Literature Review

'One Big Beautiful Bill Act': Key final Medicaid changes explained Morgan Lewis; by Jeanna Palmer Gunville and Tesch Leigh West; 7/9/25 The One Big Beautiful Bill Act was signed into law on July 4 and includes significant changes to the Medicaid program, particularly with regard to state and federal financing for the program. This LawFlash provides a high-level summary of certain key provisions that will impact various Medicaid stakeholders, including states, providers, and enrollees. ...

20 states sue after the Trump administration releases private Medicaid data to deportation officials Associated Press (AP), Washington, DC; by Amanda Seitz and Kimberly Kindy; 7/1/25The Trump administration violated federal privacy laws when it turned over Medicaid data on millions of enrollees to deportation officials last month, California Attorney General Rob Bonta alleged on Tuesday, saying he and 19 other states’ attorneys general have sued over the move. Health secretary Robert F. Kennedy Jr.’s advisers ordered the release of a dataset that includes the private health information of people living in California, Illinois, Washington state, and Washington, D.C., to the Department of Homeland Security, The Associated Press first reported last month. All of those states allow non-U.S. citizens to enroll in Medicaid programs that pay for their expenses using only state taxpayer dollars.

Medicaid provisions threaten home and community-based services for millions of vulnerable Americans National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 7/3/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature. “The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).” The home care community advocated throughout the legislative process for Congress to mitigate these harmful Medicaid provisions.

Trump administration shared Medicaid data with immigration officials: Report Straight Arrow News; by Kalé Carey; 6/13/25 A newly obtained government memo reveals that immigration officials received access to Medicaid data to assist in deportation efforts. ... The Associated Press reported that emails and a memo show the Department of Health and Human Services ordered staff at the Centers for Medicare and Medicaid Services to release data, including immigration status, on millions of federal program enrollees. The Department of Homeland Security was reportedly given the information, according to the Associated Press. Advisers to HHS Secretary Robert F. Kennedy Jr. gave CMS staff 54 minutes to hand over the data. CMS staff objected to the request, citing legal and ethical concerns over the type of data being shared. ... 

Experts warn of scams during Medicare Fraud Prevention Week Public News Service; by Suzanne Potter; 6/4/25 Medicare loses $60 billion to $80 billion a year to fraud and this year, for Medicare Fraud Prevention Week, your local Senior Medicare Patrol has good advice on how to spot a con. There are plenty of scams to be aware of. Karen Joy Fletcher, communications director with the nonprofit California Health Advocates, said beware if a caller asks to verify your Medicare number, claiming the program needs to send out a new type of card. ... ... Caregivers can be on the lookout for medical equipment arriving at the house even though the beneficiary never ordered it. Another red flag? A stranger may approach you in a parking lot asking you to sign up for new, free Medicare services like house cleaning or meals, which are then fraudulently billed to the government. ... Another scam involves tricking people into unknowingly signing up for hospice care. It is especially dangerous, because once a person is on hospice, Medicare will only approve palliative care and could mistakenly deny an essential surgery or medication.

Medicaid increase, program changes detailed in CMS Budget Proposal InsideHealthPolicy; by Dorothy Mills-Gregg; 5/30/25 Medicaid would see a nearly $57.5 billion increase under the Trump administration’s proposed 2026 budget, though federal Medicaid matching funds for state administrative expenses would be reduced by $1.2 billion compared to this year’s estimate, according to the CMS budget justification document for fiscal 2026 released Friday (May 30).

HHS faces $31B cuts in proposed FY ’26 budget: 6 notes Becker's Hospital Review; by Madeline Ashley; 6/2/25 President Donald Trump’s proposed fiscal 2026 budget slashes funding for the National Institutes of Health by $18 billion to $27.5 billion as part of a sweeping overhaul to realign federal healthcare spending.  The NIH received $46.4 billion in program level funding in 2024 and just over $46 billion in 2025, according to the budget proposal. [Continue reading for this article's lists of (1) consolidated institutes and centers; and (2) "six things to know."]

Perspectives on the challenges of planning for and accessing long-term dementia care services through Medicaid and Medicaid WaiversJournal of Applied Gerontology; Justine Scattarelli, Kelly Moeller, Dana Urbanski, Marguerite DeLiema; 4/25 Formal long-term services and supports (LTSS) are essential to support older Americans with chronic conditions, such as Alzheimer’s disease and related dementias (ADRD). However, few older adults have saved enough to pay for LTSS, and navigating Medicaid eligibility criteria presents significant challenges. We conducted semi-structured, in-depth interviews with aging services professionals and caregivers of older adults with ADRD to assess challenges to planning for and accessing LTSS coverage through Medicaid and Medicaid waivers. Using concept mapping, three main themes were identified: (1) Proactive planning, (2) decision points, and (3) the application process. Participants described misconceptions about LTSS coverage, challenges with enrollment, and lack of information about eligibility affecting the LTSS planning trajectory. Results demonstrate a critical need for resources that help caregivers estimate costs and guide them through the eligibility determination, application, and spend down processes for Medicaid programs.

[Commentary] It’s time to bring value-based care principles to hospice Medical Economics; by Asher Perzigian; 5/20/25 In the health care industry, the conversation around value-based care (VBC) has been abuzz for a while now. The idea is simple: pay for outcomes, not for services, and shift our mindset from volume to value as we reduce unnecessary care, improve outcomes and bend the cost curve. However, when we talk about VBC, we often overlook a critical part of the health care continuum: hospice care. And when it comes to end-of-life care, traditional measures like survival rates and reduced readmissions lose their relevance. Hospice embodies some of the deepest principles of VBC: aligning care with patient goals, avoiding unneeded interventions and supporting the person as a whole. Here’s what primary care physicians need to know about the integration of value-based principles in hospice care. 

HHS wants input on how to improve digital health tech for Medicare patients Fierce Healthcare; by Heather Landi; 5/14/25 The Department of Health and Human Services (HHS) wants feedback on how it can develop better digital health tools for Medicare beneficiaries and drive adoption. The Centers for Medicare & Medicaid Services (CMS), in partnership with HHS' health IT arm, now called the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), is seeking public input on how best to "advance a seamless, secure, and patient-centered digital health infrastructure."

Restructuring for risk: How home-based care providers build frameworks that boost profits Home Health Care News; by Joyce Famakinwa; 5/14/25 In the home-based care world, building a business that is equipped to take on risk-based reimbursement arrangements can be easier said than done. While no simple feat, taking on risk is an attractive option that allows home-based care providers to align incentives between their organizations, payer sources and patients. Providers that have found success with risk-based agreements have done so by addressing retention challenges, investing in data and more.

UnitedHealth Group is under criminal investigation for possible Medicare fraud The Wall Street Journal; by Christopher Weaver and Anna Wilde Mathews; 5/15/25 The Justice Department is investigating UnitedHealth Group for possible criminal Medicare fraud, people familiar with the matter said. The healthcare-fraud unit of the Justice Department’s criminal division is overseeing the investigation, the people said, and it has been an active probe since at least last summer. While the exact nature of the potential criminal allegations against UnitedHealth is unclear, the people said the federal investigation is focusing on the company’s Medicare Advantage business practices. UnitedHealth said in a statement it hadn’t been notified by the Justice Department of the criminal investigation. The statement said the company stands “by the integrity of our Medicare Advantage program.” A DOJ spokesman declined to comment.

Downside risk, upside payment highlight new CMS innovation agendaModern Healthcare; by Bridget Early; 5/13/25The Centers for Medicare and Medicaid Services is rolling out a broad new agenda for its innovation center that could lead to requirements that participants in value-based care programs to take on downside risk, the agency announced ... The Center for Medicare and Medicaid Innovation plan prioritizes shared risk and prospective payments, streamlined quality measurement, artificial intelligence and other technologies, and Medicare Advantage payment models, Director Abe Sutton said in an interview Friday [5/9]. Notably, CMS is walking away from a goal set four years ago to have all fee-for-service Medicare beneficiaries under accountable care arrangements by 2030, Sutton said. CMS provided Modern Healthcare an advance look at the new innovation center platform. ... Designing models that require providers to accept at least some downside risk could be the most consequential action stemming from the plan. Subjecting participants to potential financial losses, not just potential benefits, is key to driving cost savings and quality improvement, Sutton said.