Medicare & Medicaid
News articles in this section include actions by federal regulators like the CMS and HHS, as well as information on Medicare and state Medicaid coverage and benefits.
“This story was originally published by CalMatters. Sign up for their newsletters.” California has emerged as the epicenter of a sweeping hospice fraud crisis, one that is costing taxpayers hundreds of millions of dollars and putting vulnerable seniors at risk. Yet years after the state acknowledged the problem, key regulatory fixes remain in limbo while ...
At Martin Luther King, Jr. Community Hospital, patients on gurneys line the hallways of the emergency department waiting for care, and overflow mental health patients are consigned to outdoor tents. The 152-bed hospital, which sits on a sprawling medical campus close to the predominantly Latino and Black neighborhood of Watts, is struggling for financial stability. ...
Humana executives gave investors a peek Wednesday into the company’s thinking around the 2027 Medicare Advantage bid cycle as elevated costs continue to sting the industry. CEO Jim Rechtin said during the insurer’s earnings call that to achieve the goal of returning to a “stable margin” by 2028, it will need to look at adjustments ...
State officials remain uncertain on how to enforce a requirement that many adult Medicaid enrollees show they’re working — even as one state launches its program this week — and they’re taking a variety of approaches to the job, including, in a handful of states, using artificial intelligence. A KFF survey of Medicaid officials from 42 states and the ...
Big health insurers said today that they will standardize the process for submitting requests for prior authorizations for coverage for many common procedures by Jan. 1, 2027. Managers of the standards effort will start by applying it to “medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including ...
After decades of selling insurance, Illinois-based broker John Jaggi had never seen anything like it. More than 80 of his customers who were enrolled in the same Medicare supplemental plan from the insurer Chubb got hit last August with a 45% increase. “In my 49 years of doing biz as a broker, I’ve never seen ...
Officials have failed to halt pervasive fraud in the hospice industry despite promises of reforms five years ago after learning of widespread corruption that targeted vulnerable patients. California authorities promised to crack down after a Times investigation in late 2020 revealed that a cohort of mostly older Americans was being targeted by unscrupulous providers who ...
The system of paying Medicare agents and brokers more money if they enroll someone in a Medicare Advantage plan rather than traditional Medicare with a supplement plan needs to be changed, according to several members of the Medicare Payment Advisory Commission (MedPAC). “The broker compensation piece really frustrates me,” MedPAC member Stacie Dusetzina, PhD, of ...
Dozens of provider and patient advocacy associations are putting their weight behind a newly introduced bill they say will promote better management of Medicare patients with multiple chronic conditions. The bipartisan Chronic Care Management Improvement Act targets a copayment that beneficiaries must agree to before they may receive a slew of behind-the-scenes services coordinating their records and ...
The National Association of Benefits and Insurance Professionals (NABIP) today announced significant policy victories for agents, brokers, and the millions of Medicare beneficiaries they serve following the release of CMS’s Contract year 2027 Medicare Advantage and Part D Final Rule. The final rule reflects a strong alignment with NABIP’s advocacy to modernize Medicare marketing and ...