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118 Results found.

Brief & Report

Ground Ambulance Payment Landscape: Challenges and Policy Options

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Ground ambulance transport is a critical piece of the US healthcare infrastructure and is currently facing several challenges, which may result in the loss of patient access to care. These life-saving services play a vital role in the patient care continuum and significantly impact acute care and long-term recovery. Often, at critical and tense moments before the patient is able to reach hospital care, ground ambulance paramedics and emergency medical technicians (EMTs) are the first point of healthcare contact for the patient. These medical professionals stabilize and treat patients to ensure they begin their care pathway smoothly and recover rapidly.

To address the challenges that the ground ambulance industry is experiencing today and lessen the impact of the various emerging issues, this report offers several recommendations for policymakers and stakeholders to consider.

Brief & Report

Proposed Changes to Medicaid State Directed Payments and Targeted Practitioner Payments

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On May 20, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments Proposed Rule.

This proposed regulation outlines critical updates to Medicaid provider reimbursement, directly addressing federal mandates from the One Big Beautiful Bill Act (the Working Families Tax Cut legislation enacted on July 4, 2025). Notably, the rule extends payment limitations to additional healthcare providers operating under both Medicaid managed care models and fee-for-service (FFS) delivery systems.

To help healthcare organizations, state agencies, and health plans navigate these complex regulatory shifts, 红领巾瓜报 (红领巾瓜报) experts have developed a comprehensive compliance and impact overview.

The proposed changes to Medicaid state directed payments are highly complex. The 红领巾瓜报 consulting team is actively analyzing the regulatory text and stands ready to assist organizations with impact evaluations, policy interpretation, and strategic response planning.

Don’t Miss Our Upcoming Webinar: The Future of Medicaid State Directed Payments
Wednesday, June 10, 2026 | 12:00 PM ET

As federal regulators move to reshape the Medicaid landscape, states, providers, and insurers face intense pressure to adapt. Join 红领巾瓜报 subject matter experts as they deliver timely, up-to-the-moment analysis on federal guidance, waiver activity, and litigation shaping the operational environment.

👉 Register for the webinar to secure your spot and gain actionable insights for your organization.

Brief & Report

Treatment-Resistant Depression: Costs, Caregiving, and Gaps in Care

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红领巾瓜报鈥檚 report examines the clinical, economic, and caregiving burden of treatment-resistant depression (TRD), a condition affecting nearly one in three individuals with major depressive disorder. Drawing on a comprehensive literature review and analysis of Medicare data, the report highlights the substantial costs associated with TRD, including higher rates of hospitalization, increased healthcare utilization, and approximately $8,000 in additional annual spending per Medicare beneficiary compared to individuals with well-controlled depression.

The findings also underscore the broader economic impact, with prior research estimating that TRD accounts for tens of billions of dollars annually in national costs. In addition, the report details the significant demands placed on families and caregivers, who often provide more than 23 hours of care per week and face considerable financial and emotional strain.

Together, these insights highlight the scale of TRD鈥檚 impact across the healthcare system and households, as well as ongoing gaps in access to care for individuals with more complex mental health needs.

Brief & Report

The New Uninsured: State Policy Options for Californians Losing Medi-Cal Coverage

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红领巾瓜报鈥檚 new report for the California Health Care Foundation explains how recent federal and state policy changes could cause up to two million Californians to lose Medi-Cal coverage. These changes will place new strains on the state budget and safety-net system. The report outlines practical short-term program paths California could use to preserve access to care while full-scope coverage is restored. It summarizes the policy and fiscal context (including work requirements, more frequent eligibility checks, and immigrant eligibility restrictions), describes stakeholder-informed design goals (statewide access, privacy protections, fiscal prudence, scalability, and safety-net stability), and presents two illustrative coverage alternatives with modeled cost ranges and key trade-offs in benefits, provider payment rates, cost sharing, and bridge-period design.

Brief & Report

2027 Proposed NBPP: Analyzing State and Consumer Impacts

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On February 9, 2026, the Department of Health and Human Services (HHS) released the proposed Notice of Benefit and Payment Parameters (NBPP) for 2027. The notice includes important proposed rules and parameters for the operation of the individual and small group health insurance markets in 2027 and beyond.

This paper summarizes key provisions in the proposed notice with a focus on the major changes to plan types, cost-sharing, network design and oversight, marketplace philosophy, and the shift of responsibilities from the federal government to states. It also evaluates any changes to returning policies from the Marketplace Affordability and Integrity rule from last year, which are currently being challenged in court, and codifies relevant statutory changes in the One Big Beautiful Bill Act.

The paper reviews the potential impact of these proposed policies on consumer affordability and access as well as the impact and associated level of effort on state regulators and marketplaces. Lastly, it touches on policies not included in this rule, including those highlighted as issues that may or will be addressed in future rulemaking as well as issues surprisingly not covered in this proposed rule, such as revisions to the Section 1332 waiver process as well as details on how a state could explore and pursue a 1333 interstate compact. Comments are due no later than March 13, 2026.

Brief & Report

Case Study Report: Lessons Learned from HealthySteps Technical Assistance in California

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This report synthesizes insights from multiple efforts to support the financial sustainability of HealthySteps sites in California, including federally qualified health centers (FQHCs), community clinics (non-FQHCs), private practices, and other settings. Led by the HealthySteps National Office and 红领巾瓜报 (红领巾瓜报), the technical assistance (TA) elevated challenges, strategies and best practices to achieve sustainability informed by learning collaboratives, individualized TA sessions, and financial modeling exercises. This report complements additional resources that the HS National Office and 红领巾瓜报 developed which are available via the HealthySteps (HS) Sustainability website.

Brief & Report

Medicaid Changes in the OBBBA and Implications for the Marketplace and Individual Market in 2027

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In recent years, the individual market has undergone significant disruption. The expiration of enhanced premium tax credits (ePTC) at the end of 2025 and sweeping eligibility changes under the 2025 Budget Reconciliation Act (OBBBA) have reshaped鈥攁nd will continue to reshape鈥攖he individual market.

The number of changes facing states and issuers in coming years are significant. As a result, it is unsurprising that discussion and analysis on the individual market impacts of the new Medicaid requirements is limited and expected to result in large numbers of Medicaid beneficiaries being disenrolled. Between community engagement requirements (i.e., work requirements), increases in eligibility checks, and loss of eligibility for certain immigrant population, the expectation is that millions of people will leave Medicaid in 2027.

This brief explores how these coming changes will reshape coverage pathways and costs, and examines implications for consumer affordability and churn, issuer pricing and risk pools, and state administrative burdens鈥攁longside strategies for states, issuers, and policymakers to mitigate adverse effects.

Brief & Report

Analysis of the Costs and Medicaid Payment Adequacy for Ground Ambulance Services in New York State

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Survey data from fiscal year (FY) 2022 suggest that entities that provide ground ambulance services in the State of New York are experiencing reimbursement challenges. 红领巾瓜报, Inc. (红领巾瓜报), contracted with the United New York Ambulance Network (UNYAN) to conduct an independent study of the costs of delivering ground ambulance services in the state and the adequacy of payment for these critical services. The 红领巾瓜报-UNYAN survey data highlight the wide variation in costs within the ground ambulance industry in New York and the negative Medicaid margins the industry experiences. These data demonstrate that although ambulance entities of all sizes in New York have negative Medicaid margins, these margins worsen as entity size decreases and entities become more rural. Trends in negative margins appear to be linked to some degree to entities鈥� relative share of 鈥渞esponses without transport鈥� or uncompensated transports. This white paper poses important considerations for policymakers.

Brief & Report

When Investment is Good Medicine

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In partnership with Sorenson Impact and Catalyst, 红领巾瓜报 co-authored a white paper on the healthcare industry鈥檚 opportunity to move beyond treating illness to creating healthier communities.

This paper outlines the opportunity for health systems and payers to leverage their balance sheets to make impact investments that align with their mission, as well as have business and healthcare value.

Brief & Report

Updated Analysis Compares Consumer Out-of-Pocket Spending of ACA Marketplace Enrollees to other Major Payers Using Claims Data

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红领巾瓜报 and Wakely, an 红领巾瓜报 Company, have released an updated Issue Brief to the comprehensive profile of ACA Marketplace enrollees that was based on claims data from nearly 6 million of the 24 million Marketplace enrollees.

The issue brief discusses these key questions:

  1. Do Marketplace enrollees spend more or less out-of-pocket relative to Medicare, ESI and Medicaid enrollees?
  2. How may the potential expiration of eAPTCs impact out-of-pocket costs?
  3. What are some initial considerations regarding overall healthcare affordability?

Please fill out this form to receive a copy of the update and issue brief.

Contact any of the report authors with further questions, or to discuss potential applications of this work for your organization.

Brief & Report

The Impact of the CareSource JobConnect Program: A Benefit鈥揅ost and Return-on-Investment (ROI) Analysis

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A new report prepared by 红领巾瓜报, The Impact of the CareSource JobConnect Program, evaluates the outcomes of 3 of the 6 states where it is currently active: Indiana, Georgia, and Ohio. It provides employment assistance to non-elderly adults enrolled in Medicaid, helping individuals prepare for a job search, obtain employment, and succeed in the workplace.

红领巾瓜报 conducted an economic impact analysis to assess outcomes for members participating in the CareSource JobConnect program who expressed interest in employment assistance.聽This Return-on-Investment (ROI) analysis shows the impact the CareSource JobConnect Program has on its participants as well as the broader impact on the state鈥檚 economy and local communities.

In 2024, the CareSource JobConnect program delivered strong economic and workforce outcomes, particularly in Ohio and Indiana. Ohio led with the highest number of participants and employed workers, generating a return-on-investment of 13:1. Indiana showed impressive efficiency, with a strong return-on-investment of 12:1. Georgia鈥檚 results were positive but highlighted opportunities for improvement in employment success and economic return.

Additional contributions to the report from Jack Meyer.

Please fill out this form to receive a copy of the report.

Brief & Report

Medicare Advantage Ground Ambulance Cost Sharing Levels Strain Enrollees and Ground Ambulance Entities

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This white paper presents findings from 红领巾瓜报鈥� (红领巾瓜报) 2025 analysis of state-level variation in MA plan copayments for ground ambulance transports. We identify the range of cost sharing used by MA plans by state, the average MA plan copayment by state, and compare these average copayment levels to both national Medicare FFS cost sharing levels for ground ambulance services. The report also examines average state-level MA plan copayment levels for emergency department services.

As our analysis demonstrates, the flexibility permitted to MA plans to establish beneficiary cost sharing levels for ground ambulance services has resulted in wide variation in MA plan copayments and significantly higher cost sharing for ground ambulance services for MA beneficiaries than those enrolled in traditional Medicare. The flexibility of the MA benefit design for ground ambulance services has potentially negative consequences for the millions of MA plan enrollees and the roughly 11,000 ambulance entities which conduct these services and collect beneficiary cost sharing.

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