May 21, 2026
CMS Proposal Pushes DPP Restrictions but Near-Term Impacts on Hospitals, Nursing Homes Still Limited Due to Grandfathering
CMS’s long-awaited proposed rule implementing the One Big Beautiful Bill’s (OBBB) restrictions on state directed payment programs (DPPs) pushes the envelope a bit further than the statute itself, particularly for hospitals [HCA, THC, CYH, UHS,…
May 18, 2026
Hospitals: Latest CMS Batch of Approved Hospital-Specific DPPs [HCA, CYH, THC]
Two long-anticipated hospital-specific Medicaid state directed payment programs (DPPs) in Florida and Indiana, benefitting HCA, CYH, and THC and other hospitals in those states, appear to have been approved by CMS in recent weeks, according…
May 1, 2026
Medicaid Work Requirements: Despite Certain Restrictive Actions, Overall State Flexibility Likely Limits Risk [CNC, MOH, HCA, THC, UHS]
A wave of state actions (AR, IA, ID, IN, MO, MT, NC, NE, NH) on Medicaid community engagement requirements (aka work requirements), spanning both accelerated implementation like today’s launch in NE and in some cases,…
April 12, 2026
Inpatient Hospitals: Slight Medicare Growth for FY27, But Future Holds Mandatory Bundles and Less Automatic Bonuses for New Tech [HCA, THC, CYH, ENSG, PACS, PNTG]
FY27 Medicare reimbursement proposals for inpatient hospitals [HCA, THC, CYH, ARDT, UHS, MPT, muni-backed systems] largely met expectations for a smaller increase, versus FY26, with most changes appearing formulaic and math-based rather than policy-led. Despite…
April 5, 2026
SNFs, IRFs, IPFs: Proposed Increases in Range, But Future Risks Medicare Lurk for SNFs and IRFs [ENSG, PACS, SBRA, OHI, LTC, CTRE, EHC, SEM, UHS, ACHC]
FY27 Medicare reimbursement proposals for skilled nursing facilities [ENSG, PACS] and related REITs [SBRA, OHI, LTC, CTRE], inpatient rehab facilities (IRFs) [EHC, SEM, Kindred]and inpatient psych facilities (IPFs) [UHS, ACHC] were broadly in-line with our…
March 12, 2026
Hospitals: Latest CMS Batch of Approved Hospital-Specific DPPs [HCA, THC, UHS]
CMS’s latest approvals for hospital-specific Medicaid state directed payment programs (DPPs) provide incremental positive news for HCA, THC and UHS due to their footprint in certain states (Georgia, Michigan, Kentucky, and Nevada) where CMS recently…
February 23, 2026
Hospital DPPs: Less Dependable, Though Still Relevant Post-OBBB: Questions of Where and How Much Remain? [HCA, THC, CYH, ARDT, UHS, MPT, SGRY, govt hospitals]
While Medicaid funding from state directed payment programs (DPPs) cannot be relied upon as much a key revenue driver – and has received less attention on recent earnings calls – these incremental dollars are still…
January 13, 2026
ACA Subsidy Deal Delayed, Not Derailed; 55% Odds Still Intact [OSCR, CNC, THC, CYH, DVA, FRE.DE]
Despite reports this afternoon that a bipartisan compromise on enhanced Obamacare premium subsidies will not be ready this week and is now expected to slip to the week of January 26, we continue to expect…
December 17, 2025
Obamacare Subsidy Developments: Lots of Movement but Still in Same Place for Now; Path Remains for Subsidy Deal in 1Q
Today’s news that four House Republicans joining House Minority Leader Hakeem Jeffries’ (D-NY) discharge petition for a straight three-year extension of the enhanced Obamacare subsidies – and with House GOP leadership narrowly passing its own…
December 4, 2025
ACA Situation Stuck in Place but We Remain Optimistic of Eventual HIX Deal with a Slipping Timeline
The recent fits-and-starts for around a compromise to avert expiration of the ACA enhanced premium tax credits (eAPTCs) at year-end unsurprisingly remains stalled, with no meaningful concessions from either side’s leaders. As we head into…