Financial challenges are not new to healthcare. A perfect storm of converging trends has left many organizations operating within razor-thin margins in recent years.
For safety-net providers, the latest financial uncertainties introduced by the One Big Beautiful Bill Act present yet another hurdle. Many financial executives may fear making the wrong move and choose to “freeze” in response to Medicaid funding cuts that will equate to nearly $800 million.
Yet inaction is likely
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Medicaid | Medicaid Patients | Medicaid Reform | Regulation, Policy, Analysis, Insights - HIT Consultant
Medicaid Expansion: A Guide for Healthcare Providers to Prepare for Change
Medicaid is a lifeline for roughly 84.5 million people across the U.S., yet access to that safety net still depends on state lines. Ten states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming—continue to reject the Affordable Care Act (ACA) expansion, leaving an estimated 1.4 million adults in the infamous coverage gap. This category includes individuals whose earnings are too high for traditional Medicaid but still below the poverty level
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5 Million Adults Could Lose Medicaid Under Work Requirements in 2026
What You Should Know:
- Proposed work requirements for Medicaid could lead to millions of Americans losing their health insurance, according to a new analysis by the Urban Institute with support from the Robert Wood Johnson Foundation.
- The analysis projects that 4.6 to 5.2 million adults living in states that expanded Medicaid could lose their coverage in 2026 if work requirements are enacted.
Key Findings
Researchers caution that if work requirements were applied to
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Medicaid & Health Equity: Addressing Disparities in Maternal and Mental Health
Recent advancements in healthcare, such as telemedicine, automation, and clinical studies, have propelled the industry forward, unleashing new possibilities for fostering better patient outcomes. While many are lucky enough to reap the rewards of new research and technology, critical communities are being left behind.
The Medicaid population, who typically benefits from progress last, still grapples with harmful biases within the healthcare system that pose extreme barriers to care. A new
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CalAIM: How to Support CBOs in Medicaid Transformation
California’s bold new CalAIM Medicaid transformation program is restructuring what partnership for health looks like across the state. With a goal of better-integrating healthcare and social services for our most vulnerable residents, many eyes are turning toward local community-based organizations (CBOs) as a critical component of that evolution and investment in health equity. However, traditional health privacy, security infrastructure, and regulatory requirements, like HIPAA and HITRUST,
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The Future of Medicaid: 4 Considerations for MES Modernization
More than 75 million people access comprehensive and cost-effective care through Medicaid, including low-income families, older adults, and individuals with disabilities or chronic conditions.
Given the program’s importance in addressing the health needs of vulnerable populations, optimizing the experiences of Medicaid members and providers is critical. How they interact with the program can impact many outcomes, from member access and care utilization to provider participation and
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Navigating the Final CMS Medicaid Managed Care Rule (CMS-2439-F)
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final rule, Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality. The rule aims to promote consistency and transparency, with an increased focus on improving access, driving quality, and advancing equity for Medicaid beneficiaries. CMS has been moving in this direction for several years, and states managed care organizations, and providers have
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Cityblock, Sunshine Health Partner to Deliver Care to Florida Medicaid Members in Central Florida
What You Should Know:
- Cityblock, a value-based healthcare provider specializing in Medicaid, announced a new partnership with Sunshine Health, a Florida managed care plan. This collaboration aims to provide high-quality primary care and care coordination services to Medicaid beneficiaries with complex needs in Central Florida.
- The partnership expands Centene Corporation's, Sunshine Health's parent company, existing relationship with Cityblock. Cityblock has already established
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Pair Team Secures $9M to Connect Underserved Communities to Care
What You Should Know:
Pair Team, a virtual and community-based primary care solution connecting Medicaid's highest-risk patients to high-quality care, today announced it has raised $9 million in Series A funding. The financing was led by NEXT VENTURES, with participation from PTX Capital, Kapor Capital, Kleiner Perkins, Y Combinator, and several notable healthcare angel investors including Jay Desai.The funding will be used to help Pair Team accelerate its
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Waymark Secures $42M to Expand Community-Based Care for Medicaid Patients
What You Should Know:
- Waymark, a San Francisco, CA-based Medicaid provider enablement company raises $42M in new financing to scale technology-enabled, community-based care for primary care providers and their patients enrolled in Medicaid programs. The round was led by Lux Capital and CVS Health Ventures joins as a new investor.
- Existing investors Andreessen Horowitz (a16z) and New Enterprise Associates (NEA) also participated in the round. The investment consists of $22M in
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