Insights: Healthcare

Medicare Inpatient Hospital (IPPS) Reimbursement

As part of the FY26 IPPS proposed rule, CMS is proposing to increase inpatient hospital payments by 2.4% ($4b) relative to FY25.

Medicaid Reimbursement

CMS has informed states it will not approve new or extend existing requests for federal dollars on designated state health programs (DSHPs) and designated state investment programs (DSIPs). DSHPs and DSIPs represent ~$2.7b in Medicaid spending in CY25.

Recent/upcoming developments… In recent weeks, HHS Secretary Kennedy has made a variety of statements pressuring states to consider banning the purchase of “soda” with SNAP benefits. Republican-led states appear to be heeding those calls, with WV Governor Morrisey indicating his state would seek USDA approval of such a ban and the ID legislature...

Skilled Nursing Facilities (SNFs)

Recent/upcoming developments… Judge Kacsmaryk of the District Court for Northern Texas has struck down the most impactful components of the Biden-era SNF minimum staffing rule (the staffing quotas/minimum hours). * As previously noted, last April CMS finalized its SNF minimum staffing rule, which will require SNFs participating in Medicare and...

GLP-1 Drugs/Obesity

CMS has decided not to finalize a Biden-era proposal to formally recognize obesity as a chronic disease and reinterpret the Medicare statute to allow Part D coverage of anti-obesity medications prescribed solely for treating obesity (i.e., weight-loss).

Medicare Advantage (CY26 Rates)

CMS has released the CY26 Medicare Advantage (MA) Final Rule (also known as the Part II rule, which addresses payment issues). Under the rule, CMS asserts that aggregate plan payments will increase next year by a projected 5.06% or $25b over FY25.