Payer
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5th Circuit strikes down No Surprises billing benchmark in win for providers
The court ruled Tuesday that insurers can’t include ghost rates or exclude bonus payments in calculating a metric used to determine reimbursement for out-of-network bills. That’s set to further inflate payouts to providers.
By Rebecca Pifer Parduhn • Aug. 13, 2026 -
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‘Way off the reservation’: Brookings researchers slam assumptions in CMS work requirements rule
The rule made it harder for sick Medicaid enrollees to prove they’re exempt from work requirements than many expected. The CMS got sued. And now, the agency is being accused of fudging the data at the center of the rule.
By Rebecca Pifer Parduhn • Aug. 12, 2026 -
Explore the Trendline➔
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TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
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Humana taps ex-Johns Hopkins exec as Medicaid leader
James “J.P.” Holland is taking the reins of Humana’s Medicaid business, a key growth area for the company, starting this coming Monday. It’s part of a broader leadership transition announced late last year.
By Rebecca Pifer Parduhn • Aug. 11, 2026 -
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Insurers want to hike small businesses’ premiums by 14% next year: KFF
It’s becoming harder for small employers to offer insurance coverage, and another year of double-digit premium increases won’t help. Insurers say their hands are tied.
By Rebecca Pifer Parduhn • Aug. 7, 2026 -
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Complete Health to pay $14M to settle Medicare Advantage fraud allegations
The value-based primary care provider submitted false diagnosis codes to the CMS for three years, inflating its reimbursement by millions of dollars, according to the DOJ.
By Rebecca Pifer Parduhn • Aug. 5, 2026 -
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Sentara moves to end Anthem contracts in Virginia
Nearly 380,000 patients could go out of network with the health system if the commercial, Medicare and Medicaid contracts lapse.
By Sy Mukherjee • Aug. 5, 2026 -
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CVS triples net income thanks to booming health plan profitability
“There’s not much more to say for CVS’ 2Q other than... wow,” one analyst commented. CVS also announced a new GLP-1 deal with Eli Lilly.
By Rebecca Pifer Parduhn • Aug. 5, 2026 -
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Hospitals feel the pinch as more patients lose insurance
Half a year after enhanced Affordable Care Act subsidies expired, hospitals say more patients are going uninsured. That’s starting to drag their finances.
By Sydney Halleman • Aug. 4, 2026 -
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Sponsored by Advanced Medical Pricing Solutions (AMPS)Out-of-Network claims are costing you more than you think
88% of IDR disputes go to providers. See how health plans can fix OON claims first.
By Mark Noel, SVP & GM, AMPS ClaimInsight • Aug. 3, 2026 -
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Trump administration tries again to institute rebates in 340B
The Trump administration is again pushing to include rebates in the drug discount program after a failed attempt earlier this year. Hospitals railed against the announcement, saying it would burden already strapped providers.
By Sydney Halleman • July 31, 2026 -
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Judge rejects states’ bid to pause Medicaid work requirements
A federal judge last week said he wasn’t convinced that regulation detailing work requirements would cause irreparable harm to states. Still, the court will continue to hear the case.
By Emily Olsen • July 31, 2026 -
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Cigna’s profits jump thanks to employer-sponsored plans
Cigna increased its 2026 earnings outlook following the second quarter, unbothered by inflated costs for surprise billing dispute resolutions reported by its peer UnitedHealth.
By Rebecca Pifer Parduhn • July 30, 2026 -
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CMS to end subsidies for Medicare drug plan premiums
The CMS said the program, which went into effect last year to stabilize Part D premiums and enrollment, isn’t needed anymore. Some enrollees could see higher premium increases in 2027 as a result, according to one researcher.
By Emily Olsen • July 29, 2026 -
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ICHRA adoption slowed by ACA exchange costs, instability
Many employers are considering the coverage arrangements, but worries about the ACA marketplaces — including potentially high costs for workers — are making them hesitant to move forward, according to a survey.
By Emily Olsen • July 29, 2026 -
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Humana to exit more Medicare Advantage plans in 2027
The insurer is laser-focused on reaching margin targets, and will sacrifice some plans with lower returns next year to do so, CFO Celeste Mellet said.
By Rebecca Pifer Parduhn • July 29, 2026 -
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‘Back on track’: Centene swings to more than $1B in profit in Q2
The managed care giant raised its 2026 earnings outlook for the second time this year following the results, which its CFO called “fantastic.”
By Rebecca Pifer Parduhn • July 28, 2026 -
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Included Health to acquire Firefly Health
Included is hoping that Firefly’s offerings will help set it apart in a crowded employee benefits space, especially as employers become increasingly open to alternative health plan arrangements.
By Rebecca Pifer Parduhn • July 28, 2026 -
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HHS appeals invalidation of 2025 ACA rule
The Trump administration is fighting to restore controversial provisions that a judge threw out last month, including shorter sign-up windows and heightened eligibility verification.
By Rebecca Pifer Parduhn • July 24, 2026 -
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Molina plans additional ACA cuts in 2027
Molina’s second quarter was complicated, with stability in Medicaid and outperformance in Medicare Advantage overshadowed by problems in the ACA exchanges. The trend was “unfortunate,” according to the insurer’s CEO.
By Rebecca Pifer Parduhn • July 23, 2026 -
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No Surprises disputes continue to swell, CMS finds
Providers and payers initiated 16% more disputes in the second half of 2025 compared with the first half, according to new federal data. But arbiters are closing challenges more quickly and tackling a backlog of disputes.
By Emily Olsen • July 23, 2026 -
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CMS appeals Clover MA stars lawsuit
Last week’s appeal is the latest development in Clover’s legal saga to get the CMS to recalculate its Medicare Advantage star ratings.
By Sydney Halleman • Updated July 24, 2026 -
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Labor Department proposes rule expanding disclosure e-delivery for employer plans
The rule pitched Wednesday would make it easier for group health plans regulated by ERISA to share mandatory notices with their members. A DOL official called the proposal a “big step forward.”
By Rebecca Pifer Parduhn • July 22, 2026 -
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1 in 4 workers stay in unwanted jobs for health coverage, survey finds
More Americans are keeping jobs they would otherwise leave for fear of losing their insurance, as healthcare costs rise and non-employer coverage seems less affordable, according to a new poll.
By Emily Olsen • July 22, 2026 -
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CMS moves to codify limits on Medicaid provider taxes
The new proposed rule is meant to prevent states from guaranteeing providers will be refunded for their taxes, and should save Washington $246 billion over the next decade, regulators said.
By Rebecca Pifer Parduhn • July 22, 2026 -
Rebecca Pifer Parduhn/Healthcare Dive
Trump administration pauses $1B in Medicaid payments to California, Minnesota
The HHS halted more Medicaid funding to the states on Tuesday, citing concerns about fraud. Critics have slammed the “attack first, ask questions later” strategy of the deferrals, which have only impacted blue states to date.
By Rebecca Pifer Parduhn • July 21, 2026
