Hospitals Penalized For Readmissions
The Centers for Medicare and Medicaid Services (CMS) announced that 2,334 hospitals, about 80% of those evaluated, are being penalized under the Hospital Readmissions Reduction Program in fiscal 2027. CMS said 244 hospitals, or 8.4%, received penalties of 1% or more. Ten hospitals will face the maximum 3% penalty, with 34 facing penalties of 2% or more. Most hospitals — 71.8% — will see penalties below 1%. The share of hospitals receiving no penalty will drop to 19.8% (578 hospitals) from 21.8% (641) in 2026.
The Fiscal 2027 round of penalties used both Medicare Advantage and fee-for-service data, but penalties continue to apply only to traditional Medicare payments. The performance period included discharges from July 1, 2023, to June 30, 2025.
#hospitals #quality #readmissions
Health Plan Enrollment Declines
Health insurers’ membership declined 2.8% year-over-year to about 312.5 million people in 1H 2026. Losses in the individual market and Medicaid exceeded gains in Medicare Advantage and employer-based plans. Individual market enrollment fell 17.2%, or 4.5M. Medicaid enrollment across managed care and fee-for-service programs fell 5.3% to 73 million, down 4.1 million.
Employer group risk enrollment fell 4.3% to about 46.7 million. Medicare Advantage enrollment grew 2% to about 35.1 million. Self-funded employer plans added more than 1.1 million members, up 0.8% to about 135.8 million.
#healthplans #enrollment
Exchange Plan Comers and Goers
Healthcare policy group KFF has analyzed entrants and exits to the Exchanges. Across 15 states, there are 15 plan exits, while five entrants.
#healthplans #exchangeshttps://www.kff.org/affordable-care-act/tracking-insurer-participation-changes-in-the-aca-marketplaces-in-2027/
KFF Looks At OBBBA State Impacts
Healthcare policy group KFF looks at the states impacted by various One Big Beautiful Bill Act (OBBBA), which reduces Medicaid by over $900 billion over 10 years. It looks at the states impacted by eligibility restrictions, work requirements, and provider tax limitations. #medicaid #obbba
— Marc S. Ryan
