Category: Medicaid Managed Care

Alternative Headline: AmeriHealth Caritas and tango Partner to Expand Home Health Care in Pennsylvania

[MM Curator Summary]: tango and AmeriHealth Caritas have launched a Pennsylvania partnership to improve skilled home health access for D-SNP members, with plans for further 2025 expansion.

==============================

, /PRNewswire/ — tango, a leader in post-acute care benefit enablement services, has entered the Pennsylvania market, the first of several new growth opportunities launching in 2025. In partnership with AmeriHealth Caritas, a national leader in Medicaid managed care, tango is now facilitating the delivery of skilled home health care to Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) members in the Keystone State.

This collaboration helps patients safely recover in the comfort of their own homes while enhancing access to high quality skilled home health care. Enablement of the home, often the patient’s preferred site of care for recovery following an acute event, is a key focus of tango’s mission, honoring patient preferences while reducing avoidable readmissions and emergency department utilization.

"Our goal is to transition patients to a home setting as seamlessly as possible by creating and helping to ensure post-acute care plans that coordinate their unique care needs and focus on enabling the home as a place that supports superior outcomes and quality during the patient’s recovery," said Brian Lobley, tango CEO.  "Both tango and AmeriHealth Caritas understand that good outcomes happen when patients remain the focus of everything we do. By improving access to home-based care — particularly for Dual Eligible plans — we help ensure timely services, better outcomes, and lower costs of care. It’s an important reason this partnership is a win-win."

tango is the largest independent, risk-bearing, post-acute benefit enablement solution in the marketplace. The company’s solutions go beyond utilization management to solve critical access to care issues, improve outcomes and reduce costs for health plans. Headquartered in Phoenix, tango works with national and regional health plans, including downstream at-risk entities that serve Medicare Advantage, Managed Medicaid and Dual-Eligible populations.

"tango is a leader in driving positive outcomes across home-based care, and we are excited to partner to help ensure our members have improved access to comprehensive, high-quality skilled home health services, a growing demand across the country," said Chris McDade, president of Medicare Markets at AmeriHealth Caritas. "Our synergy with tango emphasizes our shared purpose of helping our members live healthier, fuller lives."

About tango

tango is a leader in post-acute benefit enablement services, empowering patients to remain in their homes as they receive quality healthcare. tango provides value-based care enablement platforms for payors, risk-bearing entities and providers to more collaboratively serve Medicare Advantage, Managed Medicaid and dual-eligible populations. The result is higher quality care, improved access, better patient outcomes, reduced total cost, enhanced Stars performance and administration simplification. For more information, please visit www.tangocare.com.

About AmeriHealth Caritas

AmeriHealth Caritas is one of the nation’s leaders in health care solutions for those most in need. Operating in 13 states and the District of Columbia, AmeriHealth Caritas serves millions of Medicaid, Medicare, Children’s Health Insurance Program (CHIP), and Health Insurance Marketplace® members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, and behavioral health services. Headquartered in Newtown Square, Pa., AmeriHealth Caritas is a mission-driven organization with more than 40 years of experience serving low-income and chronically ill populations. For more information, visit www.amerihealthcaritas.com.

https://www.prnewswire.com/news-releases/tango-partners-with-amerihealth-caritas-to-optimize-home-healthcare-in-pennsylvania-302521442.html

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: Superior Spends $18M on OTC Aid

[MM Curator Summary]: Superior HealthPlan spent $18M in five years on OTC benefits for Medicaid and CHIP members across Texas.

==============================

Superior HealthPlan Invests $18 Million in Over-the-counter Items in 5 Years for Texas Members

The extra benefits are in addition to regular Medicaid and CHIP coverage, helping support low-income individuals and families.

Superior HealthPlan ("Superior"), a leading managed care organization in Texas and a company of Centene (NYSE: CNC), announced today it invested $18 million in over-the-counter (OTC) items, a Value-added Service (VAS), for members enrolled in either Medicaid or Children’s Health Insurance Program (CHIP) from 2020 through 2024. Value-added Services are extra benefits that help provide additional support for low-income families and individuals across all 254 Texas counties.

"The extra benefits we provide our members are critical in supporting their overall health and well-being," said Mitch Wasden, CEO of Superior HealthPlan. "Over the years, we’ve learned how impactful these over-the-counter items can be to the families we serve, and we’re proud to be able to help them fill this need."

As a Superior HealthPlan Value-added Service*, STAR, CHIP, STAR Kids, STAR Health, and some STAR+PLUS members can receive either $25 or $30 for commonly used OTC items every quarter, per member. These include hundreds of items, such as:

• Digestive health products
• Eye, ear, and oral care products
• Household cleaning supplies
• Personal hygiene products
• Sun care supplies

Over-the-counter items are just one of the many VAS offerings from Superior. Some members, depending on the program, may also receive:

• Extra vision benefits for Medicaid and CHIP members, including a $150 retail allowance toward select prescription eyeglass frames, lenses, or contact lenses not covered by Medicaid. For members enrolled in CHIP, STAR+PLUS, and STAR Health, this allowance is once every year. For STAR and STAR Kids members, the allowance is once every 2 years.
• Annual sports/school physicals for Medicaid and CHIP members 4 to 18 years old. This Value-added Service is restricted to one physical per year with a maximum reimbursement of $35. The sports physical must be provided by a contracted Superior provider.
• Superior’s award-winning Start Smart for Your Baby® program for pregnant women offers educational materials and supplies for STAR, CHIP, STAR+PLUS, and STAR Kids members. Pregnant women can earn Value-added Services one time per pregnancy.

Value-added Services are updated annually, with new offerings planned for September 1, 2025. To see a list of available OTC items, visit SuperiorHealthPlan.com/OTC.

*Restrictions and limitations may apply.

About Superior HealthPlan 
For more than 25 years, Superior HealthPlan has offered high-quality health care to Texans, and is now a leading managed care company providing services to 2 million people. Committed to transforming the health of the communities we serve, one person at a time, Superior supports active local involvement in all 254 Texas counties with 3,500 employees throughout the state. Since 2020, Superior has contributed $11.9 million in grants, sponsorships and employee giving, helping support low-income communities. Superior is a company of Centene, a leading healthcare enterprise that is committed to helping people live healthier lives. For more information, visit www.SuperiorHealthPlan.com.

https://investors.centene.com/2025-08-05-Superior-HealthPlan-Invests-18-Million-in-Over-the-counter-Items-in-5-Years-for-Texas-Members

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: Mobile Health Clinic Launches

[MM Curator Summary]: A new mobile clinic will bring healthcare services to Hawai’i Island public schools through a mobile health clinic starting August 2025.

==============================

‘Ohana Health Plan, a leading provider of government-sponsored managed care services in Hawai’i and the Centene Foundation, the philanthropic arm of Centene Corporation (NYSE: CNC), unveiled a brand new mobile health clinic with Hawai’i Island Community Health Center (HICHC), a nonprofit community health center supporting lifelong health and wellness through quality healthcare.

Earlier this year, HICHC was awarded a grant of $550,000 by ‘Ohana Health Plan and the Centene Foundation to support their "Gateway to Health" project to expand access to essential health services, such as well-child exams, immunizations, behavioral health, and chronic care management (i.e., asthma, diabetes, ADHD, etc.) for students in underserved areas.

Various state and Hawaii County leaders gathered for a traditional Hawaiian blessing and dedication ceremony, led by Kahu Kamuela Chun. Attendees also had the opportunity to tour the mobile clinic before it begins service to Hawai’i Island’s public schools. The 2025-2026 school year begins on August 4 for students in the Hawai’i State Department of Education (HIDOE) school system.

The Gateway to Health program will roll out in phases. The Honokaʻa-Kealakehe-Kohala-Konawaena complex will be the first HIDOE complex area to receive services from the mobile clinic, followed by Kaʻū-Keaʻau-Pāhoa, and Hilo-Waiākea. It’s anticipated that all designated schools will receive service before the end of the school year in May 2026.

"We are excited to see this partnership come to life in our schools. We’re ready to hit the road and meet students where they are," said Cecilia Sakata, HICHC director of school-based health. "This clinic is equipped to provide everything from check-ups to mental health support—right outside their classroom doors. The phased rollout ensures that students across our island will benefit from this innovative approach to school-based care."

"This mobile health clinic will be a lifeline for many students and families who might otherwise struggle to access care," said Scott Sivik, plan president and chief executive officer of ‘Ohana Health Plan. "It represents a powerful step forward in ensuring that every child on Hawai’i Island has access to the care they need to thrive. We’re proud to support this partnership that brings healthcare directly to our keiki."

For more information about Hawai’i Island Community Health Center, School-Based Health Centers, and The Gateway to Health project, please visit https://www.hicommunityhealthcenter.org/.

About Hawai’i Island Community Health Center 

Hawai’i Island Community Health Center’s mission is to provide quality, comprehensive, and integrated health care services that are accessible to all, regardless of their ability to pay.

Hawai’i Island Community Health Center is one of the largest Federally Qualified Health Centers in the State of Hawai’i, employing over 400 health care professionals and support staff, serving 40,000 residents over 14 locations island-wide.

About ‘Ohana Health Plan
‘Ohana Health Plan provides government-sponsored managed care services to families – keiki to kupuna – and individuals with complex medical needs primarily through Medicaid, Medicare Advantage (Wellcare), and Medicare Prescription Drug Plans (Wellcare) across the state. ‘Ohana Health Plan is a Centene Corporation company, a leading healthcare enterprise committed to helping people live healthier lives. For more information, please visit www.ohanahealthplan.com.

About the Centene Foundation 

The Centene Foundation (the "Foundation"), a private nonprofit focused on investing in economically challenged communities, is the philanthropic arm of Centene Corporation ("Centene"). The Foundation supports projects and initiatives strategically aligned with Centene’s mission-driven culture and enhances the work Centene is doing to remove the barriers to wellness underserved and low-income populations face. The Foundation is committed to addressing social determinants of health and improving health equity in three distinct areas of focus: healthcare access, social services and education. To learn more, visit the Centene Foundation’s website.

View original content to download multimedia:https://www.prnewswire.com/news-releases/ohana-health-plan-the-centene-foundation-and-hawaii-island-community-health-center-unveil-new-mobile-clinic-to-expand-school-based-healthcare-302517954.html

SOURCE Centene Corporation

https://markets.ft.com/data/announce/detail?dockey=600-202507301811PR_NEWS_USPRX____CG41299-1

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: Health Plan Boosts School Support

[MM Curator Summary]: Peach State Health Plan expanded its partnership with Barrow County Schools to deliver vital health and wellness resources to thousands of students ahead of the 2025 school year.

==============================

 Peach State Health Plan ("PSHP"), a leading managed care organization in Georgia and a company of Centene Corporation (NYSE: CNC) ("Centene"), continues to deepen its collaboration with the Barrow County School System through community-focused initiatives that prioritize student wellness, academic readiness, and family support.

Following the success of the Barrow Together CommUNITY Fest in May 2025, PSHP partnered once again with Barrow County Schools to support the annual Back-to-BOLD back-to-school event held on July 25, 2025. This growing partnership reflects a shared commitment to holistic student development by addressing health, education, and access needs at the community level. Held at Apalachee High School, the event drew thousands of attendees and served as another healing and unifying moment for the community, nearly a year after a tragic school shooting.

A key highlight was the collaboration between PSHP, Centene Foundation, the philanthropic arm of Centene, and national nonprofit Shoes That Fit, which donated 1,000 pairs of new shoes to students regardless of their health plan membership, ensuring they step into the classroom with confidence and dignity.

"My heart is full. This is what makes our community so special. Whenever we ask, our neighbors and community partners exceed our expectations to provide for our students. We are grateful for organizations like Peach State Health Plan and Shoes That Fit, churches, businesses, and individuals who donated their time and resources to help families start the school year with needed health screenings, immunizations, school supplies, new shoes, and fresh haircuts," said Dr. Dallas LeDuff, Barrow County School System Superintendent.

Additionally, the Centene Vision Van was on-site offering free eye exams and prescription glasses. Emotional testimonials from families emphasized the event’s impact on restoring trust, creating positive memories, and getting needed resources to help families prepare for the upcoming school year.

"Strong partnerships are the foundation of strong communities," said Clyde A. White, President and CEO of Peach State Health Plan. "By working together with Barrow County Schools and organizations like Shoes That Fit, we are not only preparing students for school but also investing in their long-term success and well-being."

Free backpacks and mental health support resources were also available underscoring the power of public-private partnerships to remove barriers and uplift families. PSHP remains committed to expanding opportunities and reducing disparities for Georgia’s children, helping every student reach their fullest potential.

About Peach State Health Plan 

Peach State Health Planis a care management organization that serves the needs of Georgians through a range of health insurance solutions. Peach State Health Plan serves the Medicaid and PeachCare for Kids® population in partnership with Georgia Families. The organization also focuses on under-insured and uninsured individuals through its federal insurance marketplace plan, Ambetter, and its Medicare Advantage Special Needs Plan. Peach State Health Plan is aCentenecompany, a leading healthcare enterprise committed to helping people live healthier lives. For more information visitwww.pshpgeorgia.com. 

About Barrow County School System 

Barrow County School System is BOLDly Committed to Student Success and serves nearly 15,500 students in the metro-Atlanta area. We are the 24th largest school system in Georgia and the 4th largest Charter System.

About Centene Foundation 

TheCentene Foundation(the "Foundation"), a private nonprofit focused on investing in economically challenged communities, is the philanthropic arm of Centene Corporation (NYSE:CNC) ("Centene"). The Foundation supports projects and initiatives strategically aligned with Centene’s mission-driven culture and enhances the work Centene is doing to remove the barriers to wellness underserved and low-income populations face. The Foundation is committed to addressing social drivers of health and improving health equity in three distinct areas of focus: healthcare access, social services and education. To learn more, visit the Centene Foundation’swebsite. 

About Shoes That Fit
A national 501(c)3 nonprofit organization based in Claremont, CA., Shoes That Fit tackles one of the most visible signs of poverty in America by giving children in need new athletic shoes to attend school with dignity and joy, prepared to learn, play and thrive. Named a California Nonprofit of the Year, Shoes That Fit delivered new athletic shoes to over 180,000 children across 50 states last year alone. Help ensure that no child misses school because they don’t have shoes that fit by visiting our website  http://www.shoesthatfit.org.

https://www.morningstar.com/news/pr-newswire/20250730cg40854/peach-state-health-plan-builds-upon-community-partnership-with-barrow-county-schools-to-support-student-health-and-readiness

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: $1M Grant Targets Food Deserts

[MM Curator Summary]: A $1M Meridian-Centene grant will fund fresh food access and chronic care programs in rural Michigan through the Food Bank Council of Michigan.

========================================

Meridian Health Plan of Michigan, Inc. ("Meridian"), a leading managed care organization in Michigan, and the Centene Foundation, the philanthropic arm of Centene Corporation (NYSE: CNC), announced today a $1 million grant to the Food Bank Council of Michigan (FBCM), a cooperative network of the state’s regional food banks dedicated to alleviating hunger and food insecurity. The grant will support efforts in Prosperity Region 8, which includes Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph and Van Buren counties to upgrade current food pantries, equipping community members with food as medicine interventions, and providing technological support to future In Lieu of Services (ILOS) implementation. Additionally, the two-phased program will fund a fresh food pharmacy program at a federally qualified health center to support patients with diet-sensitive chronic conditions while offering health coaching supporting.

"Research shows that hunger, health and well-being are deeply connected," said Patty Graham, Meridian Plan President and CEO. "People who are food insecure are affected by diet-sensitive chronic diseases such as diabetes and high blood pressure. By focusing on a proactive coordinated approach, this partnership will increase food access, remove transportation barriers and create a holistic pathway to address the root causes of health problems and health disparities in rural Michigan."

Phase One will designate and upgrade two existing food pantries to serve as Nourish MI Pantries, a model developed by the Food Bank Council of Michigan in collaboration with regional food banks, funders, and healthcare partners to support and enhance community pantries across the state. The model offers a shared standard that expands access to fresh, nutritious foods, enhances client experience, and supports partnerships in health and equity.

Participation in the model reflects a commitment to practices like client-choice shopping, fresh and frozen food availability, set hours, and a wide variety of healthy options. Pantries may also receive the ILOS Certified designation, allowing them to serve enrollees of Michigan’s Medicaid Health Plans (MHPs) participating in the Comprehensive Health Care Program (CHCP) Nourish MI Pantry Packs, a curated food pack that aligns with healthcare and nutrition goals.

The Phase One pantries will be equipped to deliver food as medicine interventions supported by local food bank development teams to implement a long-term plan for sustaining access to fresh food. Support could include the purchase of food, cold storage (such as refrigerators or freezers), shelving and other storage supplies, and technological support such as computers or tablets to support future In Lieu of Services (ILOS) implementation. The food banks will also provide technical assistance as needed to help the pantries effectively support ILOS patients. The initiative aims to strengthen local food access while also building capacity for ILOS operations for all participating Medicaid health plans.

Phase Two, set to begin in 2026, will expand the program, designating and upgrading five additional Nourish MI Pantries across the same region. It will also fund the Fresh Food Pharmacy (FFP) program at Grace Health, a federally qualified health center in Battle Creek. The funding for FFP helps eligible members with diet-sensitive chronic conditions access nutritious food and health education, while also supporting efforts to build a long-term sustainability strategy for the program. Eligible patients of Grace Health with chronic conditions can shop at the on-site pantry and participate in health coaching support.

Following the COVID-19 pandemic, the number of Michiganders facing food insecurity has continued to grow and is especially prevalent in rural communities, where many travel long distances to get fresh produce because of limited grocery stores and limited public transit. This, along with other factors such as low income and few job prospects, can lead to food insecurity, which can adversely impact health and well-being. More than 1.4 million people are food insecure in Michigan, according to Feeding America’sMap the Meal Gap, and more than 378,000 of them are children.

"At the Food Bank Council of Michigan, our mission is to create a food-secure state through advocacy, collaboration and innovative solutions," said Dr. Phil Knight, Food Bank Council of Michigan Executive Director. "This partnership with Meridian and the Centene Foundation exemplifies that commitment by bringing lasting, fresh food access to rural communities in a way that’s both sustainable and designed to improve health outcomes. Together, we’re not only addressing hunger today, but laying groundwork to solve it for tomorrow."

By investing in the sustainability of the Fresh Food Pharmacy program and partnering with local pantries to strengthen and designate them as Nourish MI Pantries aligned with food as medicine principles, Meridian and the Centene Foundation further their commitment to bring fresh food year-round to rural areas. This includes areas of the state where residents face access barriers ensuring a healthier, more food-secure future for all Michiganders through this three-year partnership.

About Meridian Health Plan of Michigan, Inc.
Meridian provides government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid (Meridian), Medicare Advantage and Medicare Prescription Drug Plans (WellCare), Medicare-Medicaid Plans (MeridianComplete) and the Health Insurance Marketplace (Ambetter from Meridian). Meridian is a Centene Corporation company. For more information, visit www.mimeridian.com.

About the Centene Foundation
The Centene Foundation (the "Foundation"), a private nonprofit focused on investing in economically challenged communities, is the philanthropic arm of Centene Corporation (NYSE: CNC) ("Centene"). The Foundation supports projects and initiatives strategically aligned with Centene’s mission-driven culture and enhances the work Centene is doing to remove the barriers to wellness underserved and low-income populations face. The Foundation is committed to addressing drivers of health and improving health equity in three distinct areas of focus: healthcare, social services and education. To learn more, visit the Centene Foundation’swebsite.

About Food Bank Council of Michigan 
The Food Bank Council of Michigan (FBCM), founded in 1984, leads a unified effort to end hunger across the state. By addressing the root causes of hunger, FBCM raises awareness, advocates for policies that protect those in need, conducts in-depth research to find sustainable solutions, and provides thought leadership and resources to Michigan’s food banks. Working with its network of regional food banks, over 2,800 hunger relief agencies, private companies, farmers, state and federal officials, and other allies, FBCM strives to ensure that no Michigander goes without food.

To learn more about the Food Bank Council of Michigan’s role in eliminating food insecurity, visit www.fbcmich.org or call 517-485-1202.

View original content to download multimedia:https://www.prnewswire.com/news-releases/meridian-and-the-centene-foundation-announce-1-million-grant-to-the-food-bank-council-of-michigan-302518948.html

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: Cigna Delivers Amid High Costs

[MM Curator Summary]: Cigna posted strong Q2 earnings while advancing industry reforms and navigating persistent medical cost pressures.

========================================

Cigna reaffirmed its guidance on Thursday, logging a strong second quarter despite persistently high medical costs that are causing headaches for insurers.

Brian Evanko, president and CEO of Cigna Healthcare and Cigna’s chief financial officer, said the company expects elevated medical costs to continue throughout the year. 

But the 83.2% medical care ratio Cigna posted in Q2 was in line with expectations, helped by the lack of exposure to Medicare and Medicaid, as the organization primarily services patients through its own healthcare portfolio.

In January, Cigna agreed to sell its Medicare Advantage, Supplemental Benefits, Medicare Part D and CareAllies business to Health Care Service Corporation (HCSC) for about $3.7 billion, a move the organization said would drive value for stakeholders.

“We see eroding health status, affordability and access challenges as the key challenges to the healthcare system,” said Cigna President and CEO David Cordani on the Thursday earnings call. “But we have a number of differentiators which enable us to lead, including our orientation – anticipating and sometimes causing constructive disruption. This is a fundamental part of our strategy.”

Cordani also alluded to the insurance industry’s push for prior authorization reform, with Cigna joining Humana, Elevance and others to simplify, streamline and reduce prior authorizations nationwide. Last month Dr. Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, stressed that the insurance industry’s push for reform is not the result of legislation, executive orders or other compulsory governmental mandate, but rather an industry-led effort with guidance from the federal government.

According to Cordani, Cigna is leaning into the arrangement in a “partnership orientation.”

“We continue to lean into and embrace public-private partnerships,” said Cordani. “We’re proactively working to bring forward new solutions with the current administration. This signals a commitment from Cigna to build a better future.”

Shareholders’ net income for Q2 was $1.5 billion, or $5.71 per share, and compares to $1.5 billion, or $5.45 per share, for Q2 2024.

WHAT’S THE IMPACT

The Cigna Group’s adjusted income from operations for Q2 was $1.9 billion, or $7.20 per share, compared with $1.9 billion, or $6.72 per share, for Q2 2024.

Total revenues increased 11% relative to Q2 2024, primarily driven by Evernorth Health Services. Adjusted income from operations increased 1% from the same period last year, again attributable to Evernorth, though it was mitigated somewhat by higher stop-loss medical costs in Cigna Healthcare.

Evernorth saw adjusted revenues and adjusted income from operations, pre-tax, increase 17% and 5%, respectively, relative to Q2 2024.

Cigna boasted 182.2 million total customers as of June 30, a 2% increase since December. Pharmacy customers totaled 121.9 million, a 3% increase over that same period, and total medical customers clocked in at about 18 million, a 6% decrease.

THE LARGER TREND

The prior authorization commitments made by insurers this year are being implemented across insurance markets, including for those with commercial coverage, Medicare Advantage and Medicaid managed care consistent with state and federal regulations, and stand to benefit about 257 million Americans, according to AHIP.

Insurers are promising faster and more direct access to appropriate treatments for patients, and for providers, more efficient and transparent prior authorization workflows.

Participating health plans have signaled that they’re implementing common, transparent submissions for electronic prior authorization. This commitment includes the development of standardized data and submission requirements (using FHIR APIs) that will support streamlined processes and faster turnaround times. The goal is to have a new framework up and running by Jan. 1, 2027.

Individual plans will also commit to specific medical prior authorization reductions, as appropriate for each plan’s local market, with demonstrable results by Jan. 1, 2026.

https://www.healthcarefinancenews.com/news/cigna-reaffirms-guidance-despite-elevated-medical-costs

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: OhioRISE Marks 50K Milestone

[MM Curator Summary]: Ohio’s OhioRISE Medicaid program has expanded statewide in three years, supporting tens of thousands of youth with complex behavioral health needs.

========================================

(COLUMBUS, Ohio)—Ohio Governor Mike DeWine and Ohio Department of Medicaid (ODM) Director Maureen Corcoran recognize the three-year anniversary of Ohio Resilience through Integrated Systems and Excellence (OhioRISE), a specialized managed care behavioral health program.

Governor DeWine launched OhioRISE in July 2022 to address long-standing gaps in care for Ohio’s young people with the most complex needs. OhioRISE brings together state agencies and community support to create a statewide network of care management entities to help Ohio families manage and coordinate the care their child needs.

“OhioRISE is giving hope to children and families who have faced enormous challenges," said Governor DeWine. “This program is another example of our commitment to ensure all children have the resources they need to reach their full potential. Today we celebrate the progress OhioRISE has made in three years, and we look forward to even more growth in the years ahead.”

OhioRISE has changed the way tens of thousands of Ohio children, youth, and families are navigating complex behavioral health challenges. When OhioRISE launched, 5,500 youth were receiving behavioral health services through Medicaid, like home-based intensive care. In the first three years, OhioRISE has expanded its reach to provide services for nearly 50,000 youth.

Collaboration between state and local programs combine expertise across systems to provide services that help kids thrive at home, at school, and in their communities while keeping families together and reducing the need for hospitalization and out-of-state care. OhioRISE collaborates with 18 regional care management entities (CMEs) through Aetna Better Health of Ohio. Individual care coordinators serve as community-based experts to help Ohio families with personalized case management to better meet every child’s emotional, behavioral, and physical needs.

“OhioRISE is not a one-size-fits-all program. It is about building capacity in communities, empowering families, and developing services that meet each child where they are from the most rural areas to our largest cities,” said ODM Director Maureen Corcoran. “Together, we are changing the life trajectory for these young people and their families.”

Impact on Families

Rochelle Montes, of West Chester, Ohio, was recently connected to OhioRISE and a care coordinator through Cincinnati Children’s Hospital after her autistic teen had a crisis that impacted the family.

“Had we not had that crisis happen I don’t know that we would have known about OhioRISE,” said Rochelle Montes. “They came to our home and assessed my son and it was not long before I could start to see the pieces fall together with what OhioRISE had to offer, and it was such a blessing to our family and just what we needed.”

Growing Services

In its third year, OhioRISE is working to meet the growing needs of youth and families. Through partnership with Ohio Department of Mental Health and Addiction Services, Governor DeWine and ODM announced the statewide expansion of Mobile Response and Stabilization Services (MRSS) earlier this year. MRSS will be available in all of Ohio’s 88 counties to provide rapid, in-person crisis response and follow up care within 60 minutes of a call.

Other important services have also grown in the last three years. Intensive Home-Based Treatment is now available in 77 of Ohio’s 88 counties. Additionally, more than 150 organizations and family-selected individuals have enrolled to provide behavioral health respite, or short-term relief, to caregivers in home and community-based settings. Since its launch, OhioRISE has also opened three in-state psychiatric residential treatment facilities to provide treatment for the most intensive level of care, which was previously only accessible in facilities out of state.

Families interested in learning about eligibility should contact the Aetna OhioRISE Member Hotline at 833-711-0773, or visit OhioRISE at managedcare.medicaid.ohio.gov/OhioRISE.

About OhioRISE

Launched in July 2022, OhioRISE (Resilience through Integrated Systems and Excellence) is a first-of-its-kind statewide Medicaid managed care program designed to serve youth with complex behavioral health needs. OhioRISE integrates care across multiple child-serving systems, helping families navigate challenges that span schools, mental health, developmental disabilities, child protection, and juvenile justice. OhioRISE is a cornerstone of Governor DeWine’s Children’s Initiative lead by ODM with support from state agencies that make up the Governor’s Family and Children First Cabinet Council.

https://governor.ohio.gov/media/news-and-media/governor-dewine-recognizes-ohiorise-three-year-milestone

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: Priority Health Expands to Wisconsin

[MM Curator Summary]: Priority Health of Ohio, Indiana, and Michigan, is expanding into Wisconsin by merging with Group Health Cooperative of Eau Claire.

========================================

Priority Health — a nonprofit, provider-owned health insurer based in Grand Rapids, Michigan — is expanding into Wisconsin.

The Medicare plan issuer says it will combine with Group Health Cooperative of Eau Claire, Wisconsin, by becoming the governing member of Group Health Cooperative’s board.

Priority provides or administers health coverage for 1.3 million people in Michigan, Indiana and Ohio and is the biggest provider-sponsored health plan in the United States, with enrollees in Medicaid managed care plans, individual major medical policyholders and participants in employer-sponsored health plans as well as enrollees in Medicare plans.

Priority generated $66 million in operating income on $1.2 billion in revenue in 2022, according to its most recent public tax-exempt entity tax filing.

Group Health Cooperative was founded in 1972 and now has 61,000 enrollees. Like Priority, it has Medicaid, individual major medical and employer-sponsored health plan enrollees as well as Medicare plan enrollees.

Its most recent tax-exempt organization filing, for 2021, shows that it lost $14 million that year on $425 million in revenue.

Priority and Group Health Cooperative hope to complete their deal by the end of the year.

The other CO-OPs: Group Health Cooperative started up before the Affordable Care Act created the ill-fated Consumer Operated and Oriented Plan program, which was supposed to increase competition in the health insurance market by creating nonprofit, member-owned health insurers that were similar to Group Health Cooperative all around the country.

Federal regulators saddled the ACA CO-OPs with investment and ownership rules that crippled their ability to raise capital, and most failed or were acquired by other carriers.

CareSource of Ohio acquired Wisconsin’s CO-OP carrier, Common Ground Healthcare Cooperative, in January 2025.

https://www.thinkadvisor.com/2025/07/29/michigan-health-insurer-moves-into-wisconsin/

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: Molina Expands Medicaid Footprint

[MM Curator Summary]: Molina Healthcare is expanding its Medicaid business through new contracts and acquisitions, while focusing on complex dual-eligible populations.

========================================

Molina Healthcare, Inc. (NYSE:MOH) is a leading managed care provider offering government-sponsored healthcare programs like Medicaid and Medicare to low-income individuals and families across the U.S. Headquartered in Long Beach, California, Molina operates health plans in multiple states and serves millions through Medicaid, Medicare, and dual-eligible Special Needs Plans (D-SNPs).

The company recently secured major Medicaid contract wins and renewals in states like Georgia, Idaho, Massachusetts, and Ohio, which will contribute to revenue growth and expand access to care. Molina Healthcare, Inc. (NYSE:MOH) also acquired ConnectiCare Holding Co., adding 140,000 members, and previously took over Bright Health’s assets in California.

A key strategic focus is the dual-eligible population, those covered by both Medicaid and Medicare, due to their complex needs and potential for integrated, high-quality care. Molina is developing blended service models and adjusting policy and reimbursement structures to address this growing segment.

Molina Healthcare, Inc. (NYSE:MOH) remains active in community engagement, such as maternal health initiatives in Texas. It’s also prioritizing behavioral health and chronic condition management through updated protocols and external partnerships.

While we acknowledge the risk and potential of MOH as an investment, our conviction lies in the belief that some AI stocks hold greater promise for delivering higher returns and doing so within a shorter time frame. If you are looking for an AI stock that is more promising than MOH and that has 10,000% upside potential, check out our report about thischeapest AI stock.

NYSE:MOHYahoo FinanceMolina Healthcare Inc. (NYSE:MOH)

https://www.insidermonkey.com/blog/molina-healthcare-inc-moh-wins-major-medicaid-contracts-in-4-states-1575968/

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE