Literature Review

Medicare Advantage plan spending and payments under the hospice carve-outJAMA Network Open; by Meghan Bellerose, Andrew M Ryan, Claire K Ankuda, David J Meyers; 8/25In 2021, the Centers for Medicare & Medicaid Services implemented a Value-Based Insurance Design (VBID) model to test the impact of including hospice services in the Medicare Advantage (MA) benefits package. In December 2024, the VBID was ended following widespread dissatisfaction ... Under the carve-out model, after an MA enrollee elects hospice, health care related to their terminal illness is paid for by fee-for-service (FFS) Medicare. MA plans stop receiving the inpatient and outpatient portions of that enrollee's capitated payment but continue to receive premium and rebate payments. In this cross-sectional study, MA plans received high premium and rebate payments for beneficiaries enrolled in hospice despite low health care spending after enrollees elected hospice. To reduce excess payments, the Centers for Medicare & Medicaid Services could require MA plans to submit information on enrollees' use of supplemental benefits and adjust payments made after election of hospice to align with spending.

The hidden crisis in serious illness care and how we fix itMedCityNews; by Dr. Mihir Kamdar; 9/7/25 Every year, millions of Americans with serious illnesses find themselves caught in a dangerous limbo: not sick enough to qualify for hospice, but far too ill to be served by our traditional healthcare system. The result is care that’s expensive, fragmented, and often traumatic. These patients are shuffled between a revolving door of emergency rooms and ICUs, enduring a cascade of aggressive interventions that don’t match their goals or improve their quality of life. This approach not only undermines quality, it drives healthcare spending through the roof, particularly in the last year of life. This is the hidden crisis in serious illness care. And it’s getting worse. At the root of the problem is what many in the field call the “hospice cliff.” ...

Medicare still mattersHealth Affairs; by Marilyn Moon; 8/1/25In July 1965, Medicare and Medicaid were signed into law to provide basic health insurance for vulnerable populations. Over the past six decades, these two programs have transformed the US health care landscape, providing affordable coverage and access to care for tens of millions of Americans. To mark this milestone, the Forefront editors invited several Medicare and Medicaid experts to share their thoughts on where these programs began, how they’ve changed, and what may lie ahead. [Interesting article, including:]

Aveanna beefs up advocacy efforts, leans into preferred payer strategy Home Health Care News; by Joyce Famakinwa; 8/15/25 Amid an uncertain reimbursement environment and sea of recent policy updates, Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) remains focused on the strategies that have been helping the company achieve success. ... This means ramping up the company’s efforts around advocacy, as well as actively working with various state Medicaid programs. Home Health Care News caught up with Jim Melancon at last month’s National Alliance for Care at Home Financial Summit to learn more. Melancon serves as senior vice president of government affairs at Aveanna. ... The company has 327 locations across 34 states.

State Medicaid coverage policies for community-based palliative care: Lessons from NASHP’s State Institute National Academy for State Health Policy; by Ella Taggart, Wendy Fox-Grage; 8/11/25 Six states recently participated in NASHP’s two-year State Policy Institute to Improve Care for People with Serious Illness (the Institute): Colorado, Maine, Maryland, Ohio, Texas, and Washington. ... Specifically, the six participating states received guidance on policy mechanisms to cover palliative care services in the community and completed cost analysis on palliative care services for Medicaid beneficiaries. While all the states balanced the same forces and demands, ... each state modeled a benefit that was responsive to its particular needs and circumstances. ... CBIZ Optumas and TFA Analytics then designed a cost calculator for each state to help with different scenarios. 

National Alliance CEO Dr. Steve Landers: Hospice reform should mean more care, not less Hospice News; by Jim Parker; 7/28/25 Hospice reform efforts should focus on allowing for “more care, not less,” according to National Alliance for Care at Home CEO Dr. Steve Landers. Key elements of this should include home-based respite care and a payment system for high-acuity palliative services that hospice patients often lose out on due to the costs. ... “It means innovation in care, home-based respite services, better payment models for people that need things like dialysis or palliative radiation,” Landers said at the Alliance’s Financial Summit in Chicago. “That is that reform we’re talking about.” ... Landers also said that attempts at hospice reform should not “carve-in” hospice into Medicare Advantage. Bringing hospice under Medicare Advantage would undermine patient choice, adversely impact timely access to care and leave providers with lower reimbursement rates, according to the Alliance, the National Partnership for Healthcare and Hospice Innovation (NPHI) and LeadingAge

CMS plans hiring spree ahead of new payment models Becker's Hospital Review; by Alan Condon; 7/22/25 The CMS Innovation Center plans to hire a string of new employees as it plans to roll out several new payment models. The move comes four months after HHS, CMS’ parent department, cut about 5% of the agency’s workforce, Politico reported July 21. Four things to know:

Rural hospitals eye service expansions to weather federal cuts Modern Healthcare; by Alex Kacik; 7/14/25 Rural hospitals are hopeful they can add rather than reduce services to help soften the blow from looming Medicaid and Medicare cuts. ...  If rural providers cannot recruit physicians, lean more heavily on philanthropic donors or find other ways to reduce their reliance on Medicaid and Medicare reimbursement to get ahead of cuts in the law, hospitals will be forced to pare back services or close their doors, industry observers said. ... In response, rural providers have accelerated ongoing operational adjustments, including renegotiating vendor contracts, beefing up their coding and billing processes, freezing new hires and standardizing daily tasks to reduce administrative waste. But those tweaks alone cannot sustain rural hospitals, so some providers are aiming to grow surgeries, infusions and other services to boost their bottom lines, executives said.

Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF KFF; updated 7/8/25The chart tracking the Medicaid provisions in the House and Senate-passed version of the bill includes the following topics:  Medicaid Expansion, Eligibility Policies, Financing, Long-term Care, Access, and Prescription Drugs. The chart outlines details of the current law, House-passed bill, Senate-passed bill (enacted into law) and KFF Resources. Of particular note are the final work requirements in the statute, prohibiting the implementation, administration, or enforcement of certain provisions in both the CMS “Eligibility and Enrollment” final rules until October 1, 2034, and limits retroactive coverage to one month prior to application for expansion enrollees and two months prior to application for coverage for traditional enrollees, effective January 1, 2027. On July 1, 2025, KFF posted a CBO estimate of federal Medicaid spending reductions across the states including charts for components of the federal Medicaid cuts in the Senate reconciliation bill and a map of federal Medicaid cuts by state. Guest Editor’s Note, Judi Lund Person: While the details of the Medicaid provisions are daunting to understand and then apply to Medicaid enrollees in your area, I found this chart to at least organize the issues and track what happened between the House and Senate-passed versions, including what was enacted into law. More will likely unfold as we hear more from HHS and CMS about implementation.

'One Big Beautiful Bill Act': Key final Medicaid changes explained Morgan Lewis; by Jeanna Palmer Gunville and Tesch Leigh West; 7/9/25 The One Big Beautiful Bill Act was signed into law on July 4 and includes significant changes to the Medicaid program, particularly with regard to state and federal financing for the program. This LawFlash provides a high-level summary of certain key provisions that will impact various Medicaid stakeholders, including states, providers, and enrollees. ...

20 states sue after the Trump administration releases private Medicaid data to deportation officials Associated Press (AP), Washington, DC; by Amanda Seitz and Kimberly Kindy; 7/1/25The Trump administration violated federal privacy laws when it turned over Medicaid data on millions of enrollees to deportation officials last month, California Attorney General Rob Bonta alleged on Tuesday, saying he and 19 other states’ attorneys general have sued over the move. Health secretary Robert F. Kennedy Jr.’s advisers ordered the release of a dataset that includes the private health information of people living in California, Illinois, Washington state, and Washington, D.C., to the Department of Homeland Security, The Associated Press first reported last month. All of those states allow non-U.S. citizens to enroll in Medicaid programs that pay for their expenses using only state taxpayer dollars.

Medicaid provisions threaten home and community-based services for millions of vulnerable Americans National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 7/3/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature. “The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).” The home care community advocated throughout the legislative process for Congress to mitigate these harmful Medicaid provisions.

Trump administration shared Medicaid data with immigration officials: Report Straight Arrow News; by Kalé Carey; 6/13/25 A newly obtained government memo reveals that immigration officials received access to Medicaid data to assist in deportation efforts. ... The Associated Press reported that emails and a memo show the Department of Health and Human Services ordered staff at the Centers for Medicare and Medicaid Services to release data, including immigration status, on millions of federal program enrollees. The Department of Homeland Security was reportedly given the information, according to the Associated Press. Advisers to HHS Secretary Robert F. Kennedy Jr. gave CMS staff 54 minutes to hand over the data. CMS staff objected to the request, citing legal and ethical concerns over the type of data being shared. ...