October 16, 2025

Senate Bill 41, signed into law Friday, strengthens oversight of PBMs and private equity firms while also reducing prior authorization requirements and bolstering hospitals’ charity care programs to improve access to timely, affordable care.

Humana argued that its 2025 Star Rating of 3.5 was unfair, citing issues such as call center failures to provide foreign language interpreters. The company appealed the rating, but a judge dismissed the case, ruling that CMS’s policies were lawful and that the assigned rating was neither arbitrary nor capricious. It is estimated that Humana could lose upwards of $1 billion in revenue next year.

State Medicaid systems are notoriously rigid, complex, and resistant to modernization—an issue now compounded by the new infrastructure required to track and verify work requirements. A handful of major contractors, including Deloitte and Gainwell, dominate this market. The Senate Finance Committee has given these vendors until the end of October to respond to two dozen information requests, including whether their contracts impose penalties for wrongful terminations and what pre- and post-deployment testing safeguards they employ.

The report shows that healthcare organizations are shifting from experimenting with AI to actively implementing it—70% of providers and 80% of payers now have an AI strategy in place or under development. For providers, the most common applications are documentation tools, while insurers are focusing on call center operations and member engagement and follow-up.

Dr. Oz suggested that changes may be coming to the Medicare Advantage program. He had previously voiced support for the Biden administration’s stricter MA audit policies, though those rules were recently struck down by a federal judge.