Payer Policy Updates

Illinois is expanding coverage of weight-loss drugs to state employees, a move Gov. JB Pritzker's office estimates could cost up to $210 million annually, WBEZ reported April 30.

Individuals who are part of the Deferred Action for Childhood Arrivals program will be able to enroll in ACA marketplace plans beginning in November.  

A federal appeals court has ruled that state health plans must cover gender-affirming surgery for transgender beneficiaries, The Washington Post reported April 30. 

CMS and the NCQA are extending the quality data submission deadline for health plans by two weeks due to "extraordinary circumstances" caused by the cyberattack on Change Healthcare in late February.

California lawmakers have introduced legislation again that would provide "comprehensive universal single-payer" health coverage for all 39 million residents of the state under a program called CalCare.

CMS will delay implementation of new policies designed to heighten security around Medicare and Medicaid data that drew criticism from researchers. 

CMS issued its final 2025 Medicare Advantage and Part D rule April 4, setting new standards around marketing, broker payments, and prior authorization.

CMS finalized several proposed changes to regulations for the ACA marketplace in 2025. 

CMS has finalized a slight decrease in Medicare Advantage benchmark payments for 2025, despite large insurers reporting rising costs and utilization among MA members.

CMS finalized a slight decrease in Medicare Advantage benchmark payments for 2025.