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New Medicaid Work Requirement Could Slam Hospital Finances

The Medicaid work/community engagement requirement included in the “One Big Beautiful Bill” Act could cost hospitals millions of dollars – losses that could translate into potential declines of 11.7-13.3 percent in hospital operating margins, according to a Commonwealth Fund analysis based on Urban Institute data. Not all current Medicaid participants are subject to the new work and community engagement requirements but between 5.5 million and 6.3 million people are expected to lose their Medicaid benefits as a result of those requirements. Among them, some will be newly unemployed; some will [...]

October 1, 2025|Categories: hospitals, Medicaid|Tags: impact of Medicaid work requirement on hospital finances, Medicaid work requirement|

Hospitals to Face More Readmissions Penalties in 2026

Hospital readmissions penalties will increase, as will the size of the typical penalty, in the coming year. Beginning in FY 2026, the proportion of hospitals that will be penalized at least one percent for excessive readmissions under the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program will rise from seven percent of all hospitals to eight percent. The number of hospitals penalized less than one percent will decline. Hospitals that care for the highest proportions of dually eligible Medicare/Medicaid patients will see their penalties increase slightly. The penalties [...]

September 30, 2025|Categories: Centers for Medicare & Medicaid Services, Medicare|Tags: Medicare, Medicare hospital readmissions reduction program|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. The following is MACPAC’s own summary of its two days of public meetings. MACPAC’s September 2025 meeting began with a summary of Public Law 119-21, an Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 (2025 Budget Reconciliation Act, P.L. 119-21). This legislation included several provisions affecting Medicaid and the State Children’s Health Insurance Program (CHIP). In this session, staff provided a summary of the Medicaid and CHIP-related provisions in [...]

September 29, 2025|Categories: Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations|Tags: an Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 (2025 Budget Reconciliation Act, D.C. The following is MACPAC’s own summary of its two days of public meetings. MACPAC’s September 2025 meeting began with a summary of Public Law 119-21, Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, P.L. 119-21). This legislation included several provisions affecting Medicaid and the State Children’s Health Insurance Program (CHIP). In this session|

Federal Health Policy Update for September 25

The following is the latest health policy news from the federal government for September 19-25. Some of the language used below is taken directly from government documents. Federal Funding for Fiscal Year 2026 Telehealth and Acute Hospital Care at Home Program Flexibilities Many current telehealth flexibilities and authorization for the Acute Hospital Care at Home program will expire on September 30 unless Congress extends them. The following is CMS’s current guidance on these programs if they are not extended by September 30: The CMS Acute Hospital Care at Home web [...]

September 25, 2025|Categories: Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, hospitals, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid long-term services and supports, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|Tags: Acute Hospital Care at Home program, approved Medicaid state plan amendments, autism, Autism Data Science Initiative, Behavioral Health Integration Evidence-Based Telehealth Network Program, CDC ACIP, CDC advisory committee on immunization practices, CDC and chickenpox vaccines, CDC and COVID vaccines, CDC and MMRV vaccine, consolidation among physician practices, consolidation in health care, FDA and Barth Syndrome, federal government and autism, federal government shutdown, GAO report on urban hospitals, HB-1 visas, HB-1 visas for doctors and health care professionals, Independent Dispute Resolution entities, long covid, low-volume hospital adjustment program, MACPAC, Medicaid and CHIP and behavioral health, Medicaid and CHIP Payment and Access Commission, Medicaid and foster care, Medicaid and home- and community-based services workforce issues, Medicaid community engagement requirements, Medicaid disproportionate share, Medicaid DSH, Medicaid federal Medical Assistance percentage, Medicaid work requirements, Medicare Advantage provider directories, Medicare Part B and skin substitutes, Medicare Part D Senior Savings Model, MIPS, MLN Connects, No Surprises Act, Office of Management and Budget, provider relief fund, reasons urban hospitals close, Rural Community Hospital Demonstration, State Opioid Response program, telehealth|

Looking at Potential Health Coverage Losses

Changes adopted in the FY 2026 budget reconciliation bill (“the One Big Beautiful Bill” Act) could result in a significant increase in the ranks of the uninsured across the country. According to an Urban Institute analysis supported by the Commonwealth Fund, if current expanded health insurance premium tax credits end with the beginning of the new federal fiscal year on October 1, 4.8 million more people would become uninsured, a 21 percent increase. 3 million fewer people across the U.S. would get subsidized marketplace coverage. Premiums would soar. For people [...]

September 22, 2025|Categories: Affordable Care Act, deficit reduction|Tags: expanded health insurance premium tax credits, FY 2026 budget reconciliation bill, increases in health insurance premiums, increases in the number of uninsured, One Big Beautiful Bill Act, uninsured rates|

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