All stories
Jump to date
Friday, October 2 · 48 stories
- Industry · AZ
Aetna to Acquire Mercy Care Stakes From Ascension, CommonSpirit
CommonSpirit's Dignity Health and Ascension have each agreed to transfer their combined ownership stakes in Arizona's Mercy Care health plan to CVS Health subsidiary Aetna. CommonSpirit held a 49.75% stake in the plan as of mid-2026, and Ascension co-owns the remainder with Dignity Health. Aetna has run Mercy Care's daily operations and administrative services for more than 20 years, and the companies describe the ownership transfer as a natural evolution of that existing partnership. Mercy Care serves Medicaid and dual-eligible members through Arizona's Medicaid program and Medicare Special Needs Plans; the deal is expected to close in fiscal year 2027 pending regulatory review.
- Legal · WI
OIG Finds Wisconsin May Have Misclaimed $455M in School Medicaid Funds
The HHS Office of Inspector General reports that Wisconsin may have improperly claimed $455 million in federal Medicaid reimbursement for its school-based services program. The finding affects the state Medicaid agency and school districts that bill Medicaid for services delivered to eligible students, as OIG's audit identifies claims that did not meet federal reimbursement requirements. The report does not specify a comment deadline but signals likely recoupment action and corrective-action requirements from CMS. The audit underscores recurring compliance risk in state school-based Medicaid billing programs nationally.
- Legal
Oracle Health Breach Now Affects 29 Hospital Systems
Becker's Hospital Review reports that 29 hospitals and health systems have confirmed patient data was compromised in a 2025 breach of Oracle Health's legacy Cerner systems, with the intrusion dating back to at least Jan. 22, 2025. Affected organizations include Atrium Health, AdventHealth, Christus Health, Baptist Health South Florida, and LifeBridge Health, among others. Oracle Health reportedly asked healthcare organizations to delay patient notification while the investigation continued, and the vendor now faces legal action over the incident. Health systems are continuing to notify patients as the full scope of affected entities becomes clearer.
- Federal Policy
Explainer Chapter Covers Medicare Eligibility, Coverage, and Financing
A Health Policy 101 educational chapter provides a primer on Medicare, the federal health insurance program covering more than 68 million people age 65 and older or with long-term disabilities. It walks through eligibility rules, covered benefits, and program spending, and reviews the growing role of private Medicare Advantage plans in delivering benefits. The chapter also discusses financing challenges driven by rising health care costs and an aging population. No new policy action or data release is reported; this is background reference material rather than a report on a specific event.
- Industry · VT
Brattleboro Memorial Hospital Names Interim CEO Amid Budget Crisis
Brattleboro Memorial Hospital's board named David Sanville, a healthcare finance consultant and former Mt. Ascutney Hospital CFO, as interim CEO effective at the start of fiscal year 2027. He replaces co-CEOs Tony Blofson and Elizabeth McLarney, who led the hospital for a year following the unexplained departures of the prior president and CFO in late 2025. The hospital faces a forecast $7.1 million deficit for fiscal 2027, following an estimated $9.5 million shortfall in fiscal 2026, and Vermont's Green Mountain Care Board recently level-funded the facility's budget pending clarification of inconsistencies in its proposal. The hospital does not expect to break even until fiscal 2028 at the earliest.
- State Policy · TN
Tennessee Faces $220M SNAP Cost Shift Under Federal Law
New federal cost-sharing rules under the One Big Beautiful Bill Act could force Tennessee to cover an estimated $220 million in additional SNAP costs next year, according to state budget data and the Sycamore Institute. The law raises states' share of SNAP administrative costs from 50% to 75%, adding $58 million to Tennessee's Department of Human Services budget in fiscal year 2026, and requires states with payment error rates above 6% to begin covering a share of SNAP benefit costs starting October 2027. Tennessee's 2025 error rate was 9.44%, which would trigger a 10% benefit cost share worth an estimated $162-171 million if it doesn't improve. States can choose 2025 or 2026 error-rate data to calculate contributions, but 2026 figures won't be released until June 2027, leaving Tennessee's exact liability uncertain. The changes took effect Thursday and arrive alongside tightened SNAP work requirements that have already removed over 100,000 Tennesseans from the program.
- Industry · WA
MultiCare Health System Launches New Medicare Advantage Plan
MultiCare Health System, a 13-hospital nonprofit system based in Tacoma, Wash., announced on Oct. 1 the launch of MultiCare Health Plan, a wholly owned subsidiary. Its first product will be a Medicare Advantage HMO with drug benefits, available for the 2027 plan year in three Washington counties, supported by independent physician association Physicians of Southwest Washington. Karen Decaran-Voigt, a longtime payer and provider executive with prior roles at Molina, UnitedHealth, CommonSpirit and Elevance, will lead the new plan. The move comes as MultiCare pursues an affiliation with Samaritan Health Services, whose own health plan continues to offer Medicaid and D-SNP products, and runs counter to a broader trend of health systems shutting down their own insurance plans amid rising costs.
- Industry
Home Care Providers Expand Dementia, Behavioral Health Offerings
In an HHCN+ members-only analysis, Home Health Care News reports that dementia care and behavioral healthcare are shifting from niche differentiators to baseline expectations for home-based care providers serving older adults. The piece cites examples including HomeWell Care Services exploring expanded dementia support, VNS Health's Dementia Care at Home program launched in 2023, Empath Health's new dementia education program in Florida, and specialist firms like Author Health building businesses around older adults' behavioral health needs. The author argues providers don't need to own these service lines outright but must have a credible plan, internal training, partnerships, or specialized programs, to address cognitive and behavioral health needs as more patients aim to age in place. No regulatory action or new policy is announced; the piece reflects industry strategy trends.
- State Policy · MN
Minnesota Individual, Small Group Insurance Rates to Rise 17% in 2027
Minnesota's Department of Commerce announced average 2027 premium increases of 17% for individual and small group health insurance plans, affecting roughly 203,000 individual market enrollees and 184,000 small group enrollees. This marks a second consecutive year of double-digit hikes, following a 22% individual market increase and 14% small group increase in 2026. State officials cited rising medical and drug prices, increased utilization, and growth of "profit-driven entities" in healthcare delivery and financing as drivers. The announcement coincided with a state Senate hearing where health economists linked hospital consolidation, including a newly announced merger between Essentia and HealthPartners, to rising premiums, and comes amid reduced federal premium tax credits and election-year political blame-shifting.
- Federal Policy
CMS Opens 340B Part D Claims Data Repository for Voluntary Use
CMS launched its 340B Part D claims data repository on October 1, allowing covered entities and third-party administrators to begin submitting claims data voluntarily. CMS has proposed requiring mandatory submissions starting January 1, 2027. To support entities during the transition, CMS has published a user guide, companion guide, fact sheet, and FAQ. The repository is intended to improve tracking of 340B drug claims under Medicare Part D.
- Federal Policy
CMS Finalizes GLOBE Model Testing International Drug Rebate Benchmark
CMS finalized its Global Benchmark for Efficient Drug Pricing (GLOBE) Model on Sept. 30, a mandatory test of an alternative manufacturer rebate calculation under the Medicare Part B Inflation Rebate Program. Instead of the current domestic pricing benchmark, the model uses a benchmark derived from international pricing data. After public comment, CMS excluded biosimilars, orphan-only drugs, plasma-derived products and certain cell and gene therapies, and carved out manufacturers already participating in its GENEROUS Model, leaving only four manufacturers expected to be required to participate. The model will apply to Medicare beneficiaries in a randomly selected subset of geographic areas covering about 25% of Original Medicare beneficiaries. CMS now estimates $440 million in savings over the seven-year performance period, sharply lower than its earlier $12 billion projection.
- Industry · OK
Oklahoma Critical Access Hospital Plans Staffing, Contract Cuts for 2027
In a Becker's Hospital Review report, Arbuckle Memorial Hospital CFO Denise Welch describes how the Sulphur, Oklahoma critical access hospital is preparing its 2027 budget amid financial pressure. The hospital plans to cut staffing redundancies and hold outside contract spending flat rather than reduce wages, which Welch says would hurt amid competitive labor markets. Welch said the hospital will continue investing in technology and informatics infrastructure to avoid care delays and reduce outside exposure, while updating fully depreciated building infrastructure to maintain its current reimbursement status. The comments illustrate budget tradeoffs facing small rural hospitals heading into 2027.
- State Policy · NM
NM House Candidates Clash Over Medicaid in District 3 Race
Incumbent U.S. Rep. Teresa Leger Fernández (D) faces state Rep. Martin Zamora (R-Clovis) in the Nov. 3, 2026 general election for New Mexico's 3rd Congressional District. In an interview with Source NM, Leger Fernández criticized Trump administration and Republican-backed cuts to Medicaid and food assistance, citing 10,000 New Mexico children who lost federal benefits due to the One Big Beautiful Bill, and said she would prioritize legislation to increase healthcare providers in rural areas. Zamora, who did not respond to interview requests, has campaigned on property rights, energy jobs, crime and border security rather than healthcare. The race will determine representation for a largely rural northern and eastern New Mexico district with significant Medicaid-dependent populations.
- Industry · TN
Vanderbilt Health's FY2026 Margin Jumps on TennCare Payments, Acquisition
Vanderbilt Health reported fiscal 2026 operating income of $452 million (4.7% margin), up from $255 million (3.0% margin) in fiscal 2025, per its Sept. 30 financial report. Operating revenue rose 12% to $9.5 billion, driven by higher surgical, procedural, ambulatory and pharmacy volumes, while expenses grew 9.9% on staffing and drug cost increases. The system recognized $230 million in fiscal 2026 from TennCare's Hospital Investment Program, a supplemental Medicaid payment program using an average commercial rate approach, up from $179 million the year prior. Vanderbilt also completed full acquisition of Tennova Healthcare-Clarksville in February, and net income rose to $775 million from $424 million.
- State Policy · IA
Iowa Candidates Clash Over Medicaid, Immigration in Debate
Iowa state Rep. Lindsay James (D) and Republican Joe Mitchell debated Thursday ahead of the 2026 race for the state's 2nd Congressional District seat. Mitchell accused James of supporting Medicaid and SNAP access for undocumented immigrants, citing her vote against a measure requiring immigration status and residency verification for benefit eligibility; James called the characterization dishonest and said Iowans are her priority. The candidates also sparred over border security, immigration enforcement funding, and data-center tax incentives. The seat is open because incumbent Rep. Ashley Hinson is running for U.S. Senate.
- State Policy · NJ
NJ Advocates Demand Oversight After Opioid Funds Misspent
New spending reports released Thursday show New Jersey state, county, and municipal officials spent opioid settlement funds on bounce houses, DJs, dirt bike demonstrations, ice cream events, graduation parties, and other questionable items instead of core addiction treatment and prevention priorities. The $60 million spent over the past year is part of $1.1 billion New Jersey will receive through 2038 from drug manufacturers, distributors, and pharmacies to resolve opioid lawsuits. Harm reduction advocates, including the New Jersey Organizing Project and Sea Change Recovery Community, are calling for tighter oversight, pointing to prior criticism from the former state comptroller and attorney general over similar misuse, including a $45 million diversion to hospitals facing federal Medicaid cuts. Municipalities were singled out as the "worst offenders" of stretching definitions of prevention and treatment barriers to justify spending.
- Industry · FL
Survey Finds Mothers Face Major Barriers to Mental Healthcare Access
Count on Mothers and Inseparable released "Pulse Check 2026: Mothers on Mental Health, Care, and the Systems Around Their Families," a survey of 2,818 U.S. mothers and primary female caregivers conducted May 7-27. The report finds 50% of mothers nationally (48% in Florida) struggled with their own mental health in the past month, and 39% had a child needing behavioral health support in the past year, with 47% of those receiving only partial care or none due to barriers. Among parents facing barriers, 56% reported at least one insurance-related problem. Notably, mothers with employer-sponsored insurance reported less confidence their plans would cover adequate mental health care than mothers covered by Medicaid or CHIP, with only 6% of Medicaid mothers reporting no confidence in coverage versus higher distrust among commercially insured respondents.
- State Policy · ME
LePage, Dunlap Spar Over Medicaid in Maine House Debate
Maine Morning Star reports that Republican Paul LePage and Democrat Matt Dunlap clashed in their first debate for Maine's open 2nd Congressional District seat, sparring over healthcare policy including Medicaid. Dunlap backed restoring expired ACA marketplace premium subsidies, which 85% of Maine's 61,000 CoverME.gov enrollees relied on, and voiced long-term support for universal healthcare; LePage opposed Medicaid expansion and defended federal Medicaid cuts, citing a $50 billion rural health funding program as an offset. LePage also repeated claims of widespread Medicaid fraud in Maine, though the state's most recent federal payment error rate was 2.4%, below the 3.2% national average, with only about 0.1% of spending confirmed incorrect. The debate occurred Oct. 1, ahead of the election to replace outgoing Rep. Jared Golden.
- State Policy · SD
South Dakota House Candidates Clash Over Tariffs, Medicaid Work Requirements
At an Oct. 1 debate co-hosted by South Dakota Public Broadcasting and South Dakota News Watch, Republican Marty Jackley and Democrat Nikki Gronli, candidates for South Dakota's U.S. House seat, sparred over tariffs, energy costs and the One Big Beautiful Bill Act's healthcare provisions. Jackley criticized Trump's push to import Argentine beef but otherwise backed Trump's tariff approach, while Gronli said tariffs and the Iran conflict have driven up costs for farmers and families. On Medicaid, Jackley defended the law's new work requirements as a fraud-prevention measure and praised sending rural health transformation dollars (South Dakota has received $189 million so far) to states to decide how to spend. Gronli argued the law's cuts to Medicaid and other programs would harm residents who depend on them. The general election is Nov. 3.
- Industry
BHB Commentary: Outside Investors Improve Autism Therapy Accountability
In a Behavioral Health Business commentary, the author argues that the autism therapy industry's reputational scandals stem not from private equity or outside capital involvement, but from a lack of external accountability among founder-owned, independently run providers. The piece cites ABA Centers of America, Piece By Piece Autism, The Perfect Child, and Stepping Stones Behavioral Solutions, all organizations facing billing fraud, Medicaid scrutiny, or federal investigation, as examples lacking outside board oversight or capital-partner governance. The author contends that private equity and family office investors, while not guarantors of ethical conduct, tend to impose governance controls, compliance infrastructure, and risk oversight that founder-led organizations often cannot afford on their own. The commentary frames bringing in outside capital as a maturation step for an industry historically short on standardized oversight.