As managed Medicaid continues to expand into new states, SNF operators should evaluate their current payer contracts and billing workflows ahead of any transition, using Indiana as a case study for what operational disruption looks like in practice.
Health Insurers Promise to Reduce Barriers to Care Under Pressure From Trump Administration
Last week’s pledge from more than 40 health insurers to cut down on prior authorizations came after some behind-the-scenes convincing from the Trump administration. The administration pushed insurers to sign a voluntary pledge to cut back on prior authorizations and simplify the process, Health and Human Services Department Secretary Robert F. Kennedy Jr. said Monday. The pledge came from two major insurance industry lobbying groups, America’s Health Insurance Plans and the Blue Cross Blue Shield Association, and member insurers who together cover almost 260 million Americans.
— STAT News, June 23, 2025
‘Not Accountable to Anyone’: As Insurers Issue Denials, Some Patients Run Out of Options
Health insurers issue millions of denials every year. And like the Tennants, many patients find themselves stuck in a convoluted appeals process marked by long wait times, frustrating customer service encounters, and decisions by medical professionals they’ve never met.
— KFF Health News, June 16, 2025
It’s the rare issue where consumer advocates and nursing home providers are in near lockstep, but on this they passionately agree: Improved rules for Medicare Advantage plans made over the last several years haven’t gone nearly far enough in creating a program that ensures adequate access to high-quality care for seniors. The Centers for Medicare & Medicaid Services, prompted by a wave of consumer complaints and stinging federal investigations, has worked since 2022 to limit the runaway use of prior authorization, give consumers better appeals rights, and make MA insurers’ routine business practices more transparent.
— McKnight’s Long-Term Care News, February 24, 2025
Medicare Advantage Linked to Delays in Nursing Home Care, Longer Hospital Stays
Amid increasing evidence that prior authorization and denials in Medicare Advantage (MA) may delay access to nursing homes, a new study shows that MA patients often experience longer hospital stays before discharge to a post-acute care setting, compared to those with traditional Medicare. MA hospital discharges to PAC increased by 5.6% from 338 to 357 beneficiaries per 1,000 discharges. Meanwhile, Medicare hospital discharges decreased by 1.5% from 401 to 395 per 1,000 discharges.
— Skilled Nursing News, June 25, 2025
CarDon CEO Zach Cattell: Managed Medicaid is ‘Biggest Wrench’ Pushing System Overhaul
Managed Medicaid is only currently implemented in a few states such as Illinois, Iowa, Ohio and Arizona, and has been in place since July of last year in Indiana, where about 80% of nursing home residents are Medicaid beneficiaries. It has caused major headaches in the states, including for Indiana-based CarDon. Indiana’s transition to managed Medicaid through a dual integration program has a complicated process with impact on admissions and eligibility, requiring CarDon to overhaul internal workflows, Cattell noted.
— Skilled Nursing News, June 24, 2025
Reduce Insurance Claim Denials
The healthcare landscape continues to evolve, and with it, so do the complexities of billing and reimbursement. Home health and hospice agencies face unique challenges, from managing PDGM requirements on the home health side to navigating multiple payer systems on the hospice side. Recent data shows that denied claims significantly impact not just revenue but also patient care delivery and operational efficiency.
— The Rowan Report, February 20, 2025
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
