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112 Results found.

Brief & Report

Medicaid Changes in the OBBBA and Implications for the Marketplace and Individual Market in 2027

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In recent years, the individual market has undergone significant disruption. The expiration of enhanced premium tax credits (ePTC) at the end of 2025 and sweeping eligibility changes under the 2025 Budget Reconciliation Act (OBBBA) have reshaped—and will continue to reshape—the individual market.

The number of changes facing states and issuers in coming years are significant. As a result, it is unsurprising that discussion and analysis on the individual market impacts of the new Medicaid requirements is limited and expected to result in large numbers of Medicaid beneficiaries being disenrolled. Between community engagement requirements (i.e., work requirements), increases in eligibility checks, and loss of eligibility for certain immigrant population, the expectation is that millions of people will leave Medicaid in 2027.

This brief explores how these coming changes will reshape coverage pathways and costs, and examines implications for consumer affordability and churn, issuer pricing and risk pools, and state administrative burdens—alongside strategies for states, issuers, and policymakers to mitigate adverse effects.

Brief & Report

Analysis of the Costs and Medicaid Payment Adequacy for Ground Ambulance Services in New York State

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Survey data from fiscal year (FY) 2022 suggest that entities that provide ground ambulance services in the State of New York are experiencing reimbursement challenges. Health Management Associates, Inc. (HMA), contracted with the United New York Ambulance Network (UNYAN) to conduct an independent study of the costs of delivering ground ambulance services in the state and the adequacy of payment for these critical services. The HMA-UNYAN survey data highlight the wide variation in costs within the ground ambulance industry in New York and the negative Medicaid margins the industry experiences. These data demonstrate that although ambulance entities of all sizes in New York have negative Medicaid margins, these margins worsen as entity size decreases and entities become more rural. Trends in negative margins appear to be linked to some degree to entities’ relative share of “responses without transport” or uncompensated transports. This white paper poses important considerations for policymakers.

Brief & Report

When Investment is Good Medicine

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In partnership with Sorenson Impact and Catalyst, Health Management Associates co-authored a white paper on the healthcare industry’s opportunity to move beyond treating illness to creating healthier communities.

This paper outlines the opportunity for health systems and payers to leverage their balance sheets to make impact investments that align with their mission, as well as have business and healthcare value.

Brief & Report

Updated Analysis Compares Consumer Out-of-Pocket Spending of ACA Marketplace Enrollees to other Major Payers Using Claims Data

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HMA and Wakely, an HMA Company, have released an updated Issue Brief to the comprehensive profile of ACA Marketplace enrollees that was based on claims data from nearly 6 million of the 24 million Marketplace enrollees.

The issue brief discusses these key questions:

  1. Do Marketplace enrollees spend more or less out-of-pocket relative to Medicare, ESI and Medicaid enrollees?
  2. How may the potential expiration of eAPTCs impact out-of-pocket costs?
  3. What are some initial considerations regarding overall healthcare affordability?

Please fill out this form to receive a copy of the update and issue brief.

Contact any of the report authors with further questions, or to discuss potential applications of this work for your organization.

Brief & Report

The Impact of the CareSource JobConnect Program: A Benefit–Cost and Return-on-Investment (ROI) Analysis

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A new report prepared by HMA, The Impact of the CareSource JobConnect Program, evaluates the outcomes of 3 of the 6 states where it is currently active: Indiana, Georgia, and Ohio. It provides employment assistance to non-elderly adults enrolled in Medicaid, helping individuals prepare for a job search, obtain employment, and succeed in the workplace.

HMA conducted an economic impact analysis to assess outcomes for members participating in the CareSource JobConnect program who expressed interest in employment assistance. This Return-on-Investment (ROI) analysis shows the impact the CareSource JobConnect Program has on its participants as well as the broader impact on the state’s economy and local communities.

In 2024, the CareSource JobConnect program delivered strong economic and workforce outcomes, particularly in Ohio and Indiana. Ohio led with the highest number of participants and employed workers, generating a return-on-investment of 13:1. Indiana showed impressive efficiency, with a strong return-on-investment of 12:1. Georgia’s results were positive but highlighted opportunities for improvement in employment success and economic return.

Additional contributions to the report from Jack Meyer.

Please fill out this form to receive a copy of the report.

Brief & Report

Medicare Advantage Ground Ambulance Cost Sharing Levels Strain Enrollees and Ground Ambulance Entities

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This white paper presents findings from Health Management Associates’ (HMA) 2025 analysis of state-level variation in MA plan copayments for ground ambulance transports. We identify the range of cost sharing used by MA plans by state, the average MA plan copayment by state, and compare these average copayment levels to both national Medicare FFS cost sharing levels for ground ambulance services. The report also examines average state-level MA plan copayment levels for emergency department services.

As our analysis demonstrates, the flexibility permitted to MA plans to establish beneficiary cost sharing levels for ground ambulance services has resulted in wide variation in MA plan copayments and significantly higher cost sharing for ground ambulance services for MA beneficiaries than those enrolled in traditional Medicare. The flexibility of the MA benefit design for ground ambulance services has potentially negative consequences for the millions of MA plan enrollees and the roughly 11,000 ambulance entities which conduct these services and collect beneficiary cost sharing.

Brief & Report

Complexity for the 2026 Marketplace Open Enrollment: Risks of Consumer Confusion & Coverage Loss

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The upcoming 2026 open enrollment period for the Affordable Care Act (ACA) marketplaces is likely to be one of the most complex since the program’s implementation. Recent federal policy changes, ongoing litigation, and uncertainty around the extension of enhanced premium tax credits (ePTCs) are converging to create significant challenges for federal and state regulators, policymakers, and issuers. Rising premiums, expiring subsidies, and shifting federal regulations also have created an environment of significant uncertainty for consumers, navigators and brokers.

In this report, Complexity for the 2026 Marketplace Open Enrollment: Risks of Consumer Confusion & Coverage Loss, authored by Health Management Associates (HMA) and Wakely, an HMA Company, with support from the Robert Wood Johnson Foundation, explains these changes and their collective effect on costs and consumer experiences.

HMA and Wakely experts preview the analysis and the options policymakers, states, regulators, issuers, consumer advocates, and enrollment assisters, and other stakeholders can plan for to mitigate this confusion and coverage losses.

Brief & Report

Coding, Coverage, and Reimbursement: Considerations for Women’s Health Access

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Persistent gaps in women’s health research, funding, clinical outcomes and access are increasingly well-studied, however less emphasis is placed on the role of coding, coverage, and reimbursement and whether male or female gaps exist in each of these key market access domains. The paper, Coding, Coverage and Reimbursement: Considerations for Women’s Health Access, examines challenges in these areas and offers recommendations to increase awareness, establish evaluative processes, and collaborative action to achieve incremental policy changes that can have a significant impact over time.

Brief & Report

Finding a Path to Support Aging in Place in California 

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New HMA report discusses the unmet needs of older adults in low-income housing, highlighting the challenges of siloed programs and the difficulty in blending services

Research consistently shows that more than 70 percent of Americans want to age in place, remaining in their own homes. Yet the country’s shifting demographics, rising costs for long-term services and supports, and changing financing landscape make achieving this goal more challenging than ever, especially for low-income older adults. In fact, more than one-quarter million older Californians live in senior affordable housing developments that range in size from a few dozen apartments to over a thousand units in large high rises. Most striking was the finding that while many of these residents are not only low-income and disproportionately burdened with chronic disease and also dually eligible for Medicaid and Medicare—a group shown in countless studies to represent a considerable proportion of Medicare and Medicaid costs, but that few residents appear to participate in aligned Medicare and Medicaid special needs plans (D-SNPs) or to access Medi-Cal waiver services.

The report gathers direct input from older adults, including Asian populations, in eight languages, addresses critical funding gaps, and identifies policy priorities that if implemented offer innovative recommendations for California to reduce duplication and better serve older adults using current resources.

Brief & Report

Medicaid Financing for Social Health: A Resource Compendium for Illinois Community-Based Organizations & Networks

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Health Management Associates (HMA) prepared this compendium in September 2025 on behalf of the Chicago Department of Public Health. It was developed at a pivotal moment, as Illinois was poised to take action on multiple program initiatives of critical importance to community providers: reprocure its Medicaid Managed Care system, initiate provider training for 1115 Medicaid Waiver services that address social determinants of health (SDOH), prepare a new Community Health Worker (CHW) benefit, continue implementation of Doula services as a Medicaidcovered benefit, and establish a Third Party Administrator (TPA) support system to promote statewide access to new services, potentially via regional hubs.

A team of subject matter experts with deep experience in Illinois’s social health and healthcare sectors, as well as national social health integration efforts, created this resource to help organizations evaluate how these program initiatives will affect the services they provide, understand their opportunities to successfully participate in the Medicaid delivery system, and support their ability to effectively serve the needs of their communities. The team brings extensive knowledge of how community-based organizations (CBOs) deliver Medicaid-financed CHW and SDOH services, as well as the alternative payment methodologies managed care organizations (MCOs) use as they engage CBOs to promote population health.

In this context, this compendium is intended to address the following targeted needs identified by stakeholders across the Illinois community-based social health service ecosystem:

  • Guidance to support CBOs’ understanding of their value in advancing population health improvement goals, aligning with regional healthcare providers and payers, and identifying opportunities to sustainably fund social health services through Medicaid
  • Insights for CBOs, CBO networks, and emerging CBO hubs and Community Care Hubs (CCHs), with a focus on governance, shared IT infrastructure, financing and integration into the healthcare delivery system
  • Strategic considerations for contracting with Managed Care Organizations to provide social health care services Information to clarify the roles, scopes, and opportunities for collaboration/dual certifications within the community-based workforce that delivers Medicaid services, specifically CHWs, Doulas, and Peer Support Specialists
  • Information from other states on their Doula benefits implementation and Doula hubs to support Medicaid service delivery

Complete the form to receive a copy of the report

Brief & Report

Understanding Substance Use Disorders & the Use of Medications for Treatment

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Education Materials for Patients, Families, Educators and Non-Prescribing Providers

This is a comprehensive set of substance use disorder (SUD) education materials for patients, families, educators, and non-prescribing providers. In recognition of September being National Recovery Month, this document is fully downloadable for community use without restriction.   

The toolkit was made available through a joint effort of the California Department of Health Care Services Opioid Response Project and Health Management Associates. Coaching and technical assistance for this project was funded through DHCS by State Opioid Response Funds from SAMHSA. The bilingual patient education materials are written in accessible language for most audiences, in both Spanish and English. 

The materials can be used to broadly disseminate information across a community or with individual patients, family members and non-prescribing providers. These SUD educational materials were created using the latest research and information available. They are meant to be concrete and easily accessible with simple language that promotes increased understanding of each topic.  Some of the topics touched upon include evidenced-based treatment options such as Medications for Addiction Treatment (MAT) and Medications for Opioid Use Disorder (MOUD).  

Brief & Report

Medicaid Coverage of Breastfeeding Support and Supplies

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This report presents an independent landscape analysis by Health Management Associates (HMA) examining Medicaid coverage of breastfeeding services and supplies in six states: Arkansas, Colorado, Kansas, North Carolina, Oregon, and Vermont. The analysis explores the availability and implementation of lactation consultation services and breast pump benefits within these state Medicaid programs, based on policy reviews and interviews with key stakeholders. Participants included state Medicaid officials, WIC representatives, lactation providers, managed care organizations, community-based organizations, and breastfeeding experts.

Findings reveal persistent barriers to access, inconsistencies in policy execution, and implementation gaps. The report highlights effective practices currently in use and offers targeted policy recommendations to enhance service delivery, promote equitable access, and improve maternal and infant health outcomes. This analysis serves as a strategic resource for stakeholders seeking to strengthen Medicaid’s role in supporting breastfeeding families.

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