President Donald Trump has signed the “One Big Beautiful Bill Act,” which includes major spending and policy changes for the Medicaid program and ACA markets. Jarrod McNaughton, CEO of Inland Empire Health Plan, wrote on LinkedIn on July 3 that…
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Medicare Advantage insurers are eliminating commission payments for some of their plans, a move that has drawn criticism from broker associations. Insurers typically pay brokers commission payments for enrolling new members, or renewing existing members in Medicare Advantage and Medicare…
Chorus Community Health Plans, the insurance arm of Milwaukee-based Children’s Wisconsin, will not offer individual and family ACA plans past 2025. In a June 26 letter to providers, the insurer’s president, Mark Rakowski, cited significant increases in medical and pharmaceutical…
Humana has launched its Medicaid business in Virginia. Virginia Cardinal Care beneficiaries can now select Humana as a Medicaid managed care plan, according to a July 2 news release. The state selected Humana as one of five insurers in 2024…
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…
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…
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…
The business case for embracing electronic prior authorization, or ePA, nationwide seems overwhelming. Current prior authorization processes are a chief driver of provider and patient frustration. Needed investment in FHIR APIs is now mandated by CMS Rule 0057, and ePA…