California Gov. Gavin Newsom is proposing freezing enrollment for undocumented immigrants in the state’s Medicaid program as it faces large budget shortfalls. A proposed budget published May 14 would freeze enrollment of undocumented immigrants ages 19 and older in Medi-Cal.…
Payer Policy Updates
House Republicans are looking to finalize the details of their budget reconciliation package by the end of the month, which would include major changes to health reimbursement arrangements and high deductible health plans. 10 notes: 1. Working seniors who are…
The Center for Medicare and Medicaid Innovation is laying out a new strategy, including plans to require all alternative payment models to involve downside risk. In a May 13 news release, Abe Sutton, director of the CMMI, wrote that the…
The nation’s uninsured rate is expected to rise exponentially if ACA premium tax credits expire and GOP lawmakers implement new Medicaid policies as part of a broader budget reconciliation package. In 2024, the U.S. uninsured rate across all ages was…
CMS has proposed including select Medicare Part B drugs in the third round of its drug price negotiation program, according to draft guidance released May 12. The agency said the proposal is designed to enhance transparency, focus on high-expenditure drugs…
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Health plans are backing a proposal from Connecticut Gov. Ned Lamont to cap the rates hospitals can charge for out-of-network services, the CT Mirror reported May 9. The measure would bar providers from charging more than 240% of Medicare rates…
HHS will not enforce mental health parity regulations opposed by some large employers and insurers. In a May 9 court filing, attorneys for HHS said the department intends to reconsider the rules and may issue a proposed rule rescinding or…
Alabama Gov. Kay Ivey has signed legislation that will allow nonprofit agricultural organizations to offer health benefits in a format that would be exempt from the state’s insurance regulations, a move highly criticized by BCBS Alabama. While not classified as…
Arizona lawmakers have passed legislation that mandates health insurers to have a medical director independently review all claims denials based on medical necessity. The bill, passed May 6, requires the medical director to exercise independent medical judgment and bans relying…
Health insurers face “relatively modest short-term effect from tariffs,” according to an April 28 brief from Fitch Ratings. The short-term effects could change though depending on how long tariffs last and the industries they apply to, and insurers could face…