Category: Curator

HHS Curator is our free research service published by our team. We read hundreds of Medicaid news items each week and highlight and summarize them for you to save you time.

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STATE NEWS – Oregon’s health care program for low-income people is in ‘crisis,’ leaders say

STATE NEWS – Oregon’s health care program for low-income people is in ‘crisis,’ leaders say


Alternative Headline: Oregon Medicaid Faces Funding Crisis


[MM Curator Summary]: Oregon’s Medicaid system faces a crisis as major coordinated care organizations report hundreds of millions in losses and threaten to exit due to underfunding.

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Much publicized federal cuts haven’t even kicked in yet. But the state’s health care system for 1.4 million low-income people is already bleeding red ink, and leaders of the care organizations in the Oregon Health Plan say they can’t afford to keep delivering care at a huge loss.

This article has been updated.

The federal cuts that have been dominating headlines for months haven’t even rolled out yet — but according to those administering the program that 1.4 million low-income Oregonians rely on for free health care, the system is already in “crisis.”

The situation risks complicating or blocking care for many of the one in three Oregonians who get medical, dental and behavioral health services through the Medicaid-funded Oregon Health Plan.

Over the past year, some of the organizations paid by the state to oversee and direct care in the program have experienced massive losses. Now, some of their leaders are now considering pulling out of the program entirely, The Lund Report has learned.

The Medicaid executives’ concern? That if they keep delivering care to low-income people they’ll be hit with even larger losses due to the low reimbursement rates Oregon health officials are proposing to pay them in 2026.

Top state officials have extended a key deadline to allow talks to continue. But the crisis is coming at a time when the Oregon Health Authority is already wrestling with cost overruns. It doesn’t yet have a plan to deal for when federal cuts and costly administrative measures take effect thanks to HR 1, the federal budget plan spearheaded by Republicans in Congress.

“This is before the federal changes hit,” one longtime observer of the system told The Lund Report. “This is bad.”

State health officials charged with maintaining the integrity of the state’s Medicaid system declined to comment or confirm basic facts other than to say they were continuing to discuss the situation with CCO leaders. Citing what they called pending negotiations, a spokesperson for Gov. Tina Kotek’s office declined to comment on the situation.

Tight deadline for a deal

Things are happening fast. The groups, known as coordinated care organizations, must give notice next month of whether they intend to pull out of the Oregon Health Plan starting Jan. 1. As of now, some of them apparently would leave the program rather than renew their contracts. 

To allow talks to continue, Oregon Health Authority Director Sejal Hathi notified the CCO leaders last week that the state was extending the deadline to commit by more than two weeks.

“The timelines are very tight,” Hathi wrote in an Aug. 14 email to them, obtained under Oregon Public Records Law. She noted the agency has “limited authority” to push things back further due to an Oct. 1 deadline to submit CCO rates to federal regulators for review.

The time will allow state officials to try to boost the CCO rates and consider program changes to cut costs, records show. The new deadline is Sept. 18 for the organizations to say whether they’ll stick around.

As things stand, 11 organizations  oversee 16 regions in the state. If they pull out of any of those regions it could create chaos and disruptions for large numbers of people who live there, making it harder for them to get care at a time when many providers are already scarce and overbooked.

“Oregon’s coordinated care model has been a national leader, and it depends on strong, financially sustainable CCOs,” said a spokesperson for CareOregon, a nonprofit that oversees care for 500,000 Oregonians, including many in greater Portland. “If major CCOs were to withdraw, it would create instability for hundreds of thousands of members and providers and could jeopardize the coordinated model itself.  That’s why we are raising these concerns now: to ensure Oregon can sustain a strong, stable Medicaid system for our members who depend on it.” 

Careoregon reported losses of $200 million last year, and the spokesperson says its losses this year could exceed $300 million. That’s big even for a nonprofit organization that was holding more than $1 billion in reserves.

Like CareOregon, PacificSource ‚ which oversees care in Central Oregon, the Columbia Gorge, Marion, Polk and Lane counties —has also suffered major losses. Both organizations serve more urban populations and have seen behavioral health needs skyrocket.

Jim Havens, a PacificSource executive vice president, told The Lund Report in an email that “Like other payers in Oregon, PacificSource is facing serious financial challenges related to Medicaid. Enrollment has surged and costs have risen sharply, far outpacing the state rates meant to cover them. We project operating losses of up to $100 million in 2025, after $40 million in losses in 2024. Losses in 2026 could be significantly higher.”

Even relatively small Yamhill Community Care is worried. Its CEO, Seamus McCarthy, has been a spokesman of sorts for the Medicaid managed care groups. “Oregon’s health care system is approaching a crisis point," he said in a statement. "We hope solutions can be reached before a catastrophic event—such as a CCO not renewing its contract—forces drastic changes to the Oregon Health Plan.”

State payments trail cost trends

The prospect of CCOs pulling out of contracts to care for low-income people is prompted by the state’s proposed increases to their reimbursements averaging 6.8% — far lower than what they considered necessary to account for massive increases in people accessing health care and higher costs.

Federal funds pay for the majority, but the state also has to chip in significant funds. The Oregon Health Authority’s approved budget has to cover that, but faces  numerous other cost pressures. The agency also needs to prepare for things to get worse:: observers in Salem expect state goverment revenue projections to drop substantially due to massive layoffs at Nike and Intel.

In contrast to the reimbursement increases of 6.8%, underlying costs for Medicaid insurers and others in health care are going up far more quickly —  close to10% a year or more in Oregon and around the country, according to informed observers and nationally reported data.

Similar cost trends in the commercial health insurance market have led Oregon insurance regulators to preliminarily approve average premium increases of 9.7% for individual market insurers, and 11.5% for plans serving small businesses.

The projected losses cited by Oregon’s care organizations would  come on this year, when payments made by the state of Oregon did not cover costs. Earlier this year, because behavioral health needs outstripped the health authority’s rate-making assumptions, Oregon lawmakers had to slip a $30 million payment into the state budget  to cover some CCO losses.

On June 11, on behalf of the care organizations, McCarthy of the Yamhill nonprofit documented their concerns in a letter to Oregon Medicaid Director Emma Sandoe, saying similar messages had been shared with top agency leaders for several months.

“Underfunding by the state is threatening the health system, particularly for Oregon’s most vulnerable situations,” the letter said. 

It noted that many of the groups were spending close to 100% or more of their revenue on medical expenses. That’s way over the minimum benchmark of 85% required for medical spending, a federal benchmark intended to allow 15 % to cover administrative costs and some profit. The letter said the state faced an “impending crisis.”

Sandoe declined to comment on the letter.

Oregon is among the states most reliant on managed care organizations to operate its Medicaid program. A few states barely use outside managed care organizations or insurers. 

In Connecticut, officials years ago fired the health insurers they used to contract with and claimed they saved money by setting up new nonprofits to handle adminstrative services. Some longtime Oregon health care executives say it’s unclear how transferable that model is to Oregon given the geographic and democraphic disparities between states.

Past is prologue

For Oregon historians, the current situation might seem familiar. The birth of the Oregon Health Plan in 1993 came in response to what lawmakers at the time considered a crisis — insurers pulling out of the Medicaid market citing insufficient payments. The goal was to ensure adequate funding and community based care.

Since then, the  late state representative, Mitch Greenlick, pushed the state to take measures to make it hard for the care organizations and their reserves to leave the program, to no avail. Former Gov. John Kitzhaber and others — including then-House Speaker Tina Kotek — have pushed the Legislature to similarly take steps to keep Medicaid profits in the state’s health care system.

None of that happened. The state has no leverage to keep care organizations and the reserves they amass from leaving the program.

Meanwhile, over the last 15 years, the work of the state office that sets rates to care organizations in the Medicaid-funded program has repeatedly come into question. 

When it comes to health coverage, rates are supposed to approximate costs plus an acceptable amount of overhead. But prior to major reforms in 2012, the Oregon Health Authority used to simply tell managed care organizations how much it could afford to pay them.

Critics, including former Gov. John Kitzhaber, have noted that the system rewards inefficiencies, promoting waste. But reforms intended to change things ran into federal laws, and so did Oregon’s practices.

In 2014, federal health officials demanded Oregon Health Authority officials overhaul practices that appeared to flagrantly violate legally required actuarial rules governing rate-setting for Medicaid programs.

Two years later, care organizations, which were supposed to have rates that allowed a 2% profit margin, instead reported profits of as much as 27%, causing the state’s then-Medicaid director to advise the Oregon Health Authority’s public relations staff to kill a press release bragging about their financial health. 

In 2022, the Oregon Health Authority agreed to a $22.5 million settlement with FamilyCare, a care organization that cited expert testimony to blame poorly calculated rates for its decision to leave the state Medicaid program in 2018 and take more than $100 million in reserves from its operations with it. (FamilyCare had contributed to The Lund Report, as has the group to which it donated much of its reserves, the Heatherington Foundation for Innovation and Education in Health Care. Neither entity participates in Medicaid or is affected by the current rate flap.)

In 2024, state officials appeared to admit in press release that they tried to keep reimbursement increases in Medicaid as close as possible to 3.4% — the state’s cost-growth target — despite federal rules requiring rates to reflect cost trends, not an abstract target.

Jeff Heatherington, the former CEO of FamilyCare, told The Lund Report that care organizations can leave the program, as the nonprofit he headed did, if they feel the state’s rates are unfair or not a good return on investment. He’s not sure he completely buys the most recent complaints, since some of the care organizations are dominated by hospitals that can manipulate reimbursements to “upcode” or otherwise inflate revenue or costs.

That said, the state’s reimbursement rates appear to be way too low given the losses being reported, he added. If any CCOs pull out, it could threaten access for patients and drive up costs for the state because people can’t get primary care providers and go to the emergency rooms and urgent care instead. 

“You would have, I think, a real health problem” for affected members, he said.

https://www.thelundreport.org/content/oregons-health-care-program-low-income-people-crisis-leaders-say



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STATE NEWS- Autism therapy providers warn of crisis amid Medicaid changes

Alternative Headline: Florida Autism Therapy Providers Say Medicaid Transition Puts Kids at Risk

[MM Curator Summary]: ABA therapy providers in Florida warn that Medicaid’s switch to managed care is causing massive payment delays, denials, and cuts that threaten children’s access to autism care.

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Companies that provide therapy to children with autism are speaking out, saying they may have to stop serving some of Florida’s most vulnerable children if problems with a new Medicaid reimbursement system aren’t resolved.

Autism therapy providers warn of crisis amid Medicaid changes

“They owe us a lot of money. And it’s not just us. It’s statewide. It’s across the board,” said Alicia Anthony-Zabala, who owns Missing Piece ABA in Tampa.

“The clients we serve are in jeopardy of losing their services,” said Sara Beeler of Mindful Masterpieces in Naples.

The ABC Action News I-Team has learned the issues started in February, when Florida’s Medicaid program transitioned to a managed care system.

Providers say since that transition, payments have been delayed or denied, putting businesses, children and families at risk.

Thousands of Florida children receive ABA through Medicaid

For Anthony Meoni, who has been diagnosed with autism spectrum disorder, Missing Piece ABA offers what his family believes is his best chance to thrive.

Anthony struggles with communication and social interaction.

He’s not alone.

According to the CDC, the prevalence of autism spectrum disorder nationwide has grown from 1-in-150 children in 2000 to 1-in-31 today.

That represents about 3.1 percent of all children.

Anthony is among an estimated 41,000 Florida children who receive ABA, or Applied Behavioral Analysis therapy through Medicaid.

“ABA is the only approved scientifically-based documented treatment for autism,” Anthony-Zabala said.

ABA therapy uses positive reinforcement and consistent practice to change children’s negative behaviors.

“A lot of these kids can’t go to school”

“Some of our companies are the only lifeline these parents have to kind of work through some of these behaviors,” said Aerial Lufkin, of Sunshine ABA in Orlando.

“The majority we service are all day every day,” Beeler said. “It’s very important because the majority of clients we have don’t have other options as far as attending school or a regular daycare because they don’t provide the types of therapy they need.”

“A lot of these kids can’t go to school. Or they do go to school and they get sent home because of their behavior. Parents are having to pick them up,” said Anthony-Zabala.

Representatives of four ABA providers recently told the I-Team their businesses are struggling after Medicaid changed to a statewide managed care program in February.

“People weren’t fully prepared for a big transition like this. This is very huge and it’s really affected everyone in the state,” Lufkin said.

They say the problems stem from the way Sunshine Health, the company that administers Medicaid claims for the state, pays providers.

“Prior to this, every Thursday we would get a lump-sum deposit. So we would bill and pretty much get what we billed,” Anthony-Zabala said.

“It’s created a huge spiral in my finances”

Providers say now payments are sporadic.

“Because the payments are so spaced out, it makes it impossible to budget because you don’t know how much money you’re getting and when you’re getting it,” said Pearson Klein of Behavior Modification Solutions ABA in Ocala.

“We’ve seen no payments on some of the claims for many weeks now,” Beeler said.

Some claims submitted in February and March are still listed as “pending”.

Anthony-Zabala says claims she submitted for a single client were approved in some cases and denied in others.

“We were only reimbursed 8 out of 34 claims. And when we went back into the portal, the system, it just said that they were being denied due to no Medicaid ID… even though the Medicaid ID was on the denial,” Anthony-Zabala said.

“They’ll say a Medicaid number isn’t listed on the paperwork, but on the denial, it’s clearly listed,” Beeler said.

And providers say getting answers about the denials isn’t easy.

Alicia Anthony-Zabala

“We will sit on the phone for hours and generally get no resolution to the reason why we were calling,” Beeler said.

Under the new system, providers say reimbursement rates were also cut by 20 percent, even though they have to pay their staff the same amount.

Some companies say they’re on the brink of having to close.

“Most of us are four to six weeks away. If this continues… the lack of reimbursement… four to six weeks,” Anthony-Zabala said.

She estimates she is owed about $80,000 for claims she has submitted to Sunshine Health but haven’t been paid.

“It’s just created a huge spiral in my finances,” Klein said.

He said if his business shut down, 35 to 40 people would lose their jobs.

If ABA companies close, parents would also be impacted.

“Likely they would have to quit their jobs. Someone would have to make the decision to say home. Or hire some private care,” Beeler said. “It’s very expensive.”

Response to providers’ concerns

We contacted Florida’s Agency for Healthcare Administration, or AHCA, about the providers’ issues but have not heard back.

We also reached out to a spokesperson from Sunshine Health.

She emailed the following statement, which addresses concerns we forwarded to the company about patient privacy and reimbursement:

“Sunshine Health takes its responsibility to protect member and provider information seriously, maintaining strict compliance with HIPAA regulations to ensure all protected health information (PHI) is handled securely and appropriately.

“Access to our Provider Portal is restricted to Providers who are Covered Entities and/or their Business Associates who are authorized to handle PHI under the terms of our access agreement. Users are required to only access records for which they have a legitimate business need. The identity verification data requested reflects information typically received by providers at the point of service and is designed to help return member information efficiently and without limiting the ability of members to get the care they need when they need it.”

“Sunshine Health partners closely with our valued network of providers to deliver high quality care to our members. The state of Florida transitioned Behavioral Analysis (BA) services to managed care health plans on Feb. 1, 2025, and we have invested significant effort into making this transition as seamless as possible for both our members and provider partners. As a managed care health plan for the State of Florida, we adhere to all state requirements about how services can be billed. In an effort to be a good partner, we have been working closely to educate providers on these processes through Provider Town Hall trainings, Provider Engagement Team outreach, and quick resource guides to ensure they understand any requirements in order to deliver the best care to our members.”

Anthony-Zabala worries if the program isn’t fixed, Anthony and the other children her company cares for could be at risk of losing the progress they’ve made.

“Every small achievement, no matter how small, is a milestone. That’s why you get up every day and you believe in it. And you believe in these kids and you fight for them,” she said.

https://www.newsbreak.com/tampa-bay-28-563666/4182961849225-autism-therapy-providers-warn-of-crisis-amid-medicaid-changes

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CMS NEWS – Medicaid cuts worry adult foster care organizers in Kent County

CMS NEWS – Medicaid cuts worry adult foster care organizers in Kent County


Alternative Headline: Medicaid cuts squeeze providers

[MM Curator Summary]: Kent County foster care providers face ongoing financial challenges as Medicaid funding cuts extend into next year.


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WYOMING, Mich. (WOOD) — Organizers of adult foster care facilities in Kent County are worrying about their bottom line after they learned Medicaid funding cuts will continue through next year.

“We have to look at how we are going to be able to balance things if cuts like this are going to continue,” said Casey Kuperus, president of David’s House Ministries. “It does appear that this will continue into the next fiscal budget that Network 180 will be voting on Monday.”

Network 180 is Kent County’s community mental health authority, which means it distributes the county’s Medicaid funding. In May, it announced a 5% cut in funding for specialized residential providers. While many, like Kuperus, were not happy about the initial cuts, they never thought the decrease would spill over into the next fiscal year.

“It seems to be we are the only ones receiving reductions in these rates with expectations to continue to provide the high-quality services,” he said.

Network 180 did not return News 8’s request for comment. Its 2026 budget shows Kent County will see a $9 million increase in Medicaid. The budget will be reviewed during a public hearing next Monday.

“It’s not about providers trying to get more money out of the budget, it’s about providers trying to get fair funding to continue the services that we are providing to this county,” Kuperus said. “And right now, it’s getting more and more difficult to do that.”

https://www.woodtv.com/news/kent-county/medicaid-cuts-worry-adult-foster-care-organizers-in-kent-county/


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STATE NEWS – Rosen Delivers Floor Speech Highlighting Devastating Impacts in Nevada of Washington Republicans’ Medicaid Cuts

STATE NEWS – Rosen Delivers Floor Speech Highlighting Devastating Impacts in Nevada of Washington Republicans’ Medicaid Cuts


Alternative Headline: Rosen Slams Medicaid Cuts


[MM Curator Summary]: After speaking with health care leaders from multiple medical care centers in Nevada, Senator Jacky Rosen warned that Republican Medicaid cuts will devastate Nevada hospitals and harm families’ access to health care.

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WASHINGTON, DC – Today, U.S. Senator Jacky Rosen (D-NV) delivered a floor speech highlighting her visits to multiple medical care centers in Nevada and her conversations with health care leaders about the devastating impacts of Washington Republicans’ cuts to Medicaid. In August, Senator Rosen visited health care centers in Lovelock, Reno, and Las Vegas where she heard first-hand how they’re being hurt by the steep cuts in Medicaid funding.

Transcript of Senator Rosen’s speech:

Last month, I traveled up and down my state to speak directly with Nevadans about how Washington Republicans’ devastating cuts to Medicaid will hurt our communities. 

From the University Medical Center in Las Vegas to Northern Nevada HOPES in Reno, I heard firsthand from medical providers about how worried they are about the cuts being made to their funding by the Republican budget law. 

According to a report, Nevada hospitals are set to lose up to half a billion dollars from the Republican “Big Beautiful Bill” at a time when our state is already facing a dire shortage of doctors and nurses.

And remember, Washington Republicans did this so they could pay for even more tax breaks for billionaires.

In Las Vegas, I met with doctors and leaders of the only Level One trauma center in the entire state of Nevada. 

Our conversation made it clear: these Medicaid cuts will be devastating for the hospital’s finances and they’ll make patients less likely to seek preventative health care – often waiting until it’s too late. 

This will strain our hospitals’ resources even more and could have terrible consequences for families.

It was a similar story in Reno, where I visited Northern Nevada HOPES, a nonprofit community health center that serves families in need. 

The staff painted a harrowing picture: when Medicaid is cut and people don’t have access to health insurance, they delay care, minor conditions become severe, emergency rooms overflow, and the financial and human cost escalates. 

As their CEO Sharon Chamberlain said, “This is not a budget issue. It’s a public health emergency. And let’s be clear: No amount of innovation, no amount of efficiency, can fully offset the damage caused by policies that strip coverage of those that need it most.” 

M. President, these are not abstract worries. They reflect real fear and urgent concern from families, medical staff, and local leaders.

And what’s worse: these stories aren’t unique to Nevada. This looming crisis is going to hurt communities all across the country. 

Republicans, time after time, put politics and tax cuts for billionaires over people’s health. 

Make no mistake, people will die because of these Republican cuts – It doesn’t have to be this way.

I’ve joined my Democratic colleagues in helping to introduce a bill to overturn the cruel Republican Medicaid cuts and protect Nevadans’ access to health care.

Our hospitals and community clinics – the people on the frontlines of our health care system – they are sounding a wake-up call. It is not just their fight. It is our fight.  

Now, let’s pass that bill and repeal the damage being made to our health care system before it’s too late.

The health of Nevada families is on the line. 

Senator Rosen has strongly opposed Washington Republicans’ extreme budget law that cuts Medicaid to give more tax breaks to billionaires. In July, she condemned the Senate Republicans’ passage of the extreme so-called “Big Beautiful Bill” and she spoke on the Senate floor to oppose this dangerous legislation, warning of its devastating impact on access to health care in Nevada and across the nation. In August, she helped introduce legislation to overturn the Medicaid cuts that are taking away care from millions of Americans. 

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https://www.rosen.senate.gov/2025/09/04/rosen-delivers-floor-speech-highlighting-devastating-impacts-in-nevada-of-washington-republicans-medicaid-cuts/



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CMS NEWS – Medicaid Cuts Shift Healthcare Costs to Broader Public

CMS NEWS – Medicaid Cuts Shift Healthcare Costs to Broader Public


Alternative Headline: Medicaid Cuts Raise Hidden Costs


[MM Curator Summary]: Medicaid budget cuts shift costs to hospitals, private insurers, and the broader economy instead of creating real savings.

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Budget reductions to Medicaid programs may appear to offer immediate financial relief for government spending. Still, evidence suggests these cuts often result in widespread cost increases that affect the entire healthcare system.

The Hidden Cost TransferEconomic Impacts Beyond HealthcareCost Shifting to Private InsurancePublic Health Considerations

When policymakers face budget constraints, Medicaid frequently becomes a target for spending reductions. As one of the largest items in many state budgets, the program presents an attractive option for officials looking to address fiscal challenges. However, financial experts and healthcare analysts warn that such cuts can create a ripple effect throughout the healthcare ecosystem.

Reducing Medicaid coverage doesn’t eliminate healthcare needs – it simply shifts where and how those needs are addressed. When individuals lose Medicaid coverage, they don’t stop getting sick or requiring medical attention. Instead, they often delay care until conditions worsen and require emergency intervention.

Hospitals and emergency departments become the default providers for uninsured patients, delivering care that is both more expensive and less effective than preventive services. These facilities are legally required to treat patients regardless of insurance status, resulting in uncompensated care costs that must be absorbed somewhere in the system.

Cutting Medicaid can seem like an easy way to slash the budget. But, the costs can spread to all of us.

Economic Impacts Beyond Healthcare

The financial consequences extend beyond direct healthcare costs. When people lack access to regular medical care, workforce productivity suffers as preventable illnesses lead to increased absenteeism and disability. Families facing medical bankruptcies experience financial instability that affects local economies.

State economies also feel the impact through reduced federal matching funds. For every dollar a state cuts from Medicaid, it loses multiple dollars in federal funding that would otherwise circulate through the local healthcare economy, supporting jobs and services.

Cost Shifting to Private Insurance

Healthcare providers typically respond to Medicaid reimbursement reductions by shifting costs to private insurers. This practice, known as cost-shifting, results in higher premiums for those with private insurance coverage. Research indicates that hospitals and medical practices often increase charges to privately insured patients to compensate for losses from public programs.

The resulting premium increases affect employers and employees alike, with businesses facing higher costs for providing health benefits and workers experiencing reduced wages as employers allocate more resources to healthcare.

Public Health Considerations

Medicaid reductions can also compromise public health initiatives. The program funds critical preventive services including:

  • Vaccination programs
  • Maternal and child health services
  • Chronic disease management
  • Substance abuse treatment

When these services become less accessible, communities may experience increased rates of preventable diseases and complications, creating additional healthcare demands and costs.

Public health officials note that Medicaid plays a crucial role in addressing health disparities and providing care to vulnerable populations. Reductions in coverage can exacerbate existing inequalities and create long-term social costs.

As budget discussions continue at state and federal levels, policymakers face difficult choices about program funding. However, the evidence suggests that Medicaid cuts rarely produce the straightforward savings they promise. Instead, they often result in cost transfers that ultimately affect taxpayers, businesses, and individuals throughout the economy.

Healthcare economists recommend that budget planners consider these broader implications when evaluating potential changes to Medicaid funding, recognizing that short-term budget reductions may lead to larger long-term costs across multiple sectors of society.

https://www.considerable.com/medicaid-cuts-shift-healthcare-costs-to-broader-public/



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CMS NEWS – Medicaid Cuts and Long-Term Care Quality & Access

CMS NEWS – Medicaid Cuts and Long-Term Care Quality & Access


Alternative Headline: Medicaid Cuts Threaten Elder Care


[MM Curator Summary]: Medicaid cuts under Trump’s bill will reduce access to long-term care, hitting seniors and home services hardest.

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The One Big Beautiful Bill Act (OBBBA) is projected to cut Medicaid benefits by over $1 trillion. How will these cuts affect long-term care? The law will likely result in worsening quality of care and access to nursing homes and home-based care, said LDI’s Executive Director Rachel M. Werner, speaking on the Make Me Smart podcast with Marketplace’s Kimberly Adams.     

Werner said there will also be large differences state-by-state, and the benefits you get may depend on where you live in. So, it’s crucial to plan ahead for long-term care.   

Here are eight points from Dr. Werner’s interview on July 16, 2025.

1. OBBBA Cuts “Provider Taxes”—a Key Funding Source for Medicaid

States use taxes on health care providers and insurers to boost their share of Medicaid funding and draw matching federal funds. The new bill limits both existing and new provider taxes, cutting off a major funding pipeline.

Rachel M. Werner, MD, PhD

2. The Loss of Coverage Will be Widespread and Hit Some Seniors

Roughly 11.8 million Americans, including 1.3 million older adults on both Medicare and Medicaid, could lose access to Medicaid due to these funding cuts, according to the Congressional Budget Office.

3. Long-Term Care Will Suffer

Medicaid is the primary payer for long-term services for older adults and people with disabilities, including nursing home and in-home care. With less funding, quality and access will decline.

4. Home Care May Be Hit Hardest

Medicaid is required to pay for nursing home care, but home and community-based services are optional. So states are likely to cut these benefits first, reducing options for people who want to live independently at home.

5. Family Caregivers Will Shoulder More Burden

As formal care options shrink, unpaid family caregivers will likely have to fill in the gaps, taking on more emotional, physical, and financial burdens.

6. Where You Live Will Matter More

Medicaid programs are state-run, and the generosity of care varies across states. With reduced federal funding, wealthier states might fill the funding gap; poorer ones may reduce services—deepening geographic inequality.

7. Workforce Crisis Will Get Worse

Medicaid cuts may drive down pay for already underpaid care workers. Combined with immigration restrictions and delayed nursing home minimum staffing mandates, we could see even more severe shortages in both nursing homes and home care.

8. Plan for Long-Term Care Before You Need it

Medicare does not cover long-term care, so know your state’s Medicaid rules and start saving early.Medicaid eligibility also varies across states and requires planning. If you don’t qualify for Medicaid, you’ll need personal savings or unpaid family help. Start preparing now to avoid tough choices later.

https://ldi.upenn.edu/our-work/research-updates/how-medicaid-cuts-will-affect-quality-and-access-in-long-term-care/



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STATE NEWS – Louisiana Medicaid Increased Physician Reimbursement Rates Beginning July 1, 2025

STATE NEWS – Louisiana Medicaid Increased Physician Reimbursement Rates Beginning July 1, 2025


Alternative Headline:  Louisiana Boosts Medicaid Pay


[MM Curator Summary]: Louisiana will raise Medicaid physician reimbursement rates to 85% of Medicare levels starting July 2025.

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– The Louisiana Department of Health (LDH) announced an increase in Medicaid reimbursement rates for physicians through funding authorized by Act 306 of the 2024 Regular Legislative Session and appropriated in House Bill 1 of the 2025 Session.

Effective July 1, 2025, Medicaid physician reimbursement rates will increase to 85% of the March 2024 Region 99 Medicare rates for applicable services. Reimbursements at or above this threshold will remain the same.

To implement the new rates, LDH has initiated the formal rulemaking process and submitted a state plan amendment to the Centers for Medicare and Medicaid Services (CMS). An emergency rule was published in the July 2025 edition of the Louisiana Register with the effective date of July 1, 2025, allowing the rate increase to take effect while the final rule is being finalized.

What Providers Need to Know:

  • No action is required from providers. All eligible Medicaid claims with service dates on or after July 1, 2025, will be automatically recycled by LDH and the managed care organizations (MCO) to reflect the updated reimbursement amounts.
  • A revised Medicaid fee schedule will be posted on LDH’s website by September 30, 2025.
  • Once the fee schedule is published, MCOs will have 30 calendar days to implement the new rates.
  • LDH will issue an informational bulletin with additional details before the online posting of the revised fee schedule.

For updates and more information, providers are encouraged to monitor LDH communications.

https://ldh.la.gov/news/7537


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STATE NEWS – Vance brazenly lies about cuts to Medicaid in his home state

STATE NEWS – Vance brazenly lies about cuts to Medicaid in his home state


Alternative Headline: Vance Defends Medicaid Cuts


[MM Curator Summary]: JD Vance falsely claimed most Ohioans will retain Medicaid under Trump’s new policy, despite analysis showing massive coverage losses.

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The wildly unlikeable Vice President JD Vance returned to his home state of Ohio on Monday, speaking at a steel plant in Canton. When asked about the “hundreds of thousands of Ohioans” whose Medicaid coverage is in jeopardy as a result of President Donald Trump’s “One Big, Beautiful Bill,” Vance simply lied.

A cartoon by Clay Bennett.

“Well, what I’d say to those Ohioans is one: Don’t believe every false media report that you’ve heard because our explicit goal in the Trump administration is to protect people’s health care, so long as they’re working hard, playing by the rules,” he claimed. 

He then went on to make a false assertion about who will lose their Medicaid.

“Now, there have been a lot of lies out there. And if, for example, you’re an able-bodied person and you’re searching for work, you still got access to Medicaid. If you’re a single mom and you need access to that health care to make sure your kids can go see a doctor, you’re still going to have access to that Medicaid,” Vance said. “Who’s not going to have access to that Medicaid is people who are in the United States illegally and people who refuse to even look for a job."

Meanwhile, an analysis from the Ohio-based Center for Community Solutions found that up to 450,000 Ohio residents are at risk of losing their health insurance once the GOP’s Medicaid work requirement waiver takes effect. 

The policy resembles Arkansas’ failed 2018-2019 experiment, which not only failed to boost employment but also increased red tape, causing more than 18,000 people to lose their health insurance.

The conservative myth that millions of people live comfortably by lazily subsisting off of meager entitlements has been debunked repeatedly. But now the Trump administration is pushing a new myth: that citizens will work low-wage jobs—vacant due to the mass deportations of immigrant workers—in exchange for the poor and often inaccessible health insurance available to farmworkers.

We’ll see how that works out.

https://www.dailykos.com/stories/2025/7/28/2335623/-Vance-brazenly-lies-about-cuts-to-Medicaid-in-his-home-state



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TECH – Unite Us and Nomi Health Partner to Accelerate and Streamline Payments for Community-Based Organizations Serving Medicaid Managed Care Organizations

TECH – Unite Us and Nomi Health Partner to Accelerate and Streamline Payments for Community-Based Organizations Serving Medicaid Managed Care Organizations


Alternative Headline: Faster CBO Payments Launched


[MM Curator Summary]: Unite Us and Nomi Health have partnered to accelerate and simplify payments to community-based organizations supporting healthcare delivery, especially in Medicaid Managed Care organizations. 

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NEW YORK–(BUSINESS WIRE)–Unite Us, the nation’s trusted technology partner integrating health and community-based care, and Nomi Health, a leading national healthcare financial services platform, today announced a strategic partnership to deliver an innovative joint solution designed to dramatically streamline administration and accelerate payments to community-based organizations (CBOs) on behalf of healthcare payers.

New partnership pairs Unite Us’ billing capabilities with Nomi Health’s payment system to enhance financial flows for community services.

This strategic partnership will directly address a critical pain point for CBOs: the slow and unpredictable payment processes that hinder their financial stability and ability to deliver vital services. By integrating the Unite Us and Nomi Health platforms, the partnership ensures that essential community services are efficient and sustainably funded through faster, more reliable reimbursements.

“Nomi Health is committed to eliminating the friction points in healthcare, and this partnership with Unite Us extends that commitment directly to the community level,” said Mark Newman, founder and CEO at Nomi Health. “Our platform is built to eliminate costly administrative processes and accelerate cash flow. Together with Unite Us, we are removing the traditional roadblocks that have prevented CBOs from being reimbursed efficiently. This means less paperwork, more predictable funding, and ultimately, more resources directed towards direct patient care and community well-being.”

Historically reliant on grants, CBOs often struggle to adapt to healthcare reimbursement models, facing operational strain from delayed payments. This new integrated solution dramatically reduces these payment delays, improving financial health for the organizations on the front lines serving the most vulnerable populations. Once a claim (837) is submitted to the healthcare payer through the Unite Us platform, Nomi Health seamlessly facilitates the end-to-end payment process through its platform, delivering funds to CBOs significantly faster than what they see today.

For healthcare payers, the partnership offers an efficient, automated pathway to financially support their community based-partners, ensuring consistency in program execution and broader reach into vulnerable populations. By automating and accelerating the payment process from claim submission to direct funding, healthcare payers can now provide their CBO partners with the consistent cash flow needed to sustain and expand critical services, ultimately strengthening their entire community-based ecosystem.

“Our partnership with Nomi Health is a game-changer for healthcare payers and CBOs nationwide,” said Dan Brillman, co-founder and ceo at Unite Us. "For too long, the financial backbone of community based services has been strained by slow, complex payment processes. By integrating Nomi Health’s modern payment system with our reimbursement solutions, we are not just speeding up payments; we are fundamentally empowering CBOs with the efficiency and financial health they need to expand their impact and focus on delivering critical care and support to those who need it most. This is a monumental step towards a truly integrated and efficiently managed continuum.”

Key Features of the Joint Solution:

  • Streamlined Reimbursement Workflow: Unite Us simplifies the entire reimbursement process, facilitating accurate tracking, submission, and approval of services with unparalleled efficiency.
  • Faster Payments: Nomi Health’s advanced banking infrastructure significantly shortens payment cycles, ensuring dollars are in the hands of CBOs faster than ever before.
  • Reduced Administrative Burden, Increased Impact: Nomi Health assumes the administrative load, drastically cutting down on the paperwork and manual effort traditionally required to process reimbursements, allowing CBOs to dedicate more resources to their core mission.
  • Enhanced Financial Stability for Local Organizations: More predictable and accelerated cash flow fosters sustainability and amplifies impact at the community level, all powered by trusted technology built to scale geographically across states and across diverse service areas.

Together, Unite Us and Nomi Health are building a more integrated, resilient, and responsive health and human service ecosystem—starting with the organizations at its foundation.

For more information about the Unite Us and Nomi Health partnership and its impact on community-based organizations, including how non-profit CBOs can use the Unite Us platform free of charge, please visit uniteus.com/contact/.

About Unite Us:

Unite Us is the nation’s premier technology provider for integrating health and community-based care. Our advanced product suite is used to proactively coordinate services using data-driven insights, streamline referral and case management, and facilitate eligibility assessments and reimbursements across government, healthcare, health plans, and community organizations. The first of its kind, our closed-loop referral system prioritizes privacy and dignity and has integrated data and analytics tools used to measure impact, optimize programs, and shape policy. With over 1.7M services, we host the nation’s largest network of community-based health and economic services dedicated to improving whole-person health. Learn more at UniteUs.com and LinkedIn.

About Nomi Health:

Nomi Health is rebuilding healthcare through its direct model. Founded in 2019, the company’s integrated platform combines analytics, pharmacy management, direct provider networks and payment solutions – providing the infrastructure that powers better healthcare for self-insured employers. The company serves 4,000 customers nationwide, impacting 30 million lives and influencing over $150 billion in healthcare spend. Based in Orem, Utah, Nomi Health leads the movement to rebuild America’s healthcare system.


https://www.businesswire.com/news/home/20250723566547/en/Unite-Us-and-Nomi-Health-Partner-to-Accelerate-and-Streamline-Payments-for-Community-Based-Organizations-Serving-Medicaid-Managed-Care-Organizations


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CMS NEWS – Could the Big Beautiful Bill’s Medicaid cuts shift work, expenses to the county level?

CMS NEWS – Could the Big Beautiful Bill’s Medicaid cuts shift work, expenses to the county level?


Alternative Headline: Counties May Shoulder Medicaid Burden


[MM Curator Summary]: Medicaid changes under Trump’s bill could overwhelm local governments with new workloads and financial penalties.

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WATERTOWN, New York (WWNY) – President Trump’s Big Beautiful Bill aims to save money at the federal level. However, there’s reason to believe that as you save in Washington, you will end up paying more at the local level.

When it comes to Medicaid, President Trump’s bill requires able-bodied workers to check in and prove they are eligible for Medicaid.

There are currently 32,000 people in Jefferson County on Medicaid. At last check, around 6,000 are considered “able-bodied workers.”

Under Donald Trump’s recent Big Beautiful Bill, those people would need to essentially prove they are working or looking for work every six months.

“Early indications are that the work requirements and the recertification are going to be somewhat burdensome on counties,” said Jefferson County Administrator Ryan Piche. “If there’s 6,000 people that need to come through DSS now twice a year, and then go through The WorkPlace twice a year and seek employment opportunities and prove they’re seeking employment opportunities, that’s potentially 24,000 touch points the county government has to account for.”

That means a much bigger workload and a need to hire more people.

Cheryl Mayforth, Executive Director of The WorkPlace, says she is already looking to hire at least one person now to do the recertification.

“It could affect up to 950 families or households in Jefferson County alone, so it’s going to be a challenge,” said Mayforth.

For people who have to check in to keep their Medicaid, they’ll have to check a few boxes.

“They’re going to have to work at least 20 hours a week, 80 hours a month, and they’re going to have to report to us job searches, any volunteer work that they’re doing,” said Mayforth.

Mayforth says those on Medicaid will be exempt from re-certifying if they are 65 or older, disabled, or have a child under 14.

The Big Beautiful Bill also makes changes to who qualifies for SNAP, or the Supplemental Nutrition Assistance Program. It’ll use some of the same recertification as Medicaid.

Piche says in New York State, counties are responsible for administering SNAP, and currently, the state does not meet the new standards the federal government is trying to implement.

What does that mean? Piche says, hypothetically speaking, $5 million in penalties on Jefferson County taxpayers.

“The question is, are those penalties going to be paid by the state or are they going to be paid at the local level? If they’re paid at the local level, that means local taxpayers, on your property tax bills, are going to have to cover those penalties,” said Piche.

It’s important to note that there are still a lot of unknowns.

The changes go into effect in 2027, and Piche says the county will be working with other county governments and the state over the next year to learn more about how to best implement the changes.

Copyright 2025 WWNY. All rights reserved.


https://www.wwnytv.com/2025/07/22/could-big-beautiful-bills-medicaid-cuts-shift-work-expenses-county-level/


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