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. … Read More
Analysis of the Costs and Medicaid Payment Adequacy for Ground Ambulance Services in New York State
January 15, 2026
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 … Read More
When Investment is Good Medicine
December 16, 2025
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 … Read More
Updated Analysis Compares Consumer Out-of-Pocket Spending of ACA Marketplace Enrollees to other Major Payers Using Claims Data
December 5, 2025
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: Contact any of the report authors with further questions, or to discuss … Read More
The Impact of the CareSource JobConnect Program: A Benefit–Cost and Return-on-Investment (ROI) Analysis
November 13, 2025
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. … Read More
Medicare Advantage Ground Ambulance Cost Sharing Levels Strain Enrollees and Ground Ambulance Entities
October 31, 2025
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 … Read More
Complexity for the 2026 Marketplace Open Enrollment: Risks of Consumer Confusion & Coverage Loss
October 29, 2025
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, … Read More
Coding, Coverage, and Reimbursement: Considerations for Women’s Health Access
October 1, 2025
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 … Read More
Finding a Path to Support Aging in Place in California
September 29, 2025
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 … Read More
Medicaid Financing for Social Health: A Resource Compendium for Illinois Community-Based Organizations & Networks
September 25, 2025
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 … Read More