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Some States Step in to Help Offset Health Exchange Changes

Enhancing existing state subsidies to help pay health insurance premiums. Replacing lost premium tax credits. Reducing monthly premiums. Extending subsidies to some middle-income individuals and families. Mitigating the loss of eligibility for lawfully present immigrants. These are among the steps that some state governments have taken to try to offset the impact of changes in Affordable Care Act health exchange eligibility and insurance premium assistance that took effect on January 1. Learn more about these and other mostly one-year fixes from the Commonwealth Fund report “Some States Blunted the Impact [...]

April 22, 2026|Categories: Affordable Care Act|Tags: Affordable Care Act health insurance exchanges, enhanced health insurance premium tax credits, health insurance exchange eligibility|

CMS Introduces Next Step in Fighting Medicaid Fraud, Waste, and Abuse

In his agency’s latest attempt to identify and address Medicaid fraud, Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz has announced that states will have 30 days to submit to CMS a plan for revalidating all providers enrolled in their Medicaid programs. In explaining his rationale for this approach, Oz told participants at a recent event that "The basic thing you'd want to do, if you actually cared about the program, is to make sure that legitimate providers are providing services that you're paying for and doing it [...]

April 22, 2026|Categories: Centers for Medicare & Medicaid Services, Medicaid|Tags: Centers for Medicare & Medicaid Services, Medicaid, Medicaid fraud waste and abuse|

Federal Health Policy Update for April 16

The following is the latest health policy news from the federal government for April 11-16. Some of the language used below is taken directly from government documents. CMS – New Proposed Regulations FY 2027 Medicare Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Proposed Rule CMS has published its proposed FY 2027 Medicare hospital inpatient and long-term-care hospital prospective payment system rule. The highlights of the proposed rule are: A 2.4 percent rate increase for both acute-care hospital inpatient and long-term care hospital services. A $564 [...]

April 16, 2026|Categories: Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|Tags: CDC advisory committee on immunization practices, CMS ACCESS Model, CMS interoperability standards and prior authorization for drugs proposed rule, House Ways and Means Committee, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid and community-based behavioral health services, Medicaid and home and community-based services, Medicaid and prior authorization, Medicaid certified Community Behavioral Health Clinics CCBHC), Medicaid community engagement requirements, Medicaid managed care, Medicaid work requirements, Medicare Advantage, Medicare Part D, Medicare Payment Advisory Commission, MedPAC, MLN Connects, Programs of All-Inclusive Care for the Elderly PACE, proposed Medicare FY 2027 hospital inpatient prospective payment system rule, proposed Medicare FY 2027 long-term care hospital prospective payment system proposed rule, Rural Health Transformation Program, state directed Medicaid payments, Ways and Means Committee hearing on health care affordability|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. During the course of the deliberations, MACPAC’s staff made the following presentations to the commissioners: Implementing Community Engagement Requirements in Medicaid State and Federal Tools for Ensuring Accountability of Medicaid Managed Care Plans: Draft Chapter Children and Youth with Special Health Care Needs (CYSHCN) Transitions to Adult Coverage: Draft Chapter and Recommendations Automation in the Prior Authorization Process: Draft Recommendations Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care [...]

April 16, 2026|Categories: MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care|Tags: MACPAC, Medicaid and assistive technology, Medicaid and CHIP Payment and Access Commission, Medicaid and community-based behavioral health services, Medicaid and home and community-based services, Medicaid and prior authorization, Medicaid and the Program of All-Inclusive Care, Medicaid community engagement requirements, Medicaid managed care, Medicaid program integrity|

MedPAC Meets

MedPAC’s commissioners held their latest public meeting on Thursday, April 9 and Friday, April 11. The subjects on the meeting’s agenda were: improving payment incentives in Medicare analysis of regional benchmarks and benchmark-plan availability in the Part D prescription drug plan market preferred networks and pharmacy access in Part D estimated association between Medicare Advantage enrollment and hospitals’ and post-acute care providers’ finances information sources that beneficiaries use to make Medicare enrollment decisions institutional special-needs plans: provision of services, network-adequacy requirements, and star ratings mandated report: assessment of the Medicare [...]

April 15, 2026|Categories: Medicare regulations, Medicare reimbursement policy|Tags: Medicare Advantage, Medicare beneficiary enrollment decisions, Medicare ground ambulance data collection system, Medicare institutional special needs plans, Medicare Part D preferred networks and pharmacy access, Medicare Part D prescription drug plans, Medicare Payment Advisory Commission, Medicare payment incentives, MedPAC|

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