Medicare Advantage Signal Feed

Revalidation of ‘High-Risk’ Medicaid Providers: Early Lessons from Minnesota

On April 23, the CMS Administrator, Dr. Mehmet Oz, issued a letter to State Medicaid Directors “formally asking that your state develop and submit a comprehensive two-year provider revalidation (PR) strategy….” This SMD is not posted on Medicaid.gov with all the other SMDs, but you can view it on the Fox News website. The state […]

Digital Health Tools and Technologies: An Overview of CMS’ Recent Efforts to Expand Their Use in Medicare

As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. This brief summarizes these initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to highlight facts...

Privacy Act of 1974; Matching Program

In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of a re-established matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), titled, "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act". Under this Matching Program, CMS will share da...

Medicare Advantage Insurers Deny Prior Authorization Requests for Post Acute Care at Substantially Higher Rates Than the Overall Denial Rate

Two recent reports find that Medicare Advantage organizations deny prior authorization requests for long-term care hospital, inpatient rehabilitation hospital, and skilled nursing facility stays at higher rates than requests overall. When these decisions are appealed, they are frequently overturned, particularly for skilled nursing facility stays. This may cause delays for Medicare beneficiaries who are particularly vulnerable or have high care needs.

Post Office Rural Service and Proposed Medicaid Work Reporting Requirements on Collision Course

I recently wrote about problems with the federal government’s suggested definition of “volunteer” in the proposed rule implementing the new law (H.R. 1) passed by Congress that requires patients to meet work/volunteer reporting requirements to maintain Medicaid coverage. The changes in this law are estimated to increase the number of uninsured Americans by 10 million people […]

Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies

This proposed rule would set forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this proposed rule discusses the behavior adjustment and proposes a temporary behavior adjustment and proposes to recalibrate the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low- utilization payment adjustment (LUPA) thresholds for CY 2027. Additionally, this proposed rule discu...

Georgetown CCF Medicaid/CHIP Expert Tricia Brooks Retires (sort of) and Will Return as Professor Emeritus

For anyone who has worked with Tricia Brooks over the last twenty years, it is impossible to imagine her retiring. Tricia has been the heart and soul of much of the Center for Children and Families’ work with state and national partners and a leading national expert on Medicaid eligibility and enrollment, health care quality, […]

Medicaid Work Reporting Requirements: States Ask a Federal Court to Protect Medically Frail Individuals from CMS Overreach

On June 3, CMS issued an Interim Final Rule (IFR) misinterpreting the work reporting requirements enacted last July in H.R. 1. The H.R. 1 provisions were bad enough, but as my colleague Leo Cuello has explained, the IFR imposes policies on states and individuals that the Congress did not enact. Most notably, the IFR makes […]

Ways & Means Committee Approves Legislation Protecting Taxpayer Rights, Improving IRS Services, Combatting Fraud, & Delivering Greater Nonprofit Transparency

WASHINGTON, D.C. – Americans that are held hostage or wrongfully detained abroad will no longer return home to massive tax... The post Ways & Means Committee Approves Legislation Protecting Taxpayer Rights, Improving IRS Services, Combatting Fraud, & Delivering Greater Nonprofit Transparency appeared first on Ways and Means .

Decoding Medicare Advantage Coding Intensity

Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS, the effects on beneficiaries, and other proposals to improve payment accuracy.

Medicare Will Spend More Than $13 Billion on the Medicare Advantage Quality Bonus Program in 2026

The Medicare program will spend at least $13 billion on the Medicare Advantage quality bonus program in 2026, as 68% of Medicare Advantage enrollees are in a plan that qualifies for higher payments under the program.

Nearly Four Million Medicare Beneficiaries Met the Eligibility Criteria in 2023 for the Medicare GLP-1 Bridge

Medicare has launched a temporary program covering GLP-1s for obesity for people with Medicare, known as the Medicare GLP-1 Bridge. This analysis estimates the number of Medicare Part D enrollees who could potentially qualify for the Bridge program by meeting all of the eligibility criteria, based on claims data from 2023.

ACA Marketplace Enrollment Is Down By 3 Million After Big Jump in Premium Payments

Enrollment dropped 13% following the expiration of enhanced premium tax credits at the beginning of this year. Enrollment fell from a high of 22.1 million people in 2025 to 19.2 million people in February 2026. While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments – often in the double or even triple digits – with the expiration of enh...

Medicaid Program; Community Engagement Requirement for Certain Individuals

Kane v. UnitedHealth Group, Inc.

Case 3:16-cv-01516-HES-MCR Document 114 Filed 06/26/26 Page 1 of 37 PageID 1209 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA JACKSONVILLE DIVISION UNITED STATES OF AMERICA ex rel. ROBERT KANE, FRANKLIN W. WEST, and INTREPID5, LLC, No. 3:16-cv-1516-HES-MCR Plaintiffs, v. UNITEDHEALTH GROUP, INC., et al., Original document

Guthrie: “If you’re cheating the system, we’re going to come after you. If you’re the most vulnerable, you’re going to be taken care of.”

**WASHINGTON, D.C.** - Yesterday, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, and Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, continued their fight against fraud in Medicaid programs across the cou...

Chairman Joyce Delivers Opening Statement at Subcommittee on Oversight and Investigations Hearing with State Medicaid Directors

**WASHINGTON, D.C.** – Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, delivered the following opening statement at today’s hearing titled _State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies._ **Subcommittee Chairm...

O&I Subcommittee Holds Hearing with State Medicaid Directors as Part of Committee’s Extensive Probe into Medicaid Programs Nationwide

**WASHINGTON, D.C.** – Today, Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, led a hearing titled _State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies._ _“Let me be clear: fraud is not isolated to these states. As w...

Protecting Patients and Taxpayers: Combating Healthcare Fraud and Leakage to Strengthen Program Integrity

The post Protecting Patients and Taxpayers: Combating Healthcare Fraud and Leakage to Strengthen Program Integrity appeared first on Paragon Health Institute .

Commonwealth of Massachusetts v. UnitedHealthcare Insurance Company

Case 1:26-cv-12853-PGL Document1-6 Filed 06/23/26 Page 1 of 639 EXHIBIT F Date Filed 5/29/2026 7:47 AM Superior Court Suffolk Case 1:26-cv-12853-PGL Document1-6 Filed 06/23/26 Page 2 of 639 Docket Number COMMONWEALTH OF MASSACHUSETTS SUFFOLK, ss. SUPERIOR COURT DEPARTMENT OF THE TRIAL COURT CIVIL ACTION NO. COMMONWEALTH OF MASSACHUSETTS, Plaintiff, V. COMPLAINT UNITEDHEALTHCARE INSURANCE COMPANY d/b/a UNITEDHEALTHCARE COMMUNITY PLANS OF kg MASSACHUSETTS, Defendant. The Commonwealth of Massach...

Request for Information (RFI): Pharmacy Benefit Manager Compensation and Data Collection

This request for information (RFI) solicits technical input on the services and business practices of pharmacy benefit managers ("PBMs") and their affiliates to inform implementation of recent legislation. It specifically focuses on gathering information to inform two specific legislative requirements that are effective beginning calendar year 2028: restrictions on the remuneration that PBMs and their affiliates may receive for services in connection with the utilization of covered Part D dru...

Cavagnuolo v. Becerra

insurance benefits, and Part C—also known as Medicare Advantage—acts as a coverage alternative that uses Original document

BMA Launches Campaign Around Accurate Medicare Advantage Data

Campaign comes as MedPAC is set to release its June report to Congress. WASHINGTON — Ahead of the Medicare Payment Advisory Commission’s (MedPAC) June Report to Congress, Better Medicare Alliance … Continue reading "BMA Launches Campaign Around Accurate Medicare Advantage Data" The post BMA Launches Campaign Around Accurate Medicare Advantage Data appeared first on Better Medicare Alliance .

Better Medicare Alliance Statement on HHS-OIG Prior Authorization Report

WASHINGTON —Better Medicare Alliance (BMA) issued the following statement today from Mary Beth Donahue, President and CEO of Better Medicare Alliance, on the HHS Office of Inspector General report on … Continue reading "Better Medicare Alliance Statement on HHS-OIG Prior Authorization Report" The post Better Medicare Alliance Statement on HHS-OIG Prior Authorization Report appeared first on Better Medicare Alliance .

Medicare Part D Enrollment, Premiums, and Cost Sharing in 2026

The Medicare Part D program provides an outpatient prescription drug benefit to 56 million older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analyzes Medicare Part D enrollment, premiums, and cost sharing in 2026 and trends over time, based on data from the Centers for Medicare & Medicaid Services (CMS).