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.
The federal Consolidated Appropriations Act (CAA) of 2021 brings significant changes to the American health care and health insurance industries – as well as many other changes to unrelated sectors.
Prescription drug costs for California’s massive Medicaid program were draining the state budget, so in 2019 Gov. Gavin Newsom asked the private sector for help.
A few weeks ago, state regulators imposed a record $55 million in fines on L.A. Care, California’s largest Medi-Cal managed-care plan, for failing to ensure adequate care and allowing treatment delays that threatened enrollees’ health. Patient advocates hope the move signals stricter enforcement against other Medi-Cal insurers, which have many of the same shortcomings for which the regulators just fined L.A. Care.
As you may have read in Paul Roberts’s recent compliance column, A Deep Dive into California “Single Payer,” the most recent effort to pass some sort of single-payer health care legislation in California failed. It marks the sixth time efforts have fallen short in a push to overhaul the state’s health care system.
AHIP, the top lobbying organization for commercial insurers, is warning the feds that provisions in its proposed rule governing the Affordable Care Act’s exchanges for 2023 could “undermine” the growing stability there. For instance, the group says in comments (PDF) submitted late Thursday that potential changes to requirements for essential health benefits would limit the ability for ...
Regional healthcare markets across the country have experienced significant divergence in commercial-to-Medicare price ratios between 2012 and 2019, causing insurers to pay wildly different rates to hospital systems. In areas like Chico, California and Tacoma, Washington, private payers saw hospital price ratios increase by over 100 percentage points. On the other end of the spectrum, ...
Private insurers who administer Medicare Advantage plans can expect a 5% average increase in federal payments next year — half a percentage point above what the Biden administration proposed in February. Why it matters: The pay bump in the controversial program marks a big win for insurers like UnitedHealth Group and Humana and doused speculation the ...
Amid worries that the latest coronavirus variant could spark another rise in cases, Medicare announced Monday that millions of enrollees will finally have access to free over-the-counter COVID-19 tests at drug stores. More than 59 million people with Medicare’s “Part B” outpatient coverage will be able to get up to eight free at-home tests per month, or ...
The Health and Human Services Department would get a 26.8% spending boost in fiscal 2023 under a budget proposal the White House issued Monday. The budget plan outlines President Joe Biden's health priorities, which include improving public health infrastructure, advancing mental healthcare and making maternal health more equitable.
U.S. health care spending is likely to grow at about the rate of inflation over the rest of the decade after the pandemic fueled a nearly 10% jump between 2019 and 2020, federal experts said Monday. The big picture: The CMS actuaries’ projections in Health Affairs came with plenty of caveats. But if trends hold, out-of-pocket spending is ...