Nursing home and residential care facility employment has climbed to approximately 3.49 million workers as of May, according to Bureau of Labor Statistics data, recovering from a pandemic low of 2.96 million. The industry has added more than 500,000 workers since its lowest staffing point during the COVID-19 pandemic. This represents a steady upward trend in nursing facility workforce levels, though the article does not specify whether current staffing meets pre-pandemic benchmarks or regulatory adequacy standards.
Why it mattersImproved nursing home staffing levels affect LTSS managed care plans through potential changes in provider network capacity, quality metrics tied to staffing ratios, and institutional care costs that influence total cost of care benchmarks.
LTSS
Providers are increasingly encountering patients interested in ibogaine, a psychoactive substance being explored for substance use disorder treatment. While ibogaine remains unregulated in the United States and carries cardiac risks, some patients are pursuing treatment domestically or traveling abroad to access it. The article urges providers to understand ibogaine's risks and benefits rather than dismiss it outright, as patient interest continues to grow. No immediate regulatory or policy changes are described.
Why it mattersMedicaid managed care organizations may see members inquiring about or seeking ibogaine treatment for substance use disorder, requiring medical directors to develop clinical guidance and care coordination protocols for this emerging but high-risk intervention.
Behavioral Health
Abarca Health and LucyRx announced plans to combine operations, creating a larger independent pharmacy benefit manager serving more than 9 million members. The merger consolidates two independent PBMs in a market dominated by vertically integrated PBM-insurer entities. The combined entity will compete for Medicaid managed care pharmacy contracts as states and health plans increasingly scrutinize PBM practices and pricing transparency. No timeline for completion or details on operational integration were provided in the initial announcement.
Why it mattersThe merger creates a larger independent PBM alternative for Medicaid MCOs evaluating pharmacy benefit vendors amid growing state scrutiny of PBM pricing, rebate structures, and vertical integration conflicts.
Pharmacy · Managed Care
A Center for Healthcare Quality and Payment Reform analysis found 720 rural hospitals—roughly one-third of all rural facilities nationwide—are at risk of closure due to financial instability. Healthcare leaders are advocating for increased collaboration among rural providers rather than competition to strengthen outcomes and ensure long-term sustainability. The analysis highlights ongoing financial pressures threatening rural access to care. No specific implementation timeline or policy action is indicated.
Why it mattersRural hospital closures directly affect Medicaid managed care organizations by reducing provider networks in already underserved areas, potentially triggering network adequacy issues and increasing member access complaints.
Managed Care
Arsen Ustayev, founder and CEO of CareChoice, is adjusting his company's service offerings and geographic footprint based on hospital referral patterns and varying state Medicaid policies. The executive, who previously founded adult day care provider SarahCare in Pennsylvania, has reduced certain services where hospital system referrals have not materialized as expected. His strategy reflects the critical role that hospital discharge planning and referral networks play in home health and post-acute care success, particularly in Medicaid-focused markets where state policy differences create operational complexity.
Why it mattersHospital referral patterns directly affect managed care organizations' discharge planning, network adequacy, and care coordination strategies, particularly for post-acute and LTSS services where MCOs depend on provider capacity and referral relationships.
LTSS · Managed Care
Dr. Ziad Obermeyer discussed the evolution of AI bias in healthcare algorithms since his 2019 research exposed systematic underestimation of Black patients' health needs in a widely used commercial algorithm. The conversation covered progress the healthcare industry has made in addressing algorithmic bias in patient management tools. The discussion appears focused on clinical risk prediction models used across the healthcare sector. While the original research had significant implications for how health plans and providers identify high-risk patients for care management programs, this appears to be a retrospective industry discussion rather than new policy guidance or research findings.
Why it mattersMedicaid MCOs use risk adjustment and care management algorithms that may contain similar biases, affecting member stratification, resource allocation, and health equity outcomes.
Managed Care
Inventia Healthcare Limited is recalling 11,460 bottles of Chlorthalidone Tablets USP, 25 mg, distributed nationwide after the product failed dissolution specifications. The FDA classified the recall as Class II on June 22, following the manufacturer's June 5 recall initiation. Chlorthalidone is a diuretic used to treat hypertension. Class II recalls indicate the product may cause temporary or medically reversible adverse health consequences, with a remote probability of serious harm.
Why it mattersMedicaid managed care organizations should verify pharmacy networks are distributing replacement chlorthalidone products and confirm members on affected lots receive substitute medications to maintain hypertension management continuity.
Pharmacy · Managed Care