In this update:
- Trump Administration
- Trump Administration Agrees to Restore Public Health Data and Websites in Settlement
- Federal Agencies
- HHS to Step up Enforcement of Information Blocking
- CMS Announces Changes to AHEAD Model
- HHS Issues New Guidance on Catastrophic Coverage
- Nine Former CDC Officials Criticize Kennedy in NYT Essay
- Medicare ACOs saved $2.4B in 2024
- Legislative Update
- House Appropriations Proposes 6% Cut for HHS
- Other Update
- ACHP Releases Analysis of MA Risk Adjustment
- New York State Update
- SPG Releases 2025 NYS Medicaid Policy Primer
Trump Administration
Trump Administration Agrees to Restore Public Health Data and Websites in Court Settlement
On September 2nd, the Trump Administration agreed in a court settlement to restore public health data and related webpages that were removed by HHS on January 31, 2025, in response to President Trump’s executive orders to end federal diversity, equity, and inclusion programs. Deleted data and information came primarily from the CDC, NIH, and FDA websites, on topics like contraception, women’s health, transgender youth, HIV/AIDS, and at-risk youth. In addition, several foundational public health data repositories, such as the CDC’s Pregnancy Risk Assessment Monitoring System database, the Youth Risk Behavior Surveillance System, and PEPFAR data dashboards, were removed from government websites. Under the terms of the settlement, the nine plaintiffs, led by the Washington Medical Society, will withdraw their suit once the information is restored in full (reflecting the same content that was available January 29, 2025).
Federal Agencies
HHS to Step Up Enforcement of Information Blocking
On September 3rd, HHS announced that it will direct additional resources to, and will take an “active enforcement stance” against, health care entities blocking the access, exchange, and use of electronic health information. The announcement does not specify what additional resources might be allocated to the effort, nor does it specify any new or increased penalties for violations. HHS finalized the current penalties for health IT vendors engaging in information blocking in 2023, and the penalties for providers in 2024. These include withholding Medicare payments, imposing fines, and decertifying products. The announcement encourages patients who have experienced information blocking to report the event through HHS’s Report Information Blocking Portal.
More information is available here. The portal to report information blocking is available here.
CMS Announces Changes to AHEAD Model
On September 2nd, CMMI announced new policy and operational changes, as well as a new end date, to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model. The AHEAD Model is a total cost of care (TCOC) model in which a state assumes responsibility for managing health care outcomes, quality, and costs across all payers, including Medicare, Medicaid, and private coverage. Participating states are Maryland (Cohort 1); Connecticut, Vermont, Hawaii (Cohort 2); Rhode Island and Downstate New York/Bronx, Kings, Queens, Richmond, and Westchester Counties (Cohort 3).
Among the slated changes are expanding total cost of care accountability to all Medicare FFS beneficiaries not aligned with other accountable care models, within participating regions. Geographic entities will operate under two-sided risk arrangements, with opportunities for shared savings or losses. Participating states will also be required to implement at least two policies focused on promoting choice and competition in their health care markets, develop a Population Health Accountability Plan to improve preventive care and chronic disease management, and increase transparency around TCOC and primary care investment targets.
Programmatic and operational changes will go into effect for all cohorts in January 2026. In addition, CMMI announced an extension of the AHEAD model to give participating states additional time to implement reforms and demonstrate progress on total cost of care and quality goals. The AHEAD Model will now conclude on Dec. 31, 2035.
The CMMI AHEAD update is available here.
HHS Issues New Guidance on Catastrophic Health Coverage
On September 4th, HHS issued new guidance expanding access to catastrophic health plans in Affordable Care Act (ACA) Marketplaces. Catastrophic plans offer lower premiums than comprehensive health plans, paired with more limited coverage and higher deductibles, though they will cover three pre-deducible primary care visits. The announcement anticipates the expiration of enhanced tax credits at the end of 2025, which are expected to spike consumer premiums by an average of 18%, with wide variation by income level. CBO has projected this will cause about 4 million Americans to lose their coverage. Consumers who become newly ineligible for advanced premium tax credits or cost-sharing reductions will generally be eligible for a hardship exemption, and will be able to apply for catastrophic coverage beginning November 1st.
The CMS fact sheet is available here.
Nine Former CDC Officials Criticize Kennedy in NYT Essay
On September 1st, nine former CDC directors published a guest essay in the New York Times, criticizing HHS Secretary Kennedy for a series of managerial, funding, and political decisions that cumulatively “endanger” the health of every American. The authors’ breadth of experience and politics – having served in Republican and Democratic administrations as far back as 1977 – is presented to buttress their charge that Secretary Kennedy’s management of the CDC “is unacceptable, and it should alarm every American, regardless of political leanings.” They call on Congress to exercise its authority over HHS, and urge all stakeholders to take action to protect the health of Americans.
Among the actions cited as evidence of Secretary Kennedy’s mismanagement of the CDC, the authors include the firing of critical federal experts and program management staff, canceling investments in medical research, removing qualified experts from federal health advisory panels, weakening public access to vaccines, circulating inaccurate information about vaccine efficacy, and – most recently – the abrupt firing of CDC Director Dr. Susan Monarez.
The guest essay is available here.
Medicare ACOs Saved $2.4B in 2024
On August 28th, CMS announced Medicare’s Shared Savings Program ACO results for performance year (PY) 2024, noting it was the highest rate of shared savings since the inception of the program. Out of 476 participating ACOs, 75% earned performance payments totaling $4.1B for PY24, generating $2.4B in Medicare savings compared to benchmarks. These ACOs delivered care to 10.3M assigned Medicare beneficiaries, representing 80% of total enrollees in the MSSP program.
CMS’ Fact Sheet summarizes several financial and quality highlights from this year’s data. Of note, ACOs had higher net and gross per capita savings in PY24 compared to the previous year’s performance. Net per capita savings ($241 PY24, a $34 increase) represent Medicare-only savings, while gross per capita savings ($643 PY24, a $128 increase) represent the amount shared by ACOs and Medicare. Sixteen ACOs owed shared losses totaling $20.3 million. ACOs also posted strong quality performance along multiple indicators, including controlled blood pressure, hemoglobin A1c control, and depression screening with a follow-up plan, compared to 2023.
The CMS Fact Sheet is available here.
Legislative Update
House Appropriations Proposes 6% Cut for HHS
On September 2nd, the House Appropriations subcommittee on Labor-HHS (L-HHS) met to mark up and approve their budget bill for FY26, which proposes a 6% cut ($7B) across HHS for a total proposed FY26 operating budget of $108B. The bill includes a 19% cut to the CDC and moves to eliminate the Agency for Healthcare Research and Quality (AHRQ), deeming it to be “duplicative.” New funding is proposed for the Make America Healthy Again (MAHA) initiative, allocating $100M to support investments in prevention and innovation programs for rural communities, telehealth resources for chronic care, and nutrition services.
Other proposed appropriations include:
- $48M to NIH for biomedical research
- $3B to the Administration for Strategic Preparedness and Response
- $515M for rural health, specifically maintaining hospital and physician access
- $1.85B for community health centers and other primary care services
- $1.36B for health care workforce development and placement in underserved areas
A summary of the full L-HHS proposed budget can be found here.
Other Update
ACHP Releases Analysis on MA Risk Adjustment
On September 3rd, the Alliance of Community Health Plans (ACHP) released a new analysis of federal Medicare Advantage (MA) risk adjustment payments. The analysis shows that the largest national MA insurer collected up to $785 more per beneficiary than local, nonprofit plans in 2023, at a total federal cost of $6 billion. The two largest MA plans had average risk scores that were 19.3% and 36.2% higher than ACHP nonprofit health plans. ACHP concludes that the difference is the result of “coders capitalizing on the complexities in the program for financial gain” and recommends a new framework focused on “demographics and a small set of substantiated health conditions…ensuring Medicare payments reflect true patient care costs.”
More information is available here.
New York State Updates
SPG Releases 2025 NYS Medicaid Policy Primer
SPG has updated its NYS Medicaid Policy Primer document (previously “Glossary of New York Medicaid Policy”) for 2025. The document provides a comprehensive overview of the major components of New York’s Medicaid system, including but not limited to Medicaid reform, managed care, behavioral health, long-term care, and payment initiatives.
The 2025 NYS Medicaid Policy Primer is available here. As always, please reach out to SPG with any questions.