joe, Author at DeBrunner & Associates

ACA Marketplace Enrollment Declines

Nearly three million fewer people have enrolled in health insurance plans through the Affordable Care Act Marketplace than last year, according to new federal data. Enrollment in ACA plans so far this year stands at 19.2 million, down nearly three million, or 13 percent, from last year’s high of 22.1. This is the first time overall marketplace enrollment has declined since 2018. While many observers credit this decline to the elimination of enhanced subsidies that helped some people pay their insurance premiums, the administration attributes much of the decline to its success in addressing fraudulent applicants and applications. The reduced [...]

joe2026-06-30T17:05:56-04:00July 1, 2026|Affordable Care Act|

States Sue Feds Over Medicaid Work Requirements

Twenty-five states have sued the federal government in response to the interim final rule published by the Centers for Medicare & Medicaid Services to implement the enhanced work and community engagement requirements for Medicaid eligibility established in H.R. 1, last year’s federal budget reconciliation law. H.R. 1 calls for tougher standards for Medicaid eligibility, including a mandate that most Medicaid participants either work or are engaged in some form of approved community engagement, such as attending school or participating in volunteer work. But the 25 states – all with Democratic governors and attorneys general – claim that CMS’s implementation of [...]

joe2026-06-30T15:49:37-04:00July 1, 2026|Uncategorized|

Federal Health Policy Update for June 25

Don’t Miss: CMS posts a new presentation on Medicaid eligibility under HR 1 House health subcommittee marks up health care price transparency bills Cassidy proposes 340B bill HRSA announces two maternity-related funding opportunities The following is the latest health policy news from the federal government for June 19-25. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee’s Oversight Subcommittee held a hearing to discuss integrity and fraud risk in state Medicaid programs; witnesses included state Medicaid directors from California, Minnesota, New York, and Ohio. For more information, see the press [...]

joe2026-06-25T17:28:47-04:00June 25, 2026|340b, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy|

Remake of Organ Donation Process Continues

The current effort to remake the organ donation process is moving toward a critical juncture. The overhaul, launched more than two years ago as the “Organ Procurement and Transplantation Network Modernization Initiative,” has now moved to the stage where the organizations that facilitate organ donations in the future will be decided. The current plan, which seeks to boost the quantity of donated organs to meet national needs, is to identify and keep the highest performers among the current group of organ procurement organizations, revoke the certification of the weakest of the current performers, and invite organizations to compete for the [...]

joe2026-06-24T12:53:53-04:00June 25, 2026|Uncategorized|

States Finding Rural Transformation Money Comes With Strings

While the Centers for Medicare & Medicaid Services has announced grant awards to states under the Rural Health Transformation program, agency regulators have made it clear that they are prepared to take back some of that money if they do not like how a state’s planning is proceeding. Despite the federal approval of program funding, regulators continue to work with state Medicaid officials to mold their proposed programs to bring them into greater alignment with administration health care objectives. In some cases, states have already modified their plans in response to CMS feedback. According to one published report, CMS administrator [...]

joe2026-06-23T17:28:57-04:00June 24, 2026|Uncategorized|

Future Moms Face Challenge Finding Docs Who Accept Medicaid

The provider directories of Medicaid managed care plans often list maternal providers who do not accept Medicaid patients. At the same time, many of those provider directories list incorrect contact information for their participating maternal health providers. These are among the findings of the U.S. Department of Health and Human Services’ Office of the Inspector General. In two new audit reports, the OIG found that a review of several of the largest Medicaid managed care plans in the country found that anywhere from four to 22 percent of the maternal care providers listed in their provider networks were not actually [...]

joe2026-06-18T16:34:32-04:00June 22, 2026|Medicaid, Medicaid managed care|

Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold a hearing titled “State Medicaid Program Integrity: Examining Fraud Risks [...]

joe2026-06-18T16:07:51-04:00June 18, 2026|340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Making Sense of New Medicaid Medical Frailty Exemption

The recent release of new Medicaid work and community engagement requirements has raised nearly as many questions as it answers about who will and who will not be eligible for Medicaid when the new criteria take effect next year. While the work and community engagement requirements themselves are relatively straightforward, questions remain about the medical frailty exception and who, based on their medical condition, will be exempt from the work or community engagement requirement. A number of sources have reported on the medical frailty exception. NY Times – “Trump Administration Announces Stricter Rules for Medicaid Work Requirement” Health Affairs – [...]

joe2026-06-17T12:21:01-04:00June 18, 2026|Medicaid|

MACPAC Issues Report to Congress

The Medicaid and CHIP Payment and Access Commission has sent its 2026 report to Congress. The report – mandated by Congress – includes recommendations for: overseeing community engagement/work requirements in Medicaid, including MedPAC’s recommendation that the Centers for Medicare & Medicaid Services develop a transparent plan through which it can monitor and evaluate community engagement requirements improving CMS’s oversight of the use of automation in Medicaid prior authorization decisions improving the accountability of states’ Medicaid managed care programs appropriate access to residential treatment services for Medicaid-enrolled youth with special behavioral health needs and disabilities facilitating the transition of children and [...]

joe2026-06-17T09:45:11-04:00June 17, 2026|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care|

MedPAC Reports to Congress

The Medicare Payment Advisory Commission has issued its annual report to Congress. This year’s report examines: how Medicare payment incentives affect federal spending and the delivery of care and how those incentives can be improved the challenges beneficiaries encounter when deciding on their enrollment in Medicare how Medicare identifies improper payments – and how it can do so more effectively the association between enrollment in Medicare Advantage plans and provider finances access to selected palliative care services under Medicare’s hospice benefit MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding [...]

joe2026-06-16T16:58:28-04:00June 17, 2026|hospitals, Medicare, Medicare reimbursement policy|

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