redeterminations

This blog is part of a four-part series on Health Plan Economics. In this series, I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 3 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike Now that we have covered Medicare Advantage and the Exchanges, let’s move this week to what is happening in Medicaid managed care. Note that I base many of my

This blog is part of a four-part series on Health Plan Economics. In this series I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 2 – How The Lapse Of Premium Subsidies Could Hurt The Exchange’s Relatively Stable Finances I hope you are enjoying this blog series on health plan economics. Last week we covered some economics in the news right now for Medicare Advantage. This

This blog starts a four-part series on Health Plan Economics. In this series I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchange’s Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 1 – Medicare Advantage and New Rumors of Cigna-Humana Combination I had not thought much about the failed Cigna-Humana combination since it fell apart late last year. But I was intrigued by Jeffries analyst who just reported that the math now may work again

Following major changes in Medicare Advantage (MA) and Part D, the Centers for Medicare and Medicaid Services (CMS) finalized a number of rules impacting Medicaid, but specificially managed care. With the vast majoirty of Medicaid beneficiaries in managed care, CMS is targeting numerous prorgams to the managed care programs in states.  What are the major changes impacting Medicaid managed care? Waiting times/access Rates, spending, and transparency Quality and satisfaction Nursing homes The Biden administration finalized numerous changes impacting nursing homes, including minimum staffing requirements and directing that 80% of all payments from Medicaid (over a six-year period and with some flexibility) go to wages for aides and nurses.  The problem with the rule is that rates just are not sufficient enough to meet these requirements and proposals Biden has made. Proposals to increase dollars have not yet passed.  The fear is that the moves in each case could force many