Industry News

Below are 20 recent industry news stories procured from a host of different sources. Unified Growth Partners / Coverage Champs / Medicare Champs does not endorse any views reported in these stories. 

News Headlines & Summaries

• Headline: Medicare home healthcare faces a funding cut. A new bill aims to halt that.
  URL: https://www.marketwatch.com/story/medicare-home-healthcare-faces-a-funding-cut-a-new-bill-aims-to-halt-that-ca7ce5d1
  Summary: A bipartisan bill, the Home Health Stabilization Act of 2025, has been introduced to prevent a proposed 6.4% rate cut for Medicare home health services in 2026-2027. Advocates warn that the cuts could reduce access for seniors and disabled people, pushing them into more expensive institutional care settings. (MarketWatch)
  
  

• Headline: Trump administration investigates Medicaid spending on immigrants in Democratic states
  URL: https://apnews.com/article/e45ed693630cce4321f0c0d0b07de442
  Summary: The Centers for Medicare & Medicaid Services (CMS) is reviewing Medicaid spending in six Democrat-led states that are thought to provide full coverage to undocumented immigrants beyond what federal law allows (which is limited to emergency and pregnancy-related care). California self-reported roughly $500 million in overbilling; the investigations are part of broader federal efforts to enforce eligibility limits and cut costs. (AP News)
  
  

• Headline: New York scraps expanded state health coverage, citing GOP budget law
  URL: https://www.axios.com/2025/09/10/new-york-phase-out-expanded-health-coverage
  Summary: New York State plans to eliminate its zero-premium health coverage program for many working-class residents (including DACA recipients) because of major federal funding cuts under a Republican budget law. The state will revert to earlier eligibility rules for its Essential Plan starting July 2026. (Axios)
  
  

• Headline: UnitedHealth expects majority members in top-rated Medicare plans in 2026
  URL: https://www.reuters.com/legal/litigation/unitedhealth-expects-majority-members-top-rated-medicare-plans-2026-2025-09-09/
  Summary: UnitedHealth projects that about 78% of its Medicare beneficiaries will be enrolled in plans rated 4 stars or higher in 2026, which would likely increase the reimbursements it receives under the Medicare program. This forecast comes as insurers prepare for the 2026 plan year and the release of CMS’s official Medicare Advantage star ratings. (Reuters)
  
  

• Headline: State Health Department spent $1.2B for non-NY residents, audit says
  URL: https://www.timesunion.com/capitol/article/state-health-department-spent-1-2b-non-ny-21037413.php
  Summary: A state audit found that between 2017 and 2024, New York’s Medicaid managed care payments included $1.2 billion paid for individuals no longer residing in the state, including $509 million for over 155,000 people flagged as non-residents. Problems with residency verification contributed to the overspending. (Times Union)
  
  

• Headline: NY will shift 450K New Yorkers off Essential Plan, blaming Trump
  URL: https://www.timesunion.com/capitol/article/ny-shift-450k-new-yorkers-essential-plan-blaming-21041198.php
  Summary: Because of federal funding cuts (attributed to recent GOP policy changes), New York State will reduce eligibility for the Essential Plan, a no-premium insurance option, causing about 450,000 people to lose coverage by summer 2026. The plan will revert to its pre-2024 eligibility rules. (Times Union)
  
  

• Headline: CMS issues preliminary guidance on Medicaid state-directed payments as part of OBBBA implementation
  URL: https://www.aha.org/news/headline/2025-09-09-cms-issues-preliminary-guidance-medicaid-state-directed-payments-part-obbba-implementation
  Summary: CMS has put out earlier guidance for states on how to implement the state-directed payment changes under Section 71116 of the “One Big Beautiful Bill Act” (OBBBA). The guidance addresses rating periods, definitions, “good faith efforts,” and grandfathered payment plans, to help states adjust ahead of compliance deadlines. (American Hospital Association)
  
  

• Headline: CMS issues guidance to states on Medicaid managed care changes
  URL: https://www.hmenews.com/article/cms-issues-guidance-to-states-on-medicaid-managed-care-changes
  Summary: CMS has outlined new safeguards for state-directed payments under Medicaid managed care, effective for rating periods starting July 4, 2025. Key elements include caps on state-directed payments (SDPs) relative to Medicare rates, grandfathering certain existing arrangements through 2028, and instructions for states to revise pending or future SDP proposals to comply. (HME News)
  
  

• Headline: What You’ll Pay for Medicare in 2025 — Part B Premiums & Deductibles update
  URL: (From blog) – not a major news outlet but useful: link “What You Need to Know About Medicare Part B Premiums in 2025”
  Summary: The standard monthly Medicare Part B premium for 2025 is $185.00. Deductibles and income-related surcharges (IRMAA) will also apply, depending on income; delaying enrollment can lead to penalties. (Larry Plewniak - Larry Plewniak)
  
  

• Headline: Expanding Access to Health Insurance: Consumers to Gain Access to “Catastrophic” Health Insurance Plans in 2026 Plan Year
  URL: https://www.cms.gov/newsroom/fact-sheets/expanding-access-health-insurance-consumers-gain-access-catastrophic-health-insurance-plans-2026
  Summary: CMS is issuing new hardship exemption guidance so that individuals who are ineligible for premium tax credits or cost-sharing reductions (or whose incomes disqualify them) may still enroll in catastrophic plans under Affordable Care Act marketplaces for the 2026 plan year. This seeks to provide coverage options for those most squeezed by rising premiums. (Centers for Medicare & Medicaid Services)
  
  

• Headline: CMS Issues Guidance to Strengthen Oversight of Medicaid State-Directed Payments
  URL: https://www.cms.gov/newsroom/press-releases/cms-issues-guidance-strengthen-oversight-medicaid-state-directed-payments (Centers for Medicare & Medicaid Services)
  Summary: New preliminary guidance from CMS imposes payment limits on Medicaid “state-directed payments” (SDPs) to combat fraud, waste, and abuse, while seeking to preserve access to care. (Centers for Medicare & Medicaid Services)
  
  

• Headline: CMS issues guidance on cuts to Medicaid state-directed payments
  URL: https://www.healthcaredive.com/news/cms-issues-guidance-on-cuts-to-medicaid-state-directed-payments/759731/ (Healthcare Dive)
  Summary: Under the One Big Beautiful Bill Act, state-directed payments for Medicaid will be capped in most settings at 100% of Medicare rates in expansion states and 110% in non-expansion states; payments submitted before July 4, 2025 may be grandfathered until 2028. (Healthcare Dive)
  
  

• Headline: HHS Expands Access to Affordable Health Insurance
  URL: https://www.cms.gov/newsroom/press-releases/hhs-expands-access-affordable-health-insurance (Centers for Medicare & Medicaid Services)
  Summary: HHS has introduced new hardship exemption guidance to help consumers who don’t qualify for premium tax credits or cost-sharing reductions gain access to catastrophic health insurance plans; this change goes into effect with the open enrollment period beginning Nov 1. (Centers for Medicare & Medicaid Services)
  
  

• Headline: Expanding Access to Health Insurance: Consumers to Gain Access to “Catastrophic” Health Insurance Plans in 2026 Plan Year
  URL: https://www.cms.gov/newsroom/fact-sheets/expanding-access-health-insurance-consumers-gain-access-catastrophic-health-insurance-plans-2026 (Centers for Medicare & Medicaid Services)
  Summary: The CMS is clarifying that individuals experiencing financial hardship and ineligible for tax credits could still enroll in catastrophic plans in 2026 under certain eligibility criteria, helping those facing rising premiums maintain some coverage. (Centers for Medicare & Medicaid Services)
  
  

• Headline: Rural Washington hospitals brace for fallout from Medicaid cuts
  URL: https://www.cascadepbs.org/news/2025/09/rural-washington-hospitals-brace-for-fallout-from-medicaid-cuts/ (Cascade PBS)
  Summary: Hospitals in rural Eastern Washington warn that recent federal policy changes (notably under H.R. 1) will reduce Medicaid funding in ways that threaten their financial viability; service reductions or closures are possible. (Cascade PBS)
  
  

• Headline: Massachusetts state health insurers to be required to cover vaccines, regardless of CDC guidance
  URL: https://apnews.com/article/604c6456827b93322b8811a0e3ebf485 (AP News)
  Summary: Massachusetts has passed a policy mandating that state-regulated health plans cover vaccines recommended by its health department, even if the CDC no longer endorses them; this is part of the state's pushback against recent changes at the CDC. (AP News)
  
  

• Headline: What You Will Pay for Medicare in 2025
  URL: https://www.kiplinger.com/retirement/medicare/what-you-will-pay-for-medicare-in-2025 (Kiplinger)
  Summary: This article outlines the 2025 cost changes for Medicare: the Part B premium is up, deductibles have increased, and there are higher coinsurance amounts (for example, skilled nursing coinsurance for days 21-100). (Kiplinger)
  
  

• Headline: UnitedHealth expects majority members in top-rated Medicare plans in 2026
  URL: https://www.reuters.com/legal/litigation/unitedhealth-expects-majority-members-top-rated-medicare-plans-2026-2025-09-09/ (Reuters)
  Summary: UnitedHealth forecasts that about 78% of its Medicare members will be enrolled in plans rated 4 stars or higher in 2026, which affects both consumer choice and how reimbursements are calculated by CMS. (Reuters)
  
  

• Headline: NY will shift 450K New Yorkers off Essential Plan, blaming Trump
  URL: https://www.timesunion.com/capitol/article/ny-shift-450k-new-yorkers-essential-plan-blaming-21041198.php (Times Union)
  Summary: Federal funding cuts have forced New York to roll back its “zero-premium” Essential Plan for many working-class residents (including lawfully present immigrants), ending expanded eligibility and shifting ~450,000 people off the plan by July 2026. (Times Union)
  
  

• Headline: New York scraps expanded state health coverage, citing GOP budget law
  URL: https://www.axios.com/2025/09/10/new-york-phase-out-expanded-health-coverage (Axios)
  Summary: Because of deep cuts in federal support caused by a Republican budget law passed in July, New York will end zero-premium health coverage for many who benefited from the expansion, including DACA recipients; the rollback is tied to the state reverting the Essential Plan to its pre-2024 eligibility rules by mid-2026. (Axios)