May 7, 2025
This week's roundup:
- Empowering Healthcare Leaders: Forging Insights and Collaborations at the National Medicare, Medicaid, and ACA Marketplace Event
- HMA Medicare Experts Discuss Trends and What to Watch
- Florida Senate Sends Behavioral Health Bill to Governor
- Georgia Submits Application to Extend Medicaid 1115 Pathways to Coverage Demonstration
- Minnesota Launches Dashboard to Track Federal Funding Disruptions
- GAO Appoints Two New Members to MACPAC Through 2028
- Attorneys General Sue HHS Over Layoffs, Restructuring
- CareSource Pursues Lakeland Care Affiliation Ahead of Wisconsin Medicaid LTC Contract Awards
- Actuaries Corner: Humana Posts ‘Really Good’ First Quarter on Stable Medical Costs
- More News Here
In Focus
Empowering Healthcare Leaders: Forging Insights and Collaborations at the National Medicare, Medicaid, and ACA Marketplace Event
As new federal priorities unfold—particularly for Medicare, Medicaid, and the Affordable Care Act (ACA) Marketplace—healthcare stakeholders must anticipate and adapt to dramatic changes in funding, regulatory requirements, and technological advancements.
In light of these shifting tides, you won’t want to miss Health Management Associates (HMA), 8th National Conference, Medicare, Medicaid, And Marketplace: Adapting for Success in a Changing Healthcare Landscape, October 14-16, 2025, in New Orleans, LA. The HMA event will feature timely topics with insightful speakers who are at the center of decision making in government, healthcare service delivery, philanthropy, and industry.
The conference will inspire thought-provoking conversations that will prepare you to navigate the rapidly changing healthcare landscape. The sessions will provide context for big ideas and workshops that will delve deeper into policy, strategy, and operations. Examples include:
- The Policy and Politics of Making America Healthy
- When the Ground Shifts: Publicly Financed Health Coverage and Policy in Motion
- Where Is Disruption Poised to Make Improvements in Healthcare?
- Red, Blue, or Purple: Building Resilient Healthcare Systems to Improve Population Health
The HMA conference welcomes all healthcare stakeholders. Each year we bring together federal and state policymakers, healthcare providers, insurers, philanthropists, and C-suite industry leaders to explore and discuss cross-cutting healthcare policy and operational issues.
Networking Opportunities
In addition to insightful sessions, the conference will offer numerous networking opportunities and exhibitor space. Attendees will have the chance to connect with peers, industry leaders, and policymakers during dedicated networking breaks, receptions, and informal gatherings in the vibrant city of New Orleans. These interactions will provide valuable opportunities to share experiences, discuss challenges, and explore potential collaborations.
Learn more about the agenda, registration, and sponsorship on the conference site, Adapting for Success in a Changing Healthcare Landscape. For sponsorship information contact Andrea Maresca, HMAIS Managing Director.
HMA Medicare Experts Discuss Trends and What to Watch
Experts from Health Management Associates (HMA) and HMA companies led a town hall-style webinar April 30, 2025, to share their insights into recent federal and market-level developments in Medicare and Medicare Advantage. The session covered a range of topics, including:
- How to navigate Medicare Advantage policy changes, growth trends, and risk-adjustment mechanisms
- Outlook for risk-based payment models and new directions for the Innovation Center at the Centers for Medicare & Medicaid Services
- Federal policymakers’ attention to fraud, waste, and abuse and their oversight agenda
- Federal and state-level integration initiatives for people who are dually eligible for Medicare and Medicaid, such as aligning Dual Eligible Special Needs Plans (D-SNPs)
- Potential legislative policies that could emerge during the budget reconciliation process and bipartisan issues, such as reforms to prior authorization process and pharmacy benefit manager (PBM) policies later in the calendar year
Watch the webinar replay to dig into these issues and get answers to other timely questions.
HMA Roundup
Alabama
Alabama Enacts Presumptive Pregnancy Eligibility Bill. The Alabama Reflector reported on May 1, 2025, that Alabama Governor Kay Ivey signed SB102 into law, sponsored by Senator Linda Coleman-Madison (D-Birmingham), that establishes presumptive Medicaid eligibility for pregnant women. The law allows providers to grant up to 60 days of temporary Medicaid coverage in the first trimester based on preliminary information, without waiting for full application approval or risk of retroactive denial. The law is set to expire in October 2028.
Florida
Florida Senate Sends Behavioral Health Bill to Governor. Health News Florida reported on May 5, 2025, that the Florida Senate voted 34-3 to concur with the amended version of a bill seeking to implement recommendations made by Florida’s Commission on Mental Health and Substance Use Disorder. Some provisions of Senate Bill 1620, sponsored by Senator Darryl Rouson (D-St. Petersburg), include requiring the use of a specified assessment tool, requiring behavioral health facilities to update treatment plans within specified timeframes, and requiring the University of South Florida’s (USF) Criminal Justice, Mental Health, and Substance Abuse Technical Assistance Center at the Louis de la Parte Florida Mental Health Institute to disseminate certain evidence-based practices and best practices to grantees. The bill originally included a provision to create a mental health and substance abuse research center at USF, named after the bill sponsor, but the provision was amended out. The bill now heads to Governor Ron DeSantis for signature.
Georgia
Georgia Submits Application to Extend Medicaid 1115 Pathways to Coverage Demonstration. The Centers for Medicare & Medicaid Services (CMS) reported on May 2, 2025, that Georgia submitted an application to extend its section 1115 Pathways to Coverage demonstration, which provides Medicaid expansion coverage to certain low-income adults contingent on completing 80 hours of qualifying activities. The state is proposing several changes: shifting activity reporting from monthly to annual, adding education and training programs as qualifying activities, implementing a retroactive coverage policy for up to 90 days, eliminating monthly premiums and Member Rewards Accounts, and updating copayment amounts to align with the state’s approved Medicaid plan. The federal public comment period runs through June 1, 2025.
Indiana
Indiana Governor Signs Medicaid Expansion Work Requirement Bill. The Indiana Capital Chronicle reported on May 2, 2025, that Indiana Governor Mike Braun signed a bill to implement Medicaid work requirements into law. Senate Bill 2, sponsored by Senator Ryan Mishler (R-Mishawaka), requires the state Family and Social Services Administration (FSSA) to seek federal approval to add work requirements for the Healthy Indiana Plan (HIP), the state’s Medicaid expansion program. If approved, most HIP beneficiaries would be required to work or volunteer 20 hours per week in order to stay enrolled. Braun also signed House Bill 1391, which will now allow certain service providers in the home and community-based CHOICE program to not be Medicaid-approved and allow for a study to possibly realign coverage areas for Area Agencies on Aging.
Minnesota
Minnesota Launches Dashboard to Track Federal Funding Disruptions. Minnesota Department of Human Services announced on May 1, 2025 a new state dashboard that allows residents to track disruptions, cancellations, and restorations of federal funding and their impact on public services. The dashboard, launched in April, is updated each weekday to reflect real-time changes, including court-ordered funding restorations.
National
CMS Approves Eight State Section 1115 Family Planning Amendments, Extensions. The Centers for Medicare & Medicaid Services (CMS) announced on April 30, 2025, that it has approved amendments and extensions for eight state Section 1115 family planning demonstrations, incorporating updated guidance that expands the definition of family planning services. The changes formally recognize STI/STD screening as a family planning service and allow diagnosis of STIs/STDs as a family planning-related service in most cases. States with amended demonstrations include Georgia, Mississippi, Montana, Oregon, and Wyoming, Alabama, Florida, and Washington received extensions reflecting the same updates.
GAO Appoints Two New Members to MACPAC Through 2028. U.S. Government Accountability Office reported on May 5, 2025, that U.S. Comptroller General Gene L. Dodaro appointed April Hartman and Anne Karl to the Medicaid and CHIP Payment and Access Commission (MACPAC), with terms running through April 2028. Four current members were also reappointed: Sonja Bjork, Jennifer Gerstorff, Angelo Giardino, and Dennis Heaphy.
Stay in the know with HMA’s Daily News Roundup
Sign up for HMA Information Services (HMAIS) to access more federal and state healthcare news here: https://hmais.healthmanagement.com/
Industry News
CareSource Pursues Lakeland Care Affiliation Ahead of Wisconsin Medicaid LTC Contract Awards. CareSource announced on May 5, 2025, that it is pursuing an affiliation with Lakeland Care, a Wisconsin-based nonprofit managed care organization, to strengthen its presence in the state’s Medicaid market ahead of upcoming Family Care and Family Care Partnership contract awards expected by June 25. Both organizations serve individuals with long-term care needs and dual-eligible beneficiaries. As of December 2024, 53,077 residents were enrolled in the Family Care program and 3,350 in Family Care Partnership.
RFP Calendar
Actuaries Corner
Humana Posts ‘Really Good’ First Quarter on Stable Medical Costs. Humana beat earnings expectations for the first quarter and reaffirmed its 2025 guidance after medical costs came in as predicted. It’s a positive development for the insurer, which has been rocked by higher spending in privatized Medicare plans and the safety-net Medicaid program.
Discover other developments in the Wakely Wire here.
HMA News & Events
HMA Webinars
PACE Development Best Practices for Policy Makers and Program Sponsors. Thursday, May 15, 2025, 1 PM ET. Health Management Associates (HMA) conducted a multi-state study to examine the policy decisions influencing the operation and expansion of Programs of All-Inclusive Care for the Elderly (PACE). It explored different program structures, associated advantages and challenges, and strategies to enhance efficiency while meeting regulatory requirements. This webinar will summarize our research on 10 active PACE states (CA, FL, IL, KY, LA, MA, NJ, NY, OH, and WA) that have either implemented or expanded their PACE programs between 2020 and 2024. Using state survey responses and credible third-party, publicly available data, we will showcase the outcomes of PACE program development through open and competitive RFP processes. We will also outline development timelines to demonstrate the effectiveness of each approach and highlight key insights gained during the discovery and research phase of the study.
NEW THIS WEEK ON HMA INFORMATION SERVICES
(Exclusive Access for HMAIS Subscribers):
HMAIS Medicaid Market Overviews, Reports, and Data
- Updated Medicaid Managed Care RFP Calendar: 50 States and DC
- Updated Medicaid Managed Care Procurement Tracking Report, May-25
- Updated National Medicaid Dental Benefits Management RFP Calendar
- HMA Federal Health Policy Snapshot
- New Medicaid enrollment, RFP documents, and other market intelligence resources for dozens of states.
- Updated Connecticut and District of Columbia Overviews
A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services.
If you’re interested in becoming an HMAIS subscriber, contact Andrea Maresca at [email protected].