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Thursday, October 1 · 16 stories
- Industry
State Officials Press for Scrutiny of Hospital Megamergers
Minnesota Attorney General Keith Ellison is reviewing HealthPartners' proposed acquisition of Essentia Health, a deal that would create a 22-hospital nonprofit system with roughly 45,000 employees, and is seeking public input under state healthcare, charities and antitrust laws. In North Carolina, State Treasurer Brad Briner has called on the state attorney general and federal regulators to scrutinize Atrium Health's proposed combination with WakeMed Health & Hospitals, citing concerns about prices, competition and access. Both deals exemplify a broader wave of cross-market "megamergers" as systems seek scale, diversified risk and stronger payer leverage instead of same-market deals that draw heavier antitrust review. Kaufman Hall data shows two-thirds of Q2 hospital transactions involved independent systems seeking partners from positions of strength rather than financial distress, signaling consolidation is accelerating even among stable organizations.
- Industry
MACPAC Awards Acumen 10-Year Medicaid Data Analysis Contract
MACPAC, the nonpartisan legislative branch agency that advises Congress on Medicaid and CHIP policy, has awarded an indefinite delivery indefinite quantity contract to Acumen, LLC for analysis and management of administrative data. The contract, posted to SAM on May 28, 2026 under Notice ID 202601, covers fiscal years 2027 through 2036. The award supports MACPAC's ongoing work analyzing Medicaid and CHIP administrative data to inform the Commission's policy analysis and recommendations to Congress.
- Industry · CA
CommonSpirit Narrows Operating Loss, Books $2.3B Conifer Exit Charge
CommonSpirit's fiscal 2026 financial report shows an operating loss of $430 million (-1.0% margin) excluding special charges, improved from a $687 million loss the prior year. Including $2.8 billion in special charges, largely a $2.3 billion hit tied to exiting its Conifer Health Solutions revenue cycle venture, plus a tradename impairment and restructuring costs, the system's total operating loss was $3.2 billion. Revenue grew 8.5% to $42.4 billion, helped by $991 million in California Provider Fee Program net income, up sharply from $305 million the year before. The 136-hospital system posted a net loss of $662 million for the year, compared to $1.1 billion in net income in fiscal 2025.
- Industry
States, Hospitals Expand Automatic Enrollment in Charity Care
A Tradeoffs/KFF Health News explainer describes how hospitals use "presumptive eligibility" to automatically screen patients for charity care and wipe out medical bills without requiring a formal application. Nonprofit hospitals increasingly use this approach to comply with ACA requirements to identify financial-assistance-eligible patients before pursuing debt collection, with screening rates rising from about 70% to nearly 90% of tax-exempt hospitals since 2016. Six states, California, Delaware, Illinois, Maryland, North Carolina, and Oregon, mandate presumptive eligibility for certain patient groups, though criteria vary widely and remain difficult for patients to find. For-profit and public hospitals are not subject to the federal reporting requirement, leaving gaps in who benefits from automatic debt relief.
- Industry
KFF Health News Minute Roundup Covers Medicaid Meal Pilots, Work Rules
KFF Health News publishes weekly "KFF Health News Minute" audio digests summarizing original health policy reporting. Recent episodes touch on Medicaid-relevant topics, including states piloting medically tailored meal delivery programs to reduce costs and improve outcomes, concerns from doctors about certifying patient exemptions under new Medicaid work requirements, and warnings that homeless enrollees will need to document work activity to retain coverage. The digest format compiles brief summaries of multiple unrelated health stories each week rather than reporting a single new policy action. No specific effective dates, agency actions, or regulatory changes are detailed in the segments themselves.
- Industry
Lawyers Warn AI Fraud Tools Lack Human Oversight in Hospice Audits
In a two-part investigative series, Hospice News reports that legal experts are raising concerns about insufficient human oversight in AI-driven hospice fraud enforcement. Attorneys Edo Banach (Foley Hoag) and Howard Young (Morgan Lewis) say CMS contractors are using AI tools to select hospices for audit and process rebuttals, sometimes producing responses with apparent AI "hallucinations" that get reversed once humans review them. CMS's proposed CRUSH initiative, along with AI-driven data mining by the FBI, HHS-OIG, and DOJ's National Fraud Detection Center, are scrutinizing billing anomalies like long lengths of stay and high recertification volumes, with recent revocations concentrated in Arizona, California, Nevada and Texas. CMS did not respond to requests for comment on its AI oversight practices.
- Industry
Elevance Moves to Curb Hospital Billing for Off-Campus Care
Elevance Health is implementing a policy to restrict hospitals from charging facility fees or higher reimbursement rates for services delivered at off-campus outpatient departments, aiming to align payment with site-neutral principles. Hospital groups oppose the move, arguing the reimbursement reductions could jeopardize patient access to care, particularly in markets where hospital-owned outpatient clinics are prevalent. The policy affects hospitals and health systems contracted with Elevance across its commercial and potentially Medicaid managed care lines. Details on effective dates and scope across Elevance's state Medicaid contracts were not specified.
- Industry · OR
Oregon Candidate Beck Makes Rural Medicaid Cuts Campaign Issue
Democrat Chris Beck, challenging Republican Rep. Cliff Bentz in Oregon's 2nd Congressional District, is campaigning on protecting rural health care from Medicaid cuts included in the 2025 federal tax and spending law (H.R. 1). Beck argues the law, which Bentz supported, could cause rural hospitals to lose Medicaid reimbursements as patients lose coverage, calling it a potential "financial death knell" for rural facilities. He is calling for repeal of the law and voiced support for a national health system modeled on the Oregon Health Plan that would guarantee basic and preventive care. Bentz did not respond to an interview request; the race is ongoing ahead of the 2026 election.
- Industry · MA
Out-of-State Chains' Nursing Home Buyouts Tied to Quality Declines in Mass.
Citing a Boston Globe Spotlight investigation, Skilled Nursing News reports that out-of-state chains have rapidly acquired Massachusetts nursing homes since 2020, with nine New York and New Jersey-based chains growing their holdings from 12 facilities in 2019 to 61 by 2025, about one-fifth of the state's nursing homes. Eight of the nine chains saw average federal star ratings decline after acquisition, driven by cost-cutting that slashed nursing hours while shifting payments to owner-affiliated companies. RegalCare, led by CEO Eli Mirlis, is highlighted as a case study: facilities fell from 5-star to 1-star ratings within three years as rent and related-party payments rose even as nursing spending fell. The Globe found Massachusetts regulators have not denied an acquisition application or revoked a license in seven years, though a recent law now lets them weigh an operator's out-of-state record.
- Industry · NJ
NJ Behavioral Health Nonprofit CBH Care Files Chapter 11 Bankruptcy
Hackensack, New Jersey-based Comprehensive Behavioral Health Care Inc. (CBH Care) has filed for Chapter 11 bankruptcy protection, citing a prolonged landlord dispute over its main facility that began with HVAC failures in 2018 and escalated to an eviction motion in June 2026. The nonprofit, which derives about 45% of revenue from government grants and a substantial portion of the remainder from Medicaid reimbursements, says litigation costs and building habitability problems strained its already thin margins. CBH Care operates 20 locations across Northern New Jersey offering outpatient mental health, crisis care, residential and supported living programs, employing roughly 350 staff. Its five-week cash budget shows about $2.7 million in revenue and disbursements during the bankruptcy process.
- Industry · TX
Baylor Scott & White's Health Plan Exits Medicaid, Individual Markets
Baylor Scott & White Health reported operating income of $1.5 billion, an 8.3% margin, for the fiscal year ending June 30, 2026, down from $1.7 billion (10% margin) the prior year, despite a 6.6% rise in operating revenue. The Dallas-based system's health plan arm exited the Medicaid and individual insurance markets during the period, according to financial statements published Sept. 30. The system did not detail the exact states or enrollment affected in the summary provided. The move reflects broader insurer pullback from Medicaid managed care amid redetermination-driven enrollment losses and tightening margins.
Wednesday, September 30 · 10 stories
- Industry · OH
UPMC Completes Acquisition of Trinity Health System From CommonSpirit
UPMC has completed its acquisition of Steubenville, Ohio-based Trinity Health System from CommonSpirit Health, with ownership transferring October 1. The deal gives Pittsburgh-based UPMC its first hospital footprint in Ohio, adding four facilities: Trinity West and Trinity East in Steubenville, Trinity Twin City Medical Center in Dennison, and Trinity St. Clairsville Neighborhood Hospital. The acquisition expands UPMC's regional health system presence across the Pennsylvania-Ohio border into a new state market.
- Industry · MN
HealthPartners, Essentia Health Plan Merger Into 22-Hospital System
HealthPartners of Bloomington and Essentia Health of Duluth announced plans on Sept. 29 to merge into a combined 22-hospital health system, marking the third major deal involving a Minnesota-based system in 2026. The consolidation underscores accelerating hospital and health system M&A activity concentrated in Minnesota this year. Terms and a target closing date were not detailed in the announcement. HealthPartners also operates a Medicaid managed care plan, so the combined entity's scale could affect provider networks and negotiating leverage in the state.
- Industry
Survey: ACA Subsidy Expiration Slowing Hospital Procedure Volumes
Becker's Hospital Review reports on a Sept. 23 Evercore ISI survey finding that nearly one in four hospital executives say the expiration of enhanced ACA premium subsidies has already begun slowing procedure volumes at their facilities. Evercore ISI, the equity research arm of investment bank Evercore, surveyed hospital executives to gauge early operational effects of the subsidy lapse. The findings suggest patients losing or facing higher-cost ACA marketplace coverage may be delaying or forgoing elective and other procedures. The survey signals early volume and revenue pressure for hospitals as coverage losses tied to the subsidy expiration ripple through the health system.
- Industry · CA
Former MemorialCare CEO Argues Fee-for-Service Undermines Care Value
In a California Health Care Foundation commentary, the former longtime CEO of MemorialCare argues that fee-for-service payment rewards volume over prevention and drives unsustainable cost growth in California's health system. The author, who sits on the advisory committee of the state's Office of Health Care Affordability, cites MemorialCare's own experience with alternative payment models (APMs), noting that shared-risk, population-based payment arrangements produced roughly 5% lower total spending and up to 25% lower pharmacy costs. The piece points to the state's four-tier APM framework, which ties higher tiers to population-based payment rather than per-service billing, as the direction payers and providers should move. The author calls for hospitals, insurers, public payers, providers, and drugmakers to collectively shift toward paying for care coordination and prevention rather than individual services.
- Industry
Poll Finds Wide Disparities in Americans' Health Care Affordability
A new data note reviews recent polling on Americans' struggles to afford health care, finding that uninsured adults, Black and Hispanic adults, and lower-income individuals report disproportionately higher rates of cost-related difficulty. The polling covers issues such as paying medical bills, affording premiums, and skipping needed care due to cost. No new policy or program change is described; the piece presents survey findings on affordability burdens across demographic groups. The findings underscore persistent gaps in cost protection tied to insurance status, race, and income.
- Industry
Modivcare Names Marsha Ramos CEO of Personal Care Unit
Home Health Care News reports that Modivcare has appointed Marsha Ramos as CEO of its personal care division. Ramos points to a potential Medicare home care benefit as a possible turning point for the personal home care industry, while cautioning that fraud, waste, and abuse concerns could undermine momentum for such a benefit. She also flagged near-term priorities around sustainable growth for the home-based care segment. The piece is drawn from an interview covering her outlook on industry direction and reform.
- Industry
AMA Report: Top Four PBMs Now Control 75% of Market
The American Medical Association's September 2026 Policy Research Perspective, drawing on Decision Resources Group data from 2022 to 2024, found the four largest pharmacy benefit managers now control 75% of the national market, up from 70% in 2022. The report documents continued consolidation among PBMs and insurers tracked over the study period. Becker's Hospital Review summarizes six key findings from the analysis. The data underscores ongoing concentration trends affecting drug pricing and negotiation leverage across the pharmaceutical supply chain.
- Industry · MI
Family Fights Nursing Home Over Sedating Drugs for Dementia Patient
A Michigan family's dispute over whether to sedate their mother, who has dementia and lives in a long-term care facility, highlights the continued widespread use of potent sedating medications on agitated dementia patients despite federal efforts to discourage the practice. The sons sought to keep their mother off the drugs, clashing with facility staff over her care. The case illustrates the difficult decisions families, guardians, and facilities face when balancing behavioral symptom management against the risks and side effects of antipsychotic and sedative medications. Federal oversight has pushed nursing homes to reduce inappropriate antipsychotic use, but enforcement gaps and staffing pressures continue to drive reliance on these drugs.
- Industry
Survey: Rural Voters Say MAHA Policies Haven't Reached Them
A KFF-Associated Press survey finds rural voters who support the Make America Healthy Again (MAHA) movement report that Trump administration health policy changes have not materially reached their communities. Respondents include rural residents who back the movement's goals but say they see little visible change in local health services or outcomes. The survey does not specify a policy effective date, but reflects an ongoing gap between federal health messaging and rural on-the-ground experience. The findings matter for rural health stakeholders, including Medicaid providers and state agencies, who must gauge whether federal initiatives are translating into resources or program changes at the community level.
