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量子资源网 Insights 鈥� including our new podcast 鈥� puts the vast depth of 量子资源网鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Supporting Medicaid Dental Benefit Administrators: Oral health and dental care are vital for the health of communities听

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量子资源网 Spotlight

Supporting Medicaid Dental Benefit Administrators: Oral health and dental care are vital for the health of communities听

Whether performing under risk-based prepaid ambulatory health plan (PAHP) contracts or non-risk (administrative service organizations), Medicaid dental managed care organizations (MCOs) and dental benefit administrators (DBAs) face the same challenges as Medicaid MCOs, and state Medicaid agencies, including but not limited to:

– Getting into and staying in compliance with state regulatory and contract requirements
听
– Understanding and responding to new federal and state rules and regulations
听
– Growing market share including success in state procurements, in MCO solicitations for DBAs, and attracting and retaining enrollees

– Improving utilization to meet quality measure targets, medical loss ratios, and margin expectations including increased utilization of preventive oral health care, and decreased utilization of unnecessary care such as avoidable emergency room care for dental diagnoses

– Excelling in benefit administration operations including member services and engagement, provider network development and provider services, claim/encounter administration, reporting, and other functional areas
听
– Managing financial risk including developing or validating capitation rates and developing value-based payment arrangements

The importance of oral health and dental care

Oral health is integral to the overall health and quality of an individual鈥檚 life, and lack of access to oral health care negatively impacts entire populations.

Tooth decay affects 90% of adults 20 to 64 years of age and costs the U.S. about $45.9B in lost productivity in 2015. This frequently results in visits to hospital emergency rooms where care is often palliative but does not treat the root cause of problems1

Gum disease affects almost 50% of adults 45 to 64 years of age and is a risk factor for nearly 60 other adverse health conditions, including Alzheimer鈥檚 disease, diabetes, and heart disease2

More than half of working-age adults living in poverty have untreated caries (52%), whereas only 1 out of 5 adults with incomes of twice the federal poverty guideline or higher have untreated caries (20%)3

Tooth decay is preventable but impacts nearly 46% of U.S. children. Left untreated, tooth decay can cause chronic pain, impaired development, disfiguration, and social isolation. In severe cases, bacteria from a tooth infection can even travel to the brain and cause death. Caries disproportionately affect children who experience poverty, belong to certain racial and ethnic groups, or are affected by other social factors4

OUR EXPERTISE

At 量子资源网, our consultants have led MCOs, state Medicaid agencies, and include senior officials from Medicare, directors of large nonprofit and social services organizations, top-level advisors, C-level executives at hospitals, health systems and health plans, and senior-level physicians. We know that oral health, access to dental care, and oral health literacy play a vital role in the health of communities supported by Medicaid MCOs. 量子资源网 can support the work that DBAs do and the challenges they face in the changing Medicaid environment.

How 量子资源网 can help

量子资源网 has decades of experience working with Medicaid MCOs, DBAs, state Medicaid agency dental policy makers, and oral health providers. 量子资源网 can:

Provide actionable insights into new federal and state regulations and guidance to help clients understand potential impacts and opportunities for their business. We assist clients to determine what must be done, what can be done, and develop recommendations for what should be done, and to implement those activities. DBAs are frequently performing as PAHPs and are subject to many of the federal rules related to interoperability, prior authorization, access, and eligibility that apply to Medicaid MCOs. 量子资源网 provides our Medicaid provider and payer clients with analyses about those rules, which could also benefit DBAs.

Perform validation and compliance support to help clients identify and address any compliance gaps and support clients in validating their own compliance with any state or MCO imposed Corrective Action Plans. We also support clients to grow and strengthen their own capabilities and infrastructure to perform these functions.

Support client growth with end-to-end procurement assistance, including market conditioning and strategy, writing, mock scoring, orals preparation, implementation, and operations stabilization assistance; and with market analysis.

Support delivery system, reimbursement, and provider network design by conducting research and analysis on oral health delivery system approaches, provider reimbursement structures, coverage, and access trends.

Identify, assess, and help implement best practices in oral health care programs related to special populations, including children鈥檚 access to oral health care and dental access in rural communities.

Support quality improvement and utilization management initiatives that increase appropriate and desired utilization and curb inappropriate utilization. This can include help achieving Healthcare Effectiveness Data and Information Set (HEDIS) measure goals and developing oral health literacy programs, achieving accreditation, developing and implementing Performance Improvement Plans (PIPs), and conducting data analysis to understand utilization and evaluate the impact of program changes on utilization.

Provide actuarial services in support of benefit and program design, capitation rate development, and capitation rate validation.

Design and evaluate value-based payment models that tie provider payments to quality and value.

Project spotlight

Minnesota Medicaid Dental Program Study

The 2021 Minnesota Legislature directed the Department of Human Services (DHS) to conduct a review of Medicaid dental program delivery systems in states that have enacted and implemented a 鈥渃arve out鈥� dental delivery system. This legislation also directed DHS to conduct an analysis of dental provider hesitancy to participate in the Medical Assistance (MA) program as an enrolled provider. DHS contracted with 量子资源网 to conduct the analyses mandated in the legislation. 量子资源网 reviewed the Medicaid dental program delivery systems in states that have implemented a carve-out dental delivery system, including comparing state program designs, program costs and rates where available, and quality metrics for children one through 20 years of age with at least one preventive dental service within a year. 量子资源网 also surveyed dental providers to better understand hesitancy to participate in Medicaid and opinions on policy approaches to improve provider participation.
The final report, available at , described the analysis of state dental carve-out experiences and the dental provider survey results.

Contact our experts:

Headshot of Sarah Arvey

Sarah Arvey

Associate Principal

Sarah Arvey is a trained medical anthropologist and qualitative researcher with expertise in the impact of social determinants, cultural norms, … Read more
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Rebecca Kellenberg

Principal

Rebecca Kellenberg specializes in assisting public and private health care organizations with Medicaid and CHIP policy analysis and implementation. With … Read more
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Beth Kidder

Regional Director

Beth Kidder is a transformative and innovative health care leader with more than 20 years of experience working within the … Read more
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Stephen Palmer

Principal

Stephen Palmer, PhD has a broad range of expertise and skills, which enable him to easily join most types of … Read more
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Caroline (Carrie) Rosenzweig

Principal

Carrie Rosenzweig is an experienced consultant specializing in health policy analysis, qualitative research, grant writing, and project management. Her research … Read more

[1] Oral Health in America – April 2022 Bulletin, National Institute of Dental and Craniofacial Research, accessed 4/1/2025,

[2] Oral Health in America – April 2022 Bulletin, National Institute of Dental and Craniofacial Research, accessed 4/1/2025,

[3] National Institutes of Health. Oral Health in America: Advances and Challenges. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2021,

[4] Big Hopes for Little Teeth, National Institute of Dental and Craniofacial Research, accessed 4/1/2025,

Blog

From Policy to Practice: 量子资源网 Offers New Toolkit for Tackling the Challenges of Implementing the 1115 Justice-Involved Reentry Demonstration in Carceral Settings

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The Section 1115 Justice-Involved (JI) Reentry Demonstration marks a transformative step in closing the healthcare gap for incarcerated individuals. By allowing Medicaid coverage to resume up to 90 days prior to release, the demonstration aims to improve care continuity and reduce recidivism. Yet, translating this vision into action within jails, prisons, and juvenile detention facilities presents a host of operational challenges. For implementation to succeed, jurisdictions must navigate fragmented systems, strained resources, and competing priorities. That鈥檚 where structured tools鈥攍ike implementation checklists鈥攂ecome essential.

The Challenges: Implementation in Complex, High-Stakes Environments

Implementing the 1115 JI Reentry Demonstration is more than a policy shift鈥攊t鈥檚 a systemic overhaul that requires cross-agency collaboration, infrastructure alignment, and cultural change. Among the most significant challenges:

1. Fragmented Systems and Data Silos

Carceral systems, Medicaid agencies, and community-based providers often operate in silos, using different data platforms and standards. This fragmentation hinders real-time information exchange and care coordination during the transition from incarceration to the community.

2. Operational Readiness Gaps

Many facilities lack established procedures for conducting Medicaid eligibility screenings, care plan development, and referrals to community-based services within the release window. Without predefined workflows, implementation can stall.

3. Workforce Capacity and Training Needs

Reentry planning demands coordination among correctional officers, social workers, nurses, behavioral health clinicians, and Medicaid staff. Many jurisdictions face staffing shortages and limited training on trauma-informed care, care management, or reentry protocols.

4. Policy Misalignment and Legal Constraints

Local policies may restrict access to Medicaid-related functions during incarceration, or limit facility staff鈥檚 ability to share data. Misinterpretation of federal and state rules can create implementation delays.

5. Trust and Engagement Barriers

Justice-involved individuals often face stigma or mistrust from systems they鈥檝e interacted with. Culturally responsive engagement strategies are crucial but frequently underdeveloped.

The Solution: Using a Checklist-Based Implementation Framework

To navigate these hurdles, stakeholders need more than vision鈥攖hey need structure. Implementation checklists tailored to jails, prisons, and juvenile facilities serve as a practical roadmap that transforms policy goals into operational plans. Here’s how they help:

  • Clarify Roles and Responsibilities

Checklists break down complex goals into clear, role-specific tasks鈥攚ho enrolls individuals in Medicaid, who develops care plans, and who ensures warm handoffs to community providers.

  • Promote Cross-Sector Coordination

Structured checklists prompt regular touchpoints across agencies鈥攃orrections, health services, Medicaid, and behavioral health鈥攅nsuring alignment and accountability.

  • Standardize Procedures and Tools

By specifying recommended workflows, assessment tools, and communication protocols, checklists minimize variation and streamline implementation across facilities.

  • Track Progress and Gaps

Built-in progress indicators make it easier to monitor what鈥檚 completed, what鈥檚 pending, and where additional support or training is needed.

  • Support Compliance and Evaluation

A checklist-based approach provides the documentation trail needed for program audits, reporting, and continuous quality improvement.

Conclusion: A Strategic Tool for Lasting Impact

Implementing the Section 1115 JI Reentry Demonstration is a bold, necessary move toward health equity and system transformation. But success depends on more than ambition. With structured checklists in hand, agencies can move from aspiration to execution鈥攂uilding a thoughtful, well-orchestrated reentry infrastructure that improves health outcomes, reduces recidivism, and meets federal expectations.

Download the 量子资源网 JI Toolkit here.

Other 1115 demonstration resources that may be of interest:

Brief & Report

Section 1115 Justice-Involved Reentry Demonstration Implementation Toolkit for Jail, Prison, and Juvenile Settings

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This toolkit provides a set of implementation checklists for Section 1115 Justice-Involved Reentry Demonstrations tailored to three carceral settings: jails, prisons, and juvenile facilities. Each checklist outlines operational tasks across core domains to support effective planning, coordination, and continuity of care pre- and post-release.

This toolkit is intended to provide information for jails, prisons, and youth detention centers in states contemplating submitting a 1115 Justice-Involved Reentry Demonstration, as well as states that have an approved demonstration. All states with approved demonstrations must provide core services, including care management for physical and behavioral health, medication assisted treatment for individuals when clinically indicated before release, and medication in hand at release. It is important to note that states may vary in their populations of focus, care management models, and processes for submitting claims. It is essential to cross-reference your state鈥檚 demonstration when planning to operationalize this initiative.

Case Study

A Revenue Cycle Management Success Story: Advanced Diabetes Supply/US Medical Supply

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THE CLIENT

Advanced Diabetes Supply (ADS) acquired US Medical Supply (USMed), a Florida-based durable medical equipment provider, in 2021. At the time, ADS and USMed generated $400 million and $250 million in revenue, respectively. Over the next three years, the combined organization experienced rapid growth, reaching over $1 billion in annual revenue.

BACKGROUND

While the top-line growth was significant鈥�59% over a three-year span鈥攃ash collections failed to keep pace. This created a classic case of an organization outgrowing its infrastructure. T he foundational tools, technology, and operational structure simply weren鈥檛 in place to support the accelerated growth, particularly on the revenue cycle side.

Compounding these challenges were issues stemming from the integration of the two companies, including billing inconsistencies and reimbursement delays. USMed, like many in the industry, was severely impacted by the Change Healthcare ransomware attack, disrupting billing and collections operations nationwide. At the time this project began, USMed was facing a $40 million backlog in accounts receivable and struggling to meet payroll. The revenue cycle team was understaffed and overwhelmed.

量子资源网 had previously performed a successful revenue cycle gap assessment at an ADS office in California. Based on those results, the newly hired CFO of ADS/USMed asked 量子资源网 to replicate the process for the Florida office. The goal: support the recently appointed VP of Revenue Cycle in stabilizing operations, implementing recommendations, and aligning practices to industry best standards.

TESTIMONIAL

鈥淲hen I stepped into the role, the environment was fragmented鈥� two teams on opposite coasts, multiple disconnected systems, and a lot of inefficiencies that came from rapid growth without the right infrastructure. It was a heavy lift to get our new leadership team fully ramped, but we never lost momentum thanks to the 量子资源网 team. 量子资源网 conducted a comprehensive RCM gap assessment that enabled us to clearly identify our key pain points. Through close collaboration with the RCM team at 量子资源网, we developed a strategic roadmap for success. 量子资源网 continued to provide valuable strategic guidance and transformation support throughout the project, contributing significantly to our progress. They stepped in as our interim leadership bench, brought structure to the chaos, and helped us stabilize operations quickly. I can directly attribute our ability to collect over $1.1 billion in revenue to the expertise and hands-on support we had from 量子资源网.鈥�

Melanie Montero, Senior VP, Revenue Cycle, Advanced Diabetes Supply

APPROACH

量子资源网 completed a thorough gap assessment and was retained to lead the implementation phase. Key actions taken:

  • Developed a 6-month roadmap outlining both quick wins and long-term priorities.
  • Led a financial turnaround strategy centered on people, processes, and technology. 量子资源网 provided interim staffing, restructured workflows, and redesigned the revenue cycle team鈥檚 organizational chart.
  • Supported hiring efforts for key roles, including vendor selection and onboarding. A new financial reporting infrastructure was also introduced, replacing outdated systems with Power BI dashboards that now serve as the company鈥檚 central source of truth.
  • Identified payer-related issues and implemented solutions to drive improved cash collections using insights from Power BI.
  • Navigated the Change Healthcare crisis by facilitating a rapid transition to a new clearinghouse. A process that typically takes 4鈥�6 months was completed in just over 30 days thanks to 量子资源网鈥檚 healthcare IT expertise.
  • Implemented preventative measures to improve claim accuracy, reduce denials, and ensure long-term revenue cycle stability.

RESULTS

Thanks to 量子资源网鈥檚 hands-on support, USMed experienced a measurable financial turnaround:

  • 12% YoY increase in cash collections, resulting in more than $38 million in additional revenue.
  • $16 million reduction in outstanding A/R within six months.
  • 38 new standard operating procedures created and rolled out.
  • Offshore training and onboarding of new RCM team members, including vendor management and leadership development.
  • Root-cause analysis and resolution of denial drivers and revenue leakage risks, with new upstream workflow improvement.
  • Full implementation of the Waystar billing system, replacing Change Healthcare. T his included Medicare claims monitoring tools, custom workflows for rejections, and 30+ custom rules that led to the recovery of $900K in payments over just five months.

量子资源网 can help other organizations identify gaps in their revenue cycle, and by working with us can expect to see improvements in denial rates and reimbursement. Our experts have decades of experience in every facet of the revenue cycle. They come from all sides of the healthcare industry, including providers, payers, managed care organizations, and more. From gap assessment to strategic planning to implementation and backfilling front or back-office operations, 量子资源网 can help you improve your company鈥檚 financial position. To learn more visit: healthmanagement.com/services/healthcare-revenue-cycle-management/

Blog

President Issues Executive Order Calling for Most Favored Nation Drug Pricing

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On May 12, 2025, the President signed an Executive Order (EO), .鈥� The EO calls for or, in some cases, presumes a range of manufacturer, administrative and regulatory actions to reduce drug prices, but ultimate outcome remains unclear.

量子资源网 experts, including Leavitt Partners, an 量子资源网 company, are closely following executive agency and stakeholder responses to the EO. In this article, our experts summarize the EO and identify key considerations for healthcare stakeholders.

Policy Overview

Since his first administration, President Trump has consistently criticized disparities in brand-name prescription drug prices between the United States and other developed countries. In 2018, the previous Trump Administration issued a  to institute an International Pricing Index (IPI) model targeting Medicare payments for a subset of clinician-administered drugs. The IPI model would have set a Medicare payment amount for select Part B drugs at a lower amount to align with international prices and allow for negotiation of prices, while still providing a drug add-on payment to providers consistent with historical drug costs.  In November 2020, the administration issued an interim final rule (IFR) instituting an escalated version of this concept, entitled the . Both the IPI proposal and the MFN final rule, the latter of which was enjoined by the courts on largely procedural grounds and later rescinded by the Biden administration, would have been implemented under the Center for Medicare and Medicaid Innovation鈥檚 (CMMI) demonstration authority.

On May 12, 2025, the President signed an EO, , which reaffirms the Administration鈥檚 concerns regarding what it perceives to be American funding of pharmaceutical research and development 鈥渨hile foreign health systems get a free ride.鈥� In an effort to address the Administration鈥檚 concerns, the EO notes that the Administration 鈥渨ill take immediate steps to end global freeloading鈥� and that 鈥渟hould drug manufacturers fail to offer American consumers the most-favored-nation lowest price, my Administration will take additional aggressive action.鈥�

The EO outlines efforts to implement this policy, including:

  • Trade Efforts.听The US Department of Commerce and United States Trade Representative (USTR) are directed to ensure that foreign countries are not engaged in actions with the effect of forcing Americans to 鈥減ay for a disproportionate amount鈥� of R&D costs.
  • Direct-to-Consumer (DTC) Sales at MFN Price.听The US Department of Health and Human Services (HHS) is directed to facilitate DTC sales programs for manufacturers to offer MFN prices.
  • MFN Targets.听The HHS Secretary is directed to provide MFN targets to manufacturers within 30 days with the expectation that manufacturers will 鈥渂ring prices for American patients in line with comparably developed nations.鈥�
  • If 鈥渟ignificant progress鈥� toward MFN pricing is not made, HHS will be directed to propose a rulemaking plan to impose it.
  • The order suggests that the HHS Secretary certify, on a case-by-case basis, that reimportation will pose no additional risk to public health and will result in savings, as well as to create standard mechanisms for importation. It is unclear how this direction aligns with the current statutory framework, which is focused on Canada.
  • Federal Trade Commission/Department of Justice Action.听The EO calls for efforts 鈥渃onsistent with law鈥� to undertake enforcement action against anticompetitive practices identified in the prior drug pricing EO, including use of the Sherman Antitrust Act.

Key Considerations

At this stage, the scope and practical effects of the EO remain uncertain, as the administration has not yet provided details regarding the regulatory and subregulatory actions envisioned under the document. With respect to trade policy, for instance, the EO does not outline explicitly what particular tools it expects USTR or the Commerce Department to leverage in combating 鈥渇oreign freeloading.鈥�

Similarly, the EO does not elaborate on the steps that the administration plans to take in 鈥渇acilitat[ing]鈥� voluntary MFN target pricing under DTC purchasing arrangements. Such efforts could theoretically bring waivers or other regulatory flexibilities to bear, or else they could take a more hands-off approach, simply encouraging drugmakers to take action on their own.

Without further clarifications around how the administration might define or assess 鈥渟ignificant progress鈥� towards MFN pricing targets on the part of manufacturers, nor the form, manner, or timeline that 鈥渁ggressive action鈥� in the absence of such progress might take, the EO serves principally as an illustration of the President鈥檚 posture, perspective, and priorities with respect to prescription drug affordability and access.

Even in the absence of immediate pricing or payment interventions, the EO could provide a preview of future executive actions aligned with the document鈥檚 focus. Such actions could include CMMI models building on the IPI or MFN initiatives from the first term, explicit trade negotiation priorities, regulatory measures related to DTC purchasing arrangements, FDA reimportation program flexibilities, or any number of other drug-related policies.

Our experts will continue to monitor these activities as they progress.

Connect With Us

For details regarding the EO and potential impact on the healthcare sector, contact our featured experts below at听[email protected]

Blog

House Committees Consider Policies to Meet Budget Reconciliation Instructions

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This week, key committees in the House of Representatives released recommendations for legislative language that meets their federal savings and spending targets required in the fiscal year (FY) 2025 budget resolution. On May 11, 2025, the House Energy and Commerce Committee released legislation鈥攁nd subsequently a substitute amendment鈥攖hat contains several substantive Medicaid proposals designed to address eligibility and enrollment; financing; fraud waste, and abuse; and to institute mandatory work and community engagement requirements and cost sharing. The Committee completed its markup on May 14, 2025, voting to approve the provisions in the substitute amendment.

The release of text and committee markups are key steps in Congress鈥檚 budget reconciliation process; however, proposals may change during Senate proceedings.

量子资源网 (量子资源网), and Leavitt Partners, an 量子资源网 company, are tracking these developments and analyzing the extensive health and health-related legislative text, including the Medicaid, Medicare, and Affordable Care Act (ACA) Marketplace proposals. Below, we review the status of congressional efforts and key policies.

Background

The budget reconciliation process is a powerful tool for enacting significant fiscal policy changes, as it allows for expedited consideration and passage of budget-related legislation. It has been used in the past to enact major tax reforms, healthcare legislation, and other important budgetary measures.

In 2025, Congress has been actively working to develop its budget bills through a series of steps. The House adopted a budget resolution on February 25, 2025, which sets the framework for federal spending, revenue, and the debt limit for fiscal year 2025 and outlines budgetary levels for the following years through 2034. The Senate passed an amended version of the budget resolution on April 5, 2025. The Senate鈥檚 amendments included reconciliation instructions that require $4 billion in gross deficit reductions and allow a $5.8 trillion net deficit increase. On April 10, 2025, the House agreed to the Senate鈥檚 amendments with a vote of 216鈭�214. This agreement set the stage for the development of a reconciliation bill.

House Energy and Commerce Markup

On May 14, 2025, the House Committee on Energy and Commerce completed its second day of legislative language to comply with the Concurrent Resolution on the Budget for Fiscal Year 2025, voting to advance the proposals out of committee. The committee鈥檚 proposal excluded certain significant structural reforms that had generated concern among some members and stakeholders, such as broad reductions in the federal matching rate (enhanced federal matching assistance percentage (FMAP)) for Medicaid expansion populations, per-capita caps on federal Medicaid cost growth, or reductions in the safe harbor threshold for state Medicaid provider taxes. The proposal does, however, contain more than a dozen provisions that would reduce federal health care spending by $715 billion with the funding reductions mostly focused on Medicaid, which the Congressional Budget Office projects will reduce the federal share of Medicaid spending, including:

  • Adding mandatory work and community engagement requirements for individuals ages 19鈭�64 without dependents, subject to exceptions for pregnant women, people who are medically frail, people with disabilities, people in compliance with other government program work requirements, people living in areas experiencing a temporary hardship, and other individuals
  • Adding cost sharing for beneficiaries in the expansion population who earn more than 100 percent of the Federal Poverty Level, not to exceed $35 per item or service
  • Pausing implementation of several final rules published during the Biden Administration, including: the final rule published September 21, 2023, 鈥淪treamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment鈥�; the April 2, 2024 rule, 鈥淪treamlining the Medicaid, Children鈥檚 Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes鈥�; and the May 10, 2024, final rule, 鈥淢inimum Staffing Standards for Long Term Care Facilities and Medicaid Institutional Payment Transparency Reporting鈥�
  • Adding provider screening requirements
  • Increasing frequency of eligibility redeterminations for certain individuals and adding enrollee address verification policies
  • Reducing expansion FMAP for certain states that provide Medicaid coverage to undocumented individuals and families, regardless of the source of funding
  • Preventing certain spread pricing arrangements in Medicaid between states and pharmacy benefit managers
  • Restricting funding for certain essential community providers that furnish family planning services, reproductive health, and related healthcare services
  • Ending a temporary increased FMAP to new states adopting Medicaid expansion, revising policies governing the use of Medicaid provider taxes, and payment limits for state directed payments

Committee Markups

Various other House committees have begun holding markups for the reconciliation package. The Committee on Ways and Means conducted its markup on May 13, 2025, to discuss its  of the reconciliation bill, which involves $4.5 trillion in deficit increases. The initial Ways and Means proposal did not include many significant healthcare proposals, but on May 12, 2025, the committee released a substitute amendment that includes several changes that would affect private insurance coverage and Medicare. Key provisions include:

  • Changes to Medicare and ACA premium tax credit (PTC) eligibility requirements related to immigration status
  • Improvements to ACA PTC eligibility verification checks
  • Changes to Health Savings Account flexibilities
  • Codification and renaming of individual coverage health reimbursement accounts, which serve as a defined contribution that employees can use to purchase insurance in the individual market

Other committees, such as the Education and Workforce, Judiciary, Armed Services, and Homeland Security Committees, also have conducted markups and approved their respective portions of the reconciliation bill.

Connect With Us

These steps are part of the ongoing process to finalize the budget and reconciliation legislation for FY 2025. Our federal policy experts with Leavitt Partners and across 量子资源网 are monitoring the legislative policies and ongoing negotiations in Congress and with the administration. They work with healthcare organizations and industry to plan for the range of scenarios and policies Congress is debating.

For more information about the impact of these policies, contact our featured federal policy experts听below.

Webinar

Webinar Replay – Ask 量子资源网 Experts: Behavioral Health Town Hall

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This webinar was held on May 29, 2025.

In this dynamic and interactive Behavioral Health Town Hall hosted by 量子资源网 (量子资源网), our experts answered questions live on a wide range of critical topics, including:

  • Federal policy, personnel, and funding changes;
  • Emerging strategies for addressing social determinants of health, substance use disorder and crisis coordination (including 988);
  • Behavioral health revenue cycle management and alternative payment models; and
  • Innovations in addressing workforce shortages, integrated service delivery, digital mental health tools, and best practices for community mental health service delivery.

Blog

Health Policy in Maryland Amid Fiscal Uncertainty

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The 2025 Maryland General Assembly session closed on April 7th. While the budget deficit consumed a large portion of legislative bandwidth, there was significant action on health-related programs, including supporting the implementation of the Centers for Medicare & Medicaid Services (CMS) All-Payer Health Equity Approaches and Development (AHEAD) Model, expanding access to care, paving a way for Prescription Drug Affordability Board (PDAB) expansion and increasing access to affordable insurance. The AHEAD Model is an innovation in healthcare finance that drives improvements in population health through increased investments in activities likely to improve health outcomes, and benefits hospitals that participate by providing stable funding through hospital global budgets.

Budget Deficits and Federal Funding Fears Limited New Spending

After intense debate and discussion, House and Senate fiscal leaders reached a budget agreement on the final day of session. From the beginning, significant projected general fund shortfalls existed in the current and future fiscal years. Primarily these shortfalls were due to higher than anticipated Medicaid enrollment and growth in obligations to fund K-12 education under the Blueprint for Maryland鈥檚 Future. Through a combination of actions including budget cuts, increasing hospital assessments to cover Medicaid costs, shifting costs to counties, and new taxes and fees, the budget passed along party lines. Due to concerns about the potential harm from federal budget cuts, particularly in the Medicaid program, the final plan includes a trigger provision requiring the Governor to engage lawmakers on solutions should federal funding to the state fall by $1 billion.  

The State Readies for the AHEAD model

Despite fiscal concerns, the General Assembly established two new funds, the Population Health Improvement Fund, and the Maryland Primary Care Program Fund, to support the implementation of the AHEAD model. Revenues to both funds are collected through an increase in hospital assessments.

  • The Population Health Improvement Fund will support efforts to reach statewide population health targets under the AHEAD model.
  • The Maryland Primary Care Program Fund will support the implementation of a Medicaid advanced primary care model and support primary care providers through investments in reimbursements for evaluation and management codes, care management fees to eligible practices, and quality incentives.

Supporting Access to Care

Lawmakers passed several bills aimed at increasing or protecting access to care.

  • The Preserve Telehealth Access Act of 2025 makes permanent provisions of law requiring reimbursement parity between telehealth and in-person services and includes 鈥渁udio-only鈥� services as telehealth under certain circumstances.
  • Legislation passed to address children and youth boarding in hospital settings beyond medical necessity. The bills define a 鈥減ediatric overstay鈥� and requires the Maryland Department of Health and the Maryland Department of Human Services to establish a pediatric overstay coordinator in each department to ensure that each patient is served in the least restrictive environment.

Several pieces of legislation passed to address behavioral health and substance use disorders including:

  • Eliminating the prohibition on using 9-1-1 trust fund dollars to support the 9-8-8 suicide prevention hotline, improving coordination between 9-1-1 and 9-8-8.
  • Establishing a buprenorphine training grant program to support training paramedics to administer the drug.
  • Further delineating uses of opioid restitution fund dollars and creating additional reporting requirements for the Office of Overdose Response.

Since the Dobbs decision, rolling back protections for abortion care in states, Maryland has been on the forefront of protecting reproductive freedom. Legislation passed establishing the Public Health Abortion Grant Program and Fund to support eligible organizations providing equitable access to abortion care services.

Regulating Prescription Drug Prices

Maryland established the Prescription Drug Affordability Board (PDAB) in 2019 joining ten other states in regulating the cost of prescription drugs through affordability boards. The goal of PDABs is to address high prescription costs by setting upper payment limits (UPLs) for drugs that cause or are likely to cause affordability challenges. Currently, Maryland鈥檚 PDAB is authorized to set UPLs for prescription drug products purchased by or on behalf of a unit of state or local government.  Legislation passed creating a pathway for the PDAB to set UPLs on prescription drug products paid for by additional state regulated payors if the board determines that the product has led or will lead to an affordability challenge.

Access to Affordable Health Insurance

The General Assembly made permanent the State-Based Young Adult Health Insurance Subsidy program and requires the Maryland Health Benefit Exchange in consultation with the Maryland Insurance Commissioner to establish and implement a state-based health insurance subsidy program for all individuals. The Maryland Health Insurance Protection Commission was reestablished to monitor federal changes that could impact coverage.

Change in Leadership at the Maryland Department of Health

During the busy legislative session, Secretary Laura Herrera Scott, MD, announced she was stepping down from her position as leader of the Maryland Department of Health. Former CMS administrator, Meena Seshamani, MD, was announced as Dr. Scott鈥檚 successor and sworn in on April 9th. Secretary Seshamani will be tasked with leading the transition from Maryland鈥檚 Total Cost of Care model to the AHEAD model and leading the department through a period of uncertainty and expected budget shortfalls.

Maryland State of Reform Conference to Cover Many of these Issues

These issues and more will be covered at the on June 12th at the Baltimore Marriott Waterfront. The day will include a panel of legislative leaders as well as sessions focused on the AHEAD Model, value-based care, behavioral health, public health, and prescription drug costs.

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Governor Asa Hutchinson Announced as Keynote Speaker at 量子资源网 2025 Conference

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We鈥檙e excited to welcome former Arkansas Governor Asa Hutchinson as the keynote speaker at the 2025 量子资源网 Conference October 14-16 in New Orleans, LA.听 Governor Hutchinson brings over 40 years of leadership in law, national security, and public service. As the 46th Governor of Arkansas (2015鈥�2023), he championed innovation in maternal healthcare, initiating programs and policies focused on improving maternal health outcomes during his time in office. He established the Maternal Life360Home program, expanding access to home visitations and intensive care coordination services for women with high-risk pregnancies and for children after birth, and improving the safety and wellbeing of children in foster care. He launched the Healthy Active Arkansas program, a 10-year plan to encourage schools and businesses to promote healthier eating and more activity.

His prior federal roles include Drug Enforcement Agency (DEA) Administrator, the first Under Secretary for Border and Transportation Security at the Department for Homeland Security (DHS), U.S. Congressman, and the nation鈥檚 youngest U.S. Attorney. We鈥檙e excited to welcome his perspective on advancing health outcomes across America.

In keeping with changes being made at the federal level affecting all aspects of the healthcare system, Governor Hutchinson will be discussing “The Policy and Politics of Making America Healthy.” In his address, he will share听insights from his tenure in Arkansas, his perspective on effective health policy development, and the challenges to implementation at both state and federal levels. Join us for what promises to be an enlightening session as he explores the evolving relationship between federal and state governments and the opportunities for innovative health policy development that gives states more flexibility.

Don’t miss this opportunity to hear from one of our nation’s respected political leaders on issues that directly impact our industry and the health of Americans.

Date: October 14-16, 2025

Time: 8:30 a.m.

Location: Four Seasons New Orleans

Following the Governor鈥檚 talk, you will join with industry leaders to discuss new directions in payment and financing of publicly funded healthcare programs, community-level strategies designed to meet the needs of special populations, tailwinds driving the expanding universe of digital health policies, and innovations to strengthen access to behavioral health services. Come for the informative plenary sessions and workshops, explore strategies for navigating changes in funding, access, and coverage to ensure success in a shifting environment, and expand your network with federal and state policymakers, healthcare providers, insurers, philanthropists, and C-suite industry leaders. 

Brief & Report

What鈥檚 Really Causing the Rise in Insurance Premiums, and What Can States Do 量子资源网 It?

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Healthcare cost increases are outpacing general inflation, which jeopardizes access to coverage and care, as well as investments in other priorities. As a result, states are looking for ways to reduce the cost burden for consumers, employers, and taxpayers. The State of Maine engaged Wakely Consulting Group, an 量子资源网 Company, to analyze historical medical trends and the associated impact on premiums in Maine鈥檚 health insurance market for the period of 2021 to 2025. The goal was to assess what factors are driving rising insurance costs. This project was supported by an 量子资源网 contract with Arnold Ventures, under which we provide technical assistance to states seeking to reduce healthcare cost growth.

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Empowering Healthcare Leaders: Forging Insights and Collaborations at the National Medicare, Medicaid, and ACA Marketplace Event

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As new federal priorities unfold鈥攑articularly for Medicare, Medicaid, and the Affordable Care Act (ACA) Marketplace鈥攈ealthcare stakeholders must anticipate and adapt to dramatic changes in funding, regulatory requirements, and technological advancements. 

In light of these shifting tides, you won鈥檛 want to miss 量子资源网 (量子资源网), 8th National Conference, , October 14-16, 2025, in New Orleans, LA. The 量子资源网 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听
  • When the Ground Shifts: Publicly Financed Health Coverage and Policy in Motion听听
  • Where Is Disruption Poised to Make Improvements in Healthcare?听
  • Red, Blue, or Purple:鈥疊uilding Resilient Healthcare Systems to Improve Population Health鈥�

The 量子资源网 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 . 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, . For sponsorship information contact Andrea Maresca, 量子资源网IS Managing Director.   

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