Health Care Matters | April 11, 2025
Health Policy Tracker: Trump’s First 100 Days
OMB RFI on Deregulation
The Office of Management and Budget (OMB) has issued an RFI on deregulation, asking commenters to identify rules to be rescinded and provide detailed reasons for their rescission. For more, read the following:
Thousands laid off as Kennedy and Musk take aim at health agencies (Politico)
HHS reorganization raises questions for claims appeals process (Modern Healthcare)
Providers owe $1B for misused COVID-19 funds. DOGE just cut the office recouping them (Fierce Healthcare)
New Resource to Track Local Impact of Federal Funding, Employment, and Policy Decisions
The Impact Project has developed an Impact Map, an interactive platform designed to make the impact of complex, fast-moving federal funding, employment, and policy decisions more accessible and understandable at the local level. For more and to access the map, visit the following:
Medicare Advantage Rate Increase: CMS Finalizes Higher 2026 Benchmark
The Centers for Medicare & Medicaid Services (CMS) has finalized the 2026 Medicare Advantage (MA) payment rates, announcing a benchmark increase of 5.06%. This represents a significant upward revision from the earlier projection of 3.7%, driven primarily by higher-than-expected costs in traditional Medicare, particularly for inpatient and outpatient services. The final rule includes a notable upward revision of the effective growth rate, now exceeding 9%, though this is partly offset by adjustments in risk model normalization and Star Ratings pressures. Read more here, here, and here.
Why It Matters
This rate increase creates substantial financial opportunities for health plans participating in the MA program, which now serves over half of all Medicare beneficiaries. However, the impact on healthcare providers varies significantly across markets. Rural hospitals, which often receive substantially lower reimbursements from MA plans compared to traditional Medicare, may continue to face financial challenges despite the benchmark increase. With limited negotiating leverage and inability to offset losses through volume, rural facilities serving communities with growing MA enrollment remain particularly vulnerable.
While the higher benchmark could potentially support expanded benefits or lower premiums for enrollees, whether these rate increases will translate to improved provider reimbursement in underserved areas remains uncertain. For the MA program to achieve sustainable long-term growth, plans must address geographic disparities while developing fundamental innovations rather than relying on favorable policy shifts. As medical costs continue to rise, plans that invest in true differentiation and create tangible value for all stakeholders including members will be better positioned for success when rates inevitably tighten, particularly in markets beyond competitive urban centers.
Look for the Helpers: Medically Tailored Meals Making a Difference
In this new recurring feature, we highlight individuals and organizations making meaningful contributions to health care and community wellbeing. "Look for the helpers" reminds us that even amid challenges, dedicated people are creating positive change through innovation, compassion, and service.
A recent study published in Health Affairs reveals the potential of medically tailored meals to transform health care outcomes across the United States. Researchers found that providing customized meals to chronically ill patients could prevent approximately 1.6 million hospitalizations and save nearly $13.6 billion in health care costs annually across all 50 states. The program, which delivers nutritionally appropriate meals designed for specific medical conditions, demonstrates how addressing fundamental needs like nutrition can have outsized impacts on both individual health and health care systems. As communities search for sustainable healthcare solutions, these helpers are delivering more than just food—they're delivering better health outcomes and significant cost savings that benefit us all. Read here.
What We Are Listening To
A Health Podyssey: Seth Berkowitz on the Intersection of Income, Food, & Health
Health Affairs' Senior Deputy Editor Rob Lott interviews Seth Berkowitz of the UNC School of Medicine to discuss his recent paper that explores a new approach to help guide research and policy at the intersection of income, food, nutrition, and health. Listen here.
What We Are Reading
Affordable Access to GLP-1 Obesity Medications: Strategies to Guide Market Action and Policy Solutions
In the wake of CMS's decision not to expand coverage for drugs that treat obesity, ICER released a new white paper providing policy and market solutions to help manage affordable and equitable access to GLP-1 obesity medications. Read here.
The Role of Medicaid in Advancing Obstetric Provider Maternal Mental Health Screening and Treatment
The Policy Center for Maternal Health published an analysis of 41 state Medicaid agencies’ MCO health plan contracts and found 9 addressed the role of OBs in providing maternal mental health, by either requiring screening, addressing reimbursement, or reporting of HEDIS prenatal depression screening measures. Read here.
Hospital & Health System Reimbursement Check Newsletter: Focus On Trump 2.0: Implications for Hospitals and Health Systems
In the March 2025 edition of the Hospital & Health Systems Reimbursement Check Newsletter, Ropes & Gray LLP attorneys shared an analysis of administrative and court litigation and regulatory developments affecting federal program payments to hospitals and health systems, and other reimbursement-related issues. Read here.
Key insights into 2025 Medicare Advantage D-SNP landscape
A new Milliman white paper breaks down the latest CMS data on Dual Eligible Special Needs Plans (D-SNPs), highlighting key trends in market growth, enrollment patterns, parent organizations, and state-specific nuances. Read here.
Pop health podcast
Advancing Value-Based Care: Progress, Gaps, and Policy Signals
In the latest episode of the Pop Health Podcast, we explore the current state of value-based care with Emily Brower and Mara McDermott, including recent policy developments, emerging trends, federal alignment, and practical tips for tracking meaningful changes in the VBC landscape.