustment reform picking up. “We see this administration taking very seriously the concerns over wide gaps in risk adjustment payments — gaps that are far outside…