Oregon’s 16 Medicaid Coordinated Care Organizations (CCOs) had mixed financial results during 2024, according to an analysis by the Oregon Health Authority (OHA). Nine of the CCOs operated at a profit, and seven operated at a loss. Profit margins ranged from 9.56% to a negative margin of -5.31%. Across all 16 CCOs, the net operating…

U.S. employers project that their health care costs will increase by 9.1% in 2026, which is a higher pace than the previous two years, when increases were 8.1% in 2025 and 7.0% in 2024, according to a new survey by WTW, which provides data-driven, insight-led solutions and specializes in the areas of people, risk, and…

Nevada has become the third state to launch a public health insurance option, after Washington and Colorado, with the rollout of the Battle Born State Plans (BBSPs) administered by three of the state’s Medicaid managed care plans. BBSPs were designed as a public option to improve access and affordability, according to the Final Nevada 1332 Waiver…

New legislation in California, signed on October 6, 2025, directs health plans and health insurers to phase out prior authorization for health care services with approval rates of 90% or higher by January 1, 2028. The legislation is supported by the California Medical Association (CMA). The goal is to reduce the administrative burden on health…

Centauri Health Solutions (Centauri), a Phoenix, Arizona-based health information technology company, announced the launch of Member Insights—a comprehensive, member-centric solution designed to address the financial, social, and clinical needs of dual-eligible Medicare Advantage members who are enrolled in both Medicare and Medicaid. Member Insights combines personalized outreach with Centauri’s proprietary technology to improve care coordination,…

Pear Suite, a digital health company empowering community health workers (CHWs), announced that it has raised $7.6 million in Series A funding to advance the development of its artificial intelligence (AI)-powered platform, fuel its provider organization network growth, and expand its impact through new Medicaid and Medicare health plan contracts. Pear Suite helps health plans…

Epicured Inc., a “food-is-medicine” organization dedicated to combating and preventing chronic disease, announced a partnership with Fallon Health, which offers the Program of All-Inclusive Care for the Elderly (PACE)—a comprehensive, community-based model of care that helps older adults remain independent and in their homes for as long as possible. Together, they provide Medically Tailored Meals…

The Delaware Division of Substance Abuse and Mental Health (DSAMH), in partnership with Bamboo Health, announced the rollout of the Delaware Treatment and Referral Network 360 (DTRN360) behavioral health care coordination platform, which is designed to connect provider organizations, improve care transitions, and reduce silos across the behavioral health system. DTRN360 is the result of…

The Centers for Medicare & Medicaid Services (CMS) issued guidance explaining its updated interpretation of when states can claim federal financial participation (FFP), or matching funds, for emergency Medicaid-covered services provided to immigrants who are ineligible for full benefits. Under its new interpretation of section 1903(v) of the Social Security Act, CMS stated its intention…