Memorial Hermann Health System plans to shut down its commercial health insurance business. The wind-down affects the Houston-based system’s HMO, PPO, and self-funded products for employers. On its website, the system said it would be difficult to reach the scale…

CMS has rescinded a decade-old “fast-track” review process for certain Medicaid Section 1115 demonstration waiver extensions as the agency prepares to implement new federal budget neutrality requirements that take effect in 2027. The July 7 informational bulletin formally withdraws 2015…

Payers owe a combined $11.2 billion in ACA risk-adjustment charges for 2025, CMS said at the end of June. Risk adjustment transfers funds within a state’s individual or small group market from insurers whose members have lower risk to insurers…

Now is past time for health plans to rethink how to marshal the clinical data needed to accurately report the future risk or care needs of their members. Today, most Medicare Advantage plans start this process every year with retrospective…

In 2026, insurers have been taking steps to hone their specialty pharmacy approaches. Some health insurers are expanding their offerings and venturing into healthcare services. Others are seeking strategies to tackle cost pressures, as prescription drug spend has been a…

Enrollment in ACA marketplace plans fell in 49 of the 50 states plus D.C. between February 2025 and February 2026, according to CMS data published in late June.  Ohio, Oklahoma and Arizona posted the steepest year-over-year declines, each shedding roughly…

Three federal lawsuits are forming a tapestry of litigation related to the future of the ACA marketplace.  In recent years, CMS has pitched rules focused on promoting marketplace “integrity” by tightening eligibility, altering enrollment periods and narrowing subsidy access, to…

Nearly 97% of UnitedHealth’s in-home Medicare Advantage diagnoses were supported by a patient’s medical record in 2025, according to a review commissioned by the company. The findings are the latest in UnitedHealth’s efforts to defend HouseCalls, the in-home care program…

Centene’s Ambetter is exiting Arkansas’ Medicaid expansion program, Arkansas Health and Opportunity for Me, in 2027. In a July 6 statement to Becker’s, the company attributed the decision to “current funding challenges.” Arkansas Health & Wellness — Centene’s managed care…

Blue Cross and Blue Shield of Louisiana has lost its most recent bid challenging how CMS calculated its 2025 Medicare Advantage star rating. On June 26, the U.S. Court of Appeals for the D.C. Circuit upheld a July 2025 district…