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California’s changing Medicare landscape for dual-eligible beneficiaries
We examine the evolving dynamics as California’s Medicare Advantage market for dual-eligible beneficiaries shifts toward integrated D-SNPs delivering Medicare and Medicaid.
From counterfactuals to actuarial certification: The new math behind Medicaid innovation
We review five actions that state Medicaid agencies can take now to ensure the viability of current and future 1115 waivers.
Strengthening the other two sides of the fraud, waste, and abuse triangle
With federal healthcare fraud enforcement at its highest level on record, now is the right time to prioritize waste and abuse reduction in partnership with providers.
Medicaid managed care financial results for 2025
MCOs experienced a slight underwriting loss for 2025, continuing a trend seen since the end of the COVID-19 public health emergency.
Key insights into 2026 Medicare Advantage D-SNP landscape
We discuss historical and current growth, recent policies impacting the plans, and key insights.
HHS’s Medicaid provider spending data: Use cases and considerations for state agencies and managed care organizations
We outline four potential uses of HHS Medicaid provider spending data for state agencies and managed care organizations, including provider anomaly detection.
The evolving landscape of anti-obesity medication coverage in Medicaid
We expect states to continue balancing the coverage of anti-obesity drugs with immediate budget risks, as cuts to federal Medicaid take effect.
Savings with an asterisk: The hidden math of Medicaid enrollment movement
Using our interactive tool, see how changes to Medicaid managed care coverage policies under new eligibility and enrollment requirements could impact total cost of care.
CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers
We explore what the Medicare-Medicaid integration opportunity could mean for states as the CMS’s new ACO LEAD model details are released.
Performance management in Medicaid managed care programs
We outline current challenges State Medicaid agencies may face in their managed care programs, and offer some considerations and potential mitigation strategies.
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