Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

Latest Resources

• Medicare & Medicaid Beneficiaries With Opioid Use Disorder Less Likely to Receive Behavioral Health Treatment 
• CMS Proposes New Medicare Ambulatory Specialty Model To Improve Chronic Disease Management 
• Solving For Access
• ‘Choose Medicare Act’ Introduced To Create ‘Part E’ Opt-In Program For Individuals & Employers 
• Medicare Proposes Cuts In 2026 Aggregate Home Health Payments & Temporary Reductions To Recoup Patient-Driven Groupings Model Overpayments
• Maine Dual Eligible System: An OPEN MINDS State Profile
• Florida Dual Eligible System: An OPEN MINDS State Profile
• 55% Of Behavioral Health Professionals Accepted New Appointments For Medicare Or Medicaid Beneficiaries, With A 30-Day Wait For Many, A Survey States 
• The DSP Talent Challenge
• Choose Medicare Act
• Medicare Home Health Use Among Consumers With Dementia On The Increase
• Nearly Half Of Behavioral Health Professionals Declining New Appointments For Medicare & Medicaid Beneficiaries 
• The 2025 Federal Budget Reconciliation Bill (H.R.1 – One Big Beautiful Bill Act): Implications For The Health & Human Service Field
• Humana’s CenterWell Business Agrees To Acquire The Villages Health In Florida 
• BlueCross BlueShield Of Tennessee Winding Down Shared Health Subsidiary, With Dual Eligible Plans In Mississippi & Texas 

See All

Telehealth Flexibilities Did Not Increase Outpatient Medicare FFS Visit Volume, But Did Result In Lower Post-Visit Costs

After Medicare eased telehealth restrictions during the COVID-19 public health emergency, telehealth visits among fee-for-service (FFS) beneficiaries rose during 2020, but then stabilized in 2021 and beyond. The increased volume of telehealth visits was not associated with an increase in the volume of outpatient evaluation and management (E&M) visits. Telehealth-initiated episodes of care were associated with lower use of lab tests and imaging compared to in-person visits. Telehealth visits were associated with lower 30-day Medicare… Read

• CMS Rescinds EMTALA Guidance On Emergency Abortions 
• Medicare Advantage Capitation Payments To Increase By 7.2% For 2026 
• Medicare Beneficiaries With Psychological Distress Made Fewer Outpatient Mental Health Visits After Age 65, But Used More Acute Care Services 
• Indiana Dual Eligible System: An OPEN MINDS State Profile
• Illinois Dual Eligible System: An OPEN MINDS State Profile

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