Literature Review

Data book: Beneficiaries dually eligible for Medicare and Medicaid MEDPAC (Medicare Payment Advisory Commision) and MACPAC (Medicaid and CHIP Payment and Access Commission); December 2025 This data book is a joint project of the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC). The data book presents information on the demographic and other personal characteristics, expenditures, and health care utilization of individuals who are dually eligible for Medicare and Medicaid coverage. Dually eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of their age or disability and low income. This population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy.

Bipartisan senators: Keep hospice out of Medicare Advantage Hospice News; by Jim Parker; 11/21/25 Two U.S. Senators have penned a letter to congressional leadership urging them to oppose any measures to bring hospice reimbursement into Medicare Advantage. Sens. Dr. Roger Marshall (R-Kan.) and Sheldon Whitehouse (D-R.I.) circulated the letter on Thursday, addressed to Senate leaders from both major political parties, as well as the chair and ranking member of the Senate Finance Committee. 

'It has made my life a lot easier': New Ohio program pays people to care for their loved ones at homeWTOL-11, Columbus, OH; by Kevin Landers; 11/24/25 Mark Straub, of Delaware County, started caring for his 93-year-old mother about two years ago. As much as he loves to have his mother at home instead of a nursing home, caring for a loved one 24/7 brings with it stress, both emotional and financial. ... The average cost of in-home care in Ohio is $60,238, according to CareScout. The average cost of nursing home care is $108,500 a year, or about $9,000 per month. Thanks to a new program in Ohio, those who care for a loved one at home are about to get financially easier. It’s called Structured Family Caregiving, or SFC. Currently, at least 11 states have formal Medicaid SFC programs that pay family members. “I didn’t believe it at first, until I got that first paycheck and I really wanted to cry, “ said Tsavaris.

[United Kingdom] Warning issued as palliative care in England is ‘failing to meet people’s needs’ Independent; by Ella Pickover; 11/27/59 Palliative care services in England are "failing to meet people’s needs", a new parliamentary report has warned. Commissioned by MPs on the House of Commons Health and Social Care Committee, the findings attribute these shortcomings primarily to "insufficient funds" for services providing end-of-life and life-limiting condition care. The report highlighted that bereavement support for loved ones, while "valuable", is "frequently inaccessible". It also noted that palliative care patients and their families are "too rarely given the opportunity to plan effectively for the future". Painting a picture of services under "significant strain", the document cautions that health and care provisions are "ill-equipped" to address end-of-life needs, citing "insufficient" education and training.Editor's Note: Our ongoing distribution of posts from the United Kingdom report financial cuts from the UK government, resulting in insufficient funds to provide adequate staffing, facilities, supplies, and more. Want to learn more? Subscribers can login to your account and use the "Search Articles" field to find other posts, based on keywords you enter.

Calendar Year (CY) 2026 End-Stage Renal Disease (ESRD) Prospective Payment System Final Rule CMS Newsroom - Fact Sheets; by CMS; 11/20/25 Key points:

[United Kingdom] 'I lie awake wondering how we fund our hospice' BBC News, Manchester, England; by Paul Burnell; 11/18/25 The boss of a large hospice has told how its financial problems are giving her sleepless nights. Rachel McMillan, chief executive of Moya Cole Hospice in Manchester, said it needed £20,000 daily to run it. "It keeps me awake at night - every day it is always a challenge." "The funding model is archaic, it's not fit for purpose," Ms. McMillan said. "We have to raise £20,000 every single day of the year just to keep the doors open."Editor's Note: I trust that you--our readers--can relate. And yet, our US Medicare payments provide much more financial support than UK counterparts. Still, Moya Cole Hospice--in the midst of tough financial decisions--continues to focus on quality care, as demonstrated in their ongoing top quality scores of "Outstanding" for the pattient and family care they provide.

How CFOs can harness the power of their shifting role HealthLeaders - Analysis; by Marie Defreitas; 11/17/25 As turnover rises and expectations expand, CFOs are redefining their influence; from financial stewards to enterprise strategists and even future CEOs. The role's evolution demands new skills, deeper relationships, and a broader vision of what value means. ...

Lehigh Valley Health Network to drop UnitedHealthcare over reimbursement Becker's Payer Issues; by Andrew Cass; 10/29/25 Allentown, Pa.-based Lehigh Valley Health Network said it is planning to terminate its contract with UnitedHealthcare unless the payer works with the health system to remedy reimbursement issues. Without a resolution, LVHN will go out of network with UnitedHealthcare’s Medicare Advantage plans on Jan. 25, 2026 and commercial plans on April 25, 2026, according to an Oct. 27 news release from the health system. 

Kalos Health shutters amid Medicaid changes Hospice News; by Holly Vossel; 10/29/25 Kalos Health Inc. is closing amid changes to Medicaid reimbursement. The change could challenge access to home-based services for chronically ill adults in western New York. The nonprofit provided health insurance coverage across six counties in New York through a Medicaid managed long-term care (MLTC) plan. Since 2014, the plan has coordinated with regional health care providers to serve adults with chronic illness and health disabilities. Kalos Health is part of The Hospice and Palliative Care Group (HPCG), an organization that provides administrative services. Other providers in the group include Niagara Hospice, Liberty Home Care, Hospice of Orleans and The Niagara Hospice Alliance.  

Strategies for managing rising healthcare premiums with Jason Bradshaw Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Jason Bradshaw; 10/29/25 In this episode of TCNtalks, host Chris Comeaux welcomes back Jason Bradshaw, a seasoned benefits consultant with USI Insurance Services. Together, they unpack why healthcare premiums are rising, where volatility is coming from, and how employers can regain control without gutting benefits.  Jason shares practical funding models, transparency tools, and a playbook for building a cost culture that actually moves behavior.

Ames hospice center to close due to decline in patient numbers, rising costs We Are Iowa, Des Moines, IA; by Caleb Geer;10/23/25 After more than 25 years of service in central Iowa, the Israel Family Hospice House is preparing to close its doors, according to Mary Greeley Medical Center. The decision will be effective on Dec. 31, 2025, pending approval by the hospital's Board of Trustees during their Oct. 28 meeting. "After careful consideration, and in light of a steady decline in patient numbers, increased competition from for-profit providers, insufficient reimbursements, and rising operational costs, we have made the difficult decision to close the hospice house," a post on the Mary Greeley Facebook account says in part. Reasons for the pending closure include declining patients, increased competition and increasing deficit, according to an FAQ document provided by the hospital.

Rural Health Transformation Program must consider care at home, Alliance tells CMS McKnights Home Care; by Adam Healy; 10/17/25 As stakeholders compete for funding from the Rural Health Transformation Program, the Centers for Medicare & Medicaid Services’ $50 billion rural healthcare grant initiative, home care providers are asking for their cut. “The RHTP represents a chance to reshape rural health systems around a continuum of care that extends beyond hospital walls,” Steve Landers, MD, chief executive officer of the National Alliance for Care at Home, said Wednesday in a letter to CMS. “The National Alliance for Care at Home strongly urges CMS to view home-based care not as an adjunct, but as an essential partner in the transformation of rural health delivery.”

AdventHealth saves $47.5M with redesigned nurse career ladderBecker's Clinical Leadership; by Mariah Taylor; 10/9/25 AdventHealth’s redesigned career ladder has prevented the departure of more than 700 nurses and saved the system an estimated $47.5 million in 2024. The Professional Excellence Program launched in 2022 to keep nurses at the bedside and counter the notion that they had to migrate into leadership, quality or safety roles to progress in their career. “Historically, to advance, nurses often felt they had to step away from the bedside because those roles didn’t fully recognize the specialized competencies they bring,” Trish Celano, RN, system chief nurse executive for the Altamonte Springs, Fla.-based system, told Becker’s. “The clinical ladder changes that.”