On the Margins — 2026-03-06
On the Margins
Your daily health economics & actuarial brief
Friday, March 06, 2026
What's happening today
| ■ | Clover Health says it is the first payer live on a CMS-aligned interoperability network. |
| ■ | CMS imposed a DMEPOS enrollment moratorium to curb fraud in medical supply billing. |
| ■ | Grow Therapy raised $150 million to expand enterprise deals with physicians and employers. |
Key Stories
Clover says it is first payer live on CMS-aligned network
Clover Health said in a March 4 news release it is the first insurer live on a CMS-aligned network for patient-directed data requests. CMS had labeled other payers "early adopters," but a Clover spokesperson said Clover was the first to fully integrate. In parallel, HHS officials told a Senate subcommittee they are progressing on information-blocking enforcement nearly a decade after Congress banned it. That makes interoperability spend less optional: once members can pull data on demand, plans own the operating cost and the service expectations.
CMS uses DMEPOS enrollment moratorium to squeeze medical supply fraud
CMS flagged a new DMEPOS enforcement move in its March 5, 2026 MLN Connects newsletter: a temporary enrollment moratorium on medical supply companies. The moratorium blocks new Medicare supplier enrollments where applied, a blunt tool CMS uses when it sees elevated fraud risk. For MA and FFS administrators, fewer new supplier NPIs narrows procurement options and can concentrate volume with incumbent vendors. That may cut exposure to "pop-up" billing, but it can also tighten capacity and trigger higher prices or complaints that flow into MLR and quality.
Grow Therapy raises $150M to sell into physicians and employers
Grow Therapy raised $150 million to expand enterprise partnerships with physicians and employers, Fierce Healthcare reported. The company said doctors and employers are newer customer types but have driven its growth focus over the past five years. Grow aims to streamline referrals and care coordination across settings, positioning itself as infrastructure rather than just a therapy marketplace. For payers and employer sponsors, tighter referral plumbing can mean higher behavioral utilization with clearer steerage, shifting PMPM assumptions and network management leverage.
Significant Digit
If Medicaid is paying 85% of a state's "provider tax," that is less financing strategy and more budget Perpetual Motion Machine.
In a CMS proposed rule to close a Medicaid health care-related tax loophole, the agency estimates $23.6B of revenue from 8 approved tax waivers across 7 states in 2024. CMS estimates $20.1B of that (85%) was assessed against Medicaid taxable units even though Medicaid was 48% of the taxable units. That gap is the price tag of "non-federal share" engineering, and CMS is clearly sharpening the scissors.
Other Relevant Headlines
Policy & Regulation
| CMS draws record 47,000 comments on proposed 2027 MA payment rule | Becker's Payer |
| UnitedHealth shrinks SEC subsidiary list to 10 from thousands | Becker's Payer |
| Minnesota 340B windfall: 12% of entities captured over 80% | Fierce Healthcare |
| HAP puts ASR TPA president in charge of broader markets growth | Becker's Payer |
| Report: Most states investing in value-based care via the Rural Health Transformation Program | Fierce Healthcare |
| CMS proposed state directed payment rule under review at OMB | Inside Health Policy |
| Oz pushes catastrophic health plans, which critics call junk insurance | forbes.com |
| Medicaid workers and job-based insurance: who is offered, eligible, and enrolled | KFF |
Pharmacy & Drug Pricing
| A month in, TrumpRx falls short of the president's promises | STAT |
| Optum Rx and Caremark report progress in FTC insulin case settlement talks | Healthcare Dive |
| More telehealth companies warned over advertising compounded GLP-1s as FDA-approved | Inside Health Policy |
Provider Economics
| Mount Sinai and Anthem fail to reach new contract | Healthcare Dive |
ICYMI (Recent Key Stories)
- West Virginia probe hits Express Scripts with $1.5M penalty, pharmacy repayments -- West Virginia regulators fined Express Scripts and ordered repayments to pharmacies after a state probe. (2026-03-05)
- Wakely: Medicaid MCO margins flip to losses as enrollment drops -- A Wakely analysis found Medicaid managed care plans' profits turned to losses amid declining enrollment. (2026-03-04)
- Medicaid dental coverage in three dozen states meets $900B cut threat -- Potential $900B Medicaid cuts could put dental benefits at risk across roughly three dozen states. (2026-03-03)
- OIG flags $285M Colorado Medicaid overpayments for autism ABA therapy -- HHS OIG reported Colorado Medicaid overpaid about $285M for autism ABA therapy services. (2026-03-02)
- KFF: Enhanced ACA subsidies expiring in 2025 hit older enrollees hardest -- KFF said ending enhanced ACA premium tax credits in 2025 would raise costs most for older enrollees. (2026-02-27)