Health Care Matters | January 30
Health Care Funding in Limbo as Shutdown Looms Over DHS Dispute
A partial government shutdown looms as Senate Democrats blocked a six-bill spending package Thursday that would have funded agencies through September 30, including the Department of Health and Human Services. The current situation stems from a short-term funding extension passed to end the previous government shutdown last fall, with congressional leaders agreeing to temporarily authorize funding only through January 30. The standoff now centers on $64.4 billion in Department of Homeland Security funding, which Democrats are demanding be separated from the broader package amid concerns over federal immigration enforcement operations. Senate Minority Leader Chuck Schumer and President Trump began negotiations Wednesday on a tentative framework that would split off DHS funding for further talks while advancing the other five bills, though no agreement has been reached. The package includes critical health care provisions, such as a two-year extension of Medicare telehealth flexibilities and hospital-at-home programs set to expire January 30, plus $116.6 billion for HHS and $49 billion for NIH research. Read more here and here.
Why It Matters
If Congress fails to act by Friday's midnight deadline, millions of Medicare beneficiaries could lose access to telehealth services starting January 31, forcing a return to geographic restrictions and limited provider types that were waived during the pandemic. The shutdown would also delay crucial health care funding, including $418 million for rural hospitals and $1.9 billion for community health centers, while stalling pharmacy benefit manager reforms and Medicare Advantage "ghost network" fixes that have bipartisan support. The political calculus has shifted dramatically from typical budget disputes to a broader confrontation over immigration enforcement tactics. Even if negotiators reach a deal to separate DHS funding, the House is in recess until February 2, making at least a brief shutdown into early next week likely and leaving health care providers and patients in limbo over telehealth access.
CMS Proposes Nearly Flat Medicare Advantage Payments for 2027
CMS released its proposed Medicare Advantage payment policies for 2027, signaling an effectively flat year for MA funding amid persistently elevated medical cost trends. While the headline update reflects only modest benchmark growth, the more consequential story lies in CMS’s continued tightening of risk adjustment policy, particularly proposals to exclude diagnoses not tied to documented patient encounters and to restrict the use of unlinked chart reviews.
From a plan and provider perspective, the significance is less about the nominal rate update and more about the structural pressure created by simultaneous payment restraint and coding reforms. Industry stakeholders have warned that this combination could materially constrain benefit design flexibility and intensify financial pressure across markets, especially where margins are already thin. Read more here, here, and here.
Why It Matters
Taken together, the proposal reflects a clear policy direction: tighter payment scrutiny in Medicare Advantage, coupled with a sustained effort to curb perceived overpayments linked to coding practices. While CMS frames the update as maintaining stability, plans are more likely to experience 2027 as a flat funding environment layered on top of rising utilization and medical cost trends.
If finalized, the practical effects are likely to surface in concrete ways across the MA ecosystem: reduced capacity to sustain supplemental benefits, increased pressure on premiums and cost sharing, more selective market participation, and heightened scrutiny of risk adjustment operations and provider documentation practices. For providers and value-based organizations, this environment raises the stakes on accurate clinical documentation, risk capture workflows, and partnership models, as plans reassess bid strategies, benefit design, network structures, and market footprint.
Look for the Helpers: Great Lakes Bay Health Centers Expands Mobile Service
A community health center in Michigan is expanding access to care in a very tangible way: by bringing it directly to patients. Great Lakes Bay Health Centers recently launched a new 39-foot mobile dental clinic as part of its “Smiles are Everywhere” program, delivering preventive and restorative dental services to schools and underserved communities across 12 counties. The mobile unit helps remove common barriers like transportation, cost, and time away from work or school, and is already reaching thousands of children and families who might otherwise go without regular dental care. Read more.
What We’re Writing
What the New CMS and CMMI Models Signal About the Future of Value-Based Payment
CMS is rolling out a new wave of Innovation Center models that point to a more targeted and strategic approach to value-based care. Rather than a single pathway, these models test different levers for specialists, regions, prevention, technology-enabled care, and advanced ACOs. Our latest blog breaks down what this shift means and how health care organizations can decide whether to apply, partner, or prepare. Read here.
What We Are Reading
Growth in National Health Expenditures: It’s Not the Prices, Stupid
A Health Affairs Forefront article argues that Medicare should modernize its ACO framework to strengthen care coordination and population health while making traditional Medicare more competitive with Medicare Advantage through clearer accountability and more systematic beneficiary assignment. Read here.
Social Determinants of Health Under the Trump Administration — Good as Well as Bad News
A JAMA Health Forum article examines how recent federal policy choices have shaped social determinants of health, highlighting both setbacks and limited progress in addressing housing, food security, and other nonmedical drivers of health outcomes. Read here.
Advancing Medicaid Primary Care Through Population-Based Payment Models
A Health Affairs Scholar journal article explores the promise and uncertainty of Medicare’s ACCESS model, a novel payment approach for chronic disease management that ties recurring payments to clinical improvement rather than discrete services while highlighting unresolved questions about payment levels, quality measurement, and care coordination. Read here.
What We're Attending
Primary Care: The Missing Link in America’s Fight Against Chronic Disease
On February 12, 2026 at 2:00 PM ET, a discussion will examine findings and policy implications from the new Health of US Primary Care report, with a focus on the role of primary care in preventing and managing chronic disease. The report is produced by the Robert Graham Center and co-sponsored by The Physicians Foundation and the Milbank Memorial Fund. Register here.
Pop Health Podcast
New Model Mania: Unpacking CMS's RHTP, ASM, LEAD, ACCESS, and ELEVATE
In the latest episode of the Pop Health Podcast, we break down CMS’s expanding portfolio of payment and delivery reform models, from the Rural Health Transformation Program and the Ambulatory Specialty Model to the new LEAD and ACCESS initiatives and the emerging ELEVATE framework, and discuss what these shifts mean for providers, payers, and health care leaders navigating value-based care in 2026 and beyond.