HealthPayerIntelligence News

Nonprofit Sues GA for Refusing to Cover Transgender-Related Healthcare

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The Transgender Legal Defense and Education Fund (TLDEF) has filed a lawsuit against the state of Georgia for denying coverage of transgender-related healthcare for members of the Georgia State Health...

SCAN Group, CareOregon Plan to Combine, Form HealthRight Group

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SCAN Group and CareOregon have announced that they will combine under the name HealthRight Group (HealthRight). “For far too long, America’s not-for-profit managed care organizations have...

ACAP Health Plans Will Identify Birthing-Friendly Hospitals in Directories

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Nine safety net health plans that are part of the Association for Community Affiliated Plans (ACAP) announced they would include the CMS birthing-friendly hospital designation in their provider...

7 Key Changes to ACA Enrollment, Plan Selection in 2024 Proposed Rule

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The Biden administration has released its 2024 Notice of Benefit and Payment Parameters Proposed Rule which focused on streamlining Affordable Care Act health plan selection, simplifying Affordable...

Number of Uninsured Children Declined by 210K During Pandemic

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The number of uninsured children declined during the COVID-19 pandemic due to Medicaid’s continuous coverage requirement, with 12 states seeing significant decreases, according to a report from...

Payer Announces Partnership to Offer In-Home Care with Flexible Hours

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Blue Shield of California (Blue Shield) has partnered with an in-home care organization to help members recover from injuries and illnesses. The goal was to make care more accessible and convenient...

Aetna Grants $9.3M to Support Behavioral Health for Youth in Foster Care

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Aetna’s Medicaid plan in West Virginia has granted $9.3 million to 10 community-based organizations to support behavioral health and social care needs for children in foster care. The funding...

Heat-Related Illness Diagnoses Among Private Payer Members Are Increasing

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Privately-insured Americans experienced higher rates of heat-related illness diagnoses in 2021 compared to 2016, in some cases a more than 37 percent increase, according to a report from FAIR...

High Deductibles Create Barriers to Screening Mammograms, Follow-Up Tests

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High deductibles may discourage women from receiving follow-up testing after an abnormal mammogram, with one in five saying they would skip additional imaging if they knew they had to pay a deductible,...

7 Challenges, Opportunities for All-Payer Claims Databases

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All-payer claims databases (APCDs) offer healthcare leaders and policymakers a wealth of data, but there are still many gaps in the data and challenges in data collection practices that states can...

Elevance Health ACO Generated Cost Savings Among Fully Insured Members

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Elevance Health’s commercial accountable care organization (ACO) program was associated with significant cost savings between 2016 and 2021, particularly among the fully insured population,...

Top 3 Major Trends in National Health Outcomes Measures

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Overall, major health outcomes measures are trending in a negative direction, according to America’s Health Rankings Annual Report for 2022. The Annual Report examines 23 measures to assess...

PHE Expiration Will Lead to Medicaid Coverage Losses for 18M People

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If the COVID-19 public health emergency (PHE) ends in April 2023, 18 million people may lose Medicaid coverage in the 14 months following its expiration, according to a brief from the Robert Wood...

Payer, Provider Orgs React to Prior Authorization Proposed Rule

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Payer and provider organizations are responding positively to the CMS proposed rule that would change the prior authorization process to better support electronic prior authorization. “CMS is...

Behavioral Health Treatment was Associated with Lower Healthcare Costs

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Having one or more outpatient behavioral health treatment (OPBHT) visits was associated with lower healthcare costs among patients with newly diagnosed behavioral health conditions, a JAMA Network Open...

19 States Must Align Medicaid Vaccine Coverage Policies with IRA

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Almost two-fifths of US states—particularly those that have avoided Medicaid expansion—will need to change their Medicaid vaccine coverage policies in order to align with the Inflation...

Plan Value, Expected Care Use Drove ACA Consumers into Uninsurance More than Cost

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Among Californians enrolled in the Affordable Care Act marketplace, perceptions about plan value and expectations about how often they would need healthcare services were more likely to motivate them...

CareFirst Funds Community-Based Orgs to Boost Behavioral Healthcare Access

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CareFirst BlueCross BlueShield (CareFirst) is providing community-based organizations with nearly $8 million in grants to help improve behavioral healthcare access and quality for underserved...

Payer Sees Significant Mental Healthcare Utilization, Network Size Growth

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Mental healthcare services utilization and network size have grown significantly since 2019 among Blue Cross Blue Shield of Massachusetts (“Blue Cross”) members, according to data from Blue...

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