�鶹Ů��

Health systems are deploying an often-overlooked resource to combat a potential increase in uninsured patients — community health workers. Health systems hope community health workers can help prevent people from losing insurance coverage due to expiring subsidies for health insurance exchange customers and the new tax law. Providers warn a rush of uninsured people could overwhelm already overcrowded emergency departments and hospitals. (Kacik, 8/18)

The new law passed by Congress gets in the way of Idaho’s plan to tap into one tool to pay providers more for Medicaid services, by capping state-set payment rates. (Pfannenstiel, 8/18)

One hot June night, Carrie and Kristy Madden sat in their modest home on the outskirts of Los Angeles waiting for their caregivers to arrive. Their living area hummed with fans and the patter of a Dodgers baseball game. “What time are they supposed to be here today?” Carrie, 60, asked around 7.“They didn’t say,” Kristy, 64, answered. Muscular dystrophy had afflicted the sisters since birth, weakening the muscles in their trunks, arms and legs. In middle school, each could manage an awkward walk. Now neither could stand for more than a minute. Each woman had worked a full day that Thursday, writing emails, making phone calls and chatting with colleagues. But they needed help with the essentials of domestic living: bathing, dressing, cooking and cleaning. Neither could raise her elbows more than a few inches or drive to get groceries. (Valdes, 8/18)

Elevance Health is integrating its food as medicine program for Medicaid members in community health centers, the insurer announced Monday. In partnership with the National Association of Community Health Centers (NACHC), the company said it will begin training primary provider teams. Now, certain Medicaid members at risk for diet-related chronic conditions can receive personalized nutrition support, a news release said. (Tong, 8/18)

Regulators lifted an enrollment suspension of one of Centene’s Medicare Advantage contracts for the upcoming sign-up season. Last year, the Centers for Medicare and Medicaid Services barred Centene’s Wellcare of Missouri from enrolling new members because the company charged too much in premiums and failed to spend enough on patient care over a three-year period. CMS requires Medicare Advantage insurance companies spend at least 85% of premiums on enrollee claims and tracks insurers’ spending through a metric known as the medical loss ratio. (Tepper, 8/18)

Legal challenges to Medicare Advantage marketing, health insurance exchange regulations and the No Surprises Act are working their way through the courts with major implications for the healthcare sector. Here are some key cases that could change how health insurance companies sell Medicare plans, how insurers and providers resolve out-of-network billing disputes, how consumers sign up for health insurance exchange plans, and how preventive healthcare is covered. (Early, 8/18)