Maryland Insurers Warn AHEAD Model Transition Could Shift Hospital Costs to Commercial Payers
Maryland is transitioning from its Total Cost of Care model to the AHEAD (Achieving Healthcare Efficiency through Accountable Design) model, which will remove the state's authority to set Medicare hospital rates starting in 2028. CareFirst BlueCross BlueShield officials warned at a Maryland Association of Counties conference that the federal government is expected to contribute less under AHEAD than under the previous all-payer rate-setting system, likely shifting costs to commercial insurance. The Health Service Cost Review Commission will continue setting rates for non-Medicare payers, but insurers anticipate rate increases for counties, businesses, and individuals as the transition unfolds.
Maryland's shift away from its unique all-payer rate-setting authority could increase Medicaid managed care premiums and provider payments if Medicare underpayment drives cost-shifting to commercial and Medicaid plans.
Managed Care · Finance
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