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October 4, 2026

Takeaways from the most recent news in the technology and policies shaping healthcare.

Payers

Medicaid's Rocky Summer: 6 States Signal What Comes Next

More than a year after the passage of HR 1, Medicaid remains in flux, and the changes ahead are starting to feel concrete. According to Becker's Hospital Review, the run-up to 2027 brings more frequent eligibility checks and work requirements, two shifts that could push large numbers of enrollees off the rolls and reshape how states, insurers, and hospitals plan.

Becker's flags six states as bellwethers for the national picture, where policy changes, fraud concerns, and insurer strategies are colliding. How these states handle redeterminations and administrative burden will offer an early read on coverage losses and the downstream hit to provider revenue.

For hospitals, the practical stakes are clear: more eligibility churn means more uninsured patients, higher uncompensated care, and tighter margins. For insurers with Medicaid managed care books, the moves will test enrollment forecasts and risk. Executives should watch these states closely, because their outcomes will preview the pressures spreading across the system through 2027.

More in Payers

Payers

7 Health System Insurers to Exit Medicare Advantage in 2027

Seven health system-owned insurers are among 11 health plans exiting the individual Medicare Advantage market in 2027, with several others narrowing to special needs plans only.

Why it matters: The exits signal that even provider-owned plans are struggling with Medicare Advantage economics, forcing seniors to find new coverage.

Payers

CMS Projects Lower MA Premiums, Flat Enrollment for 2027

CMS projects lower average Medicare Advantage premiums and flat enrollment of 34 million for 2027, a figure that already trails current membership of 36.1 million.

Why it matters: Medicare Advantage now covers nearly half of all Medicare enrollees, so its premium and growth trajectory shapes revenue for insurers, providers, and the federal budget.

Payers

PBMs Become Rare Bipartisan Target in Washington and States

A bipartisan push in Congress and statehouses aims to rein in pharmacy benefit managers, including proposals to force CVS and rivals to split their PBM and pharmacy businesses.

Why it matters: PBMs sit at the center of US drug pricing, and forced divestiture would upend the business models of the largest healthcare conglomerates.