HMA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.
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2027 Proposed NBPP: Analyzing State and Consumer Impacts
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.
Case Study Report: Lessons Learned from HealthySteps Technical Assistance in California
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 黑料网 (HMA), 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 HMA developed which are available via the HealthySteps (HS) Sustainability website.
Medicaid Changes in the OBBBA and Implications for the Marketplace and Individual Market in 2027
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.
Analysis of the Costs and Medicaid Payment Adequacy for Ground Ambulance Services in New York State
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. 黑料网, Inc. (HMA), 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 HMA-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.
When Investment is Good Medicine
In partnership with Sorenson Impact and Catalyst, 黑料网 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.
Updated Analysis Compares Consumer Out-of-Pocket Spending of ACA Marketplace Enrollees to other Major Payers Using Claims Data
HMA and Wakely, an HMA 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:
- Do Marketplace enrollees spend more or less out-of-pocket relative to Medicare, ESI and Medicaid enrollees?
- How may the potential expiration of eAPTCs impact out-of-pocket costs?
- 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.
The Impact of the CareSource JobConnect Program: A Benefit鈥揅ost and Return-on-Investment (ROI) Analysis
A new report prepared by HMA, 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.
HMA 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.
Medicare Advantage Ground Ambulance Cost Sharing Levels Strain Enrollees and Ground Ambulance Entities
This white paper presents findings from 黑料网鈥� (HMA) 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.
Complexity for the 2026 Marketplace Open Enrollment: Risks of Consumer Confusion & Coverage Loss
The upcoming 2026 open enrollment period for the Affordable Care Act (ACA) marketplaces is likely to be one of the most complex since the program鈥檚 implementation. Recent federal policy changes, ongoing litigation, and uncertainty around the extension of enhanced premium tax credits (ePTCs) are converging to create significant challenges for federal and state regulators, policymakers, and issuers. Rising premiums, expiring subsidies, and shifting federal regulations also have created an environment of significant uncertainty for consumers, navigators and brokers.
In this report, Complexity for the 2026 Marketplace Open Enrollment: Risks of Consumer Confusion & Coverage Loss, authored by 黑料网 (HMA) and Wakely, an HMA Company, with support from the Robert Wood Johnson Foundation, explains these changes and their collective effect on costs and consumer experiences.
HMA and Wakely experts preview the analysis and the options policymakers, states, regulators, issuers, consumer advocates, and enrollment assisters, and other stakeholders can plan for to mitigate this confusion and coverage losses.
Coding, Coverage, and Reimbursement: Considerations for Women’s Health Access
Persistent gaps in women’s health research, funding, clinical outcomes and access are increasingly well-studied, however less emphasis is placed on the role of coding, coverage, and reimbursement and whether male or female gaps exist in each of these key market access domains. The paper, Coding, Coverage and Reimbursement: Considerations for Women鈥檚 Health Access, examines challenges in these areas and offers recommendations to increase awareness, establish evaluative processes, and collaborative action to achieve incremental policy changes that can have a significant impact over time.
Finding a Path to Support Aging in Place in California聽
New HMA report discusses the unmet needs of older adults in low-income housing, highlighting the challenges of siloed programs and the difficulty in blending services
Research consistently shows that more than 70 percent of Americans want to age in place, remaining in their own homes. Yet the country鈥檚 shifting demographics, rising costs for long-term services and supports, and changing financing landscape make achieving this goal more challenging than ever, especially for low-income older adults. In fact, more than one-quarter million older Californians live in senior affordable housing developments that range in size from a few dozen apartments to over a thousand units in large high rises. Most striking was the finding that while many of these residents are not only low-income and disproportionately burdened with chronic disease and also dually eligible for Medicaid and Medicare鈥攁 group shown in countless studies to represent a considerable proportion of Medicare and Medicaid costs, but that few residents appear to participate in aligned Medicare and Medicaid special needs plans (D-SNPs) or to access Medi-Cal waiver services.
The report gathers direct input from older adults, including Asian populations, in eight languages, addresses critical funding gaps, and identifies policy priorities that if implemented offer innovative recommendations for California to reduce duplication and better serve older adults using current resources.