Q3 2026 hospital earnings show ACA coverage losses and rising Medicaid risks
Changes to federal coverage and Medicaid financing are manifesting in hospital volumes, payer mix and earnings both currently and in projections, according to Q3 2026 investor calls held recently by hospital companies. The most immediate issue is that coverage losses in the Affordable Care Act (ACA) insurance marketplaces continue to create uncompensated-care pressure. For example,…
Court vacates CMS medical frailty restriction in Medicaid work requirement
In a ruling considered favorable to Medicaid beneficiaries and providers, a federal court sided with plaintiffs’ argument that CMS exceeded its authority in regulations defining the medical frailty exemption to the Medicaid work requirement. An Oct. 29 summary judgment by a Massachusetts federal court vacated regulatory language that would have complicated the task of deciding…
Healthcare purchasing falls amid financial pressures
Amid rising costs and constrained margins, healthcare and life sciences organizations are pulling back on new purchasing commitments, in contrast to other major industries, according to a new report. Although the data in the report do not establish causation, the trend suggests how healthcare organizations are responding to financial uncertainty. “Healthcare experienced real shocks and…
ACA marketplace subsidy verification rule would reduce enrollment starting in 2028
Proposed annual verification processes for Affordable Care Act (ACA) marketplace insurance subsidies could prove disruptive to returning enrollees. A CMS proposed rule would implement provisions of H.R. 1 (also known as the One Big Beautiful Bill Act or the Working Families Tax Cut Act) starting with 2028 open enrollment. An enrollee applying for subsidies with…
CMS undertakes Medicare Worksheet S-12 audits of hospital cost reports
CMS is emphasizing hospital compliance with updated Medicare cost-reporting requirements, recently announcing an audit of first-year submissions of a brand-new worksheet. For cost-reporting periods ending on or after Jan. 1, 2026, most hospitals paid under the Inpatient Prospective Payment System have had to complete Worksheet S-12. Those submissions will be subject to auditing by a…
CMS proposes Medicare Advantage provider directory requirements for 2028
Medicare Advantage (MA) plans are set to face requirements aimed at improving the accuracy of provider directories, according to a proposed rule. Issued Oct. 16 by CMS, the proposed regulations would implement provisions of the Consolidated Appropriations Act of 2026 (CAA 2026). Beginning in 2028, new mandates applicable to network-based MA plans and certain private…
How proposed restrictions on corporate practice of medicine could affect hospitals
Hospitals would face new restrictions on some of their business practices, according to language in recently proposed legislation. However, the core provision of the Stop Corporate Takeovers of Physicians Act of 2026 would exempt hospitals. A ban on ownership or majority control of a medical practice would apply to insurance companies, private equity funds and…
CMS exclusion authority brings new fraud enforcement questions for providers
HHS’s decision to grant CMS exclusion authority creates a new enforcement consideration for healthcare providers participating in federal programs. HHS Secretary Robert F. Kennedy Jr. announced the update during a July news conference, and an Oct. 14 regulatory notice formalized the change, effective immediately. The notice gives CMS permissive exclusion authority under the Social Security…
Hospital financial performance improves as Medicaid funding risks grow
Going back to early 2026, hospital and health system financials have started to reflect industry responses to H.R. 1, the One Big Beautiful Bill Act (OBBBA). In new reporting (registration required) from Strata Decision Technology on first-half 2026 trends, health system financial performance improved over the six-month period, even as margins remained tight. After falling…
340B rebate model lawsuit seeks to halt 2027 rollout, citing hospital costs
Oct. 12 Update Another potential challenge to the 340B rebate model is forming in Congress, where a bipartisan quartet in the House introduced the 340B Rebate Model Delay Act on Oct. 9. The legislation, which has not yet been posted, would delay the model until 2029 to give Congress more time to evaluate the financial…