Payer Policy Updates

CMS has approved requests from five states to provide Medicaid coverage to incarcerated people before they are released. 

Oregon has launched a program to provide Medicaid benefits to individuals earning up to 200% of the federal poverty level, the Oregon Capital Chronicle reported July 1. 

Blue Cross and Blue Shield of Rhode Island is eliminating nearly 65% of prior authorization requirements for primary care providers by early 2025. 

The House Ways and Means Committee advanced a proposal to allow Medicare coverage of weight loss drugs for beneficiaries who were prescribed the drug for at least a year before switching to Medicare. 

Lawmakers are pushing CMS to do more to prevent misuse of artificial intelligence by Medicare Advantage plans. 

A federal court kept the ACA preventive care mandate in place for now but raised questions about its constitutionality. 

Washington state opened applications for its Medicaid-like health insurance program for  undocumented adult immigrants on June 20.

Three states recently passed legislation reforming the prior authorization process:

In 2025, Minnesota's Medicaid program will no longer award managed care contracts to for-profit HMOs.

The Illinois General Assembly has passed a pair of health insurance reform bills, which Gov. JB Pritzker has indicated he will sign.