Medicare Advantage Landscape Released – CMS released the 2027 MA landscape file, which provides key insights into MA and PDP information. Overall, Healthcare Dive’s analysis of CMS data finds that the national MA plan count is edging down from 5,553 to 5,532, with most major insurers reducing their traditional individual MA footprints. Healthcare Dive’s analysis of the MA files indicates that a significant number of seniors will have to change plans. For example, Centene will offer about 3,000 fewer plans, while Humana will offer 2,400 fewer plans. UnitedHealthcare will cut 690 plans. CMS projects that the weighted-average MA premium will decline 16.5%, from $14.37 in 2026 to $12.00 in 2027. Healthcare Dive found that average maximum-out-of-pocket limits rising by about 10% and Part D deductibles about 30% among major carriers.
Medicaid Funding Changes – Today, October 1st, changes in Medicaid and CHIP matching funds for states took effect. As part of the reconciliation bill, federal Medicaid and CHIP matching funds are no longer available for coverage of certain lawfully present immigrants. KFF compiled estimates from states on the effects of these changes and found that approximately 281,000 people in nine states could lose Medicaid coverage this month.
Nebraska Reports Early Work Requirement Results – Nebraska, the first state to implement work requirements for Medicaid beneficiaries, released data on the requirements’ early effects. KFF published a summary of the findings, available here.
- Among new applicants who were subject to the work requirements, 46% met qualifying activity requirements, 39% qualified for an exclusion, 14% had their applications denied, and a very small number qualified for a hardship exemption.
- Among returning applicants, 57% qualified for an exclusion, 34% met the qualifying activity requirements, 7% lost coverage for not meeting the work requirements, and a small number qualified for a hardship exemption.
- For both returning and new applicants, the primary reason for denial was failure to respond to a request for information rather than affirmative finding that an applicant had not complied with the work requirements.
State-Directed Payment Estimates – New Research on the potential effects of the cuts to state-directed payments was published in Health Affairs ($) this week. The research found that 15 states spent more than 20% of their fiscal year 2024 Medicaid budgets on state-directed payments and could therefore face the largest reductions. Those states are Nebraska, Louisiana, South Carolina, Iowa, Nevada, Arizona, Kentucky, New Mexico, Illinois, Tennessee, Florida, Georgia, North Carolina, Michigan, and Mississippi.
GLOBE Model Finalized – CMS finalized the GLOBE model, which runs from January 2, 2027, through March 2032. The model modifies Part B rebate calculations for selected drugs by incorporating prices from other countries. One key change exempts participants in the GENEROUS model from mandatory participation in the GLOBE model. As a result of this and other changes in the final rule, CMS estimates that the GLOBE model will save $440 million, compared with the $11.9 billion savings estimated under the proposed rule.
