On the Margins -- Apr 02: Medicaid immigration rechecks find few ineligi...
On the Margins
Your daily health economics & actuarial brief
Thursday, April 02, 2026
What's happening today
| ■ | Medicaid immigration reverification found few ineligible enrollees after seven months. |
| ■ | CMS opened LEAD applications for a 10-year ACO model that lets some participants keep up to 100% of savings. |
| ■ | CMS gave Elevance until May 30 to fix Medicare Advantage risk-adjustment reporting and avoid sanctions. |
| ■ | A judge let Elevance's New York ghost-network lawsuit move forward over mental health directories. |
Key Stories
Medicaid immigration rechecks find few ineligible enrollees
Federal officials told states to reverify the immigration status of hundreds of thousands of Medicaid enrollees. Seven months in, findings from five states showed few immigrants without legal status were receiving benefits improperly. For states and Medicaid plans, that suggests plenty of administrative cost and churn before any material claims savings appear.
CMS opens LEAD applications for decade-long ACO model
CMS released applications on March 31 for the Long-term Enhanced ACO Design, or LEAD, model. The test runs from Jan. 1, 2027, through Dec. 31, 2036, and Becker's said participating ACOs can keep up to 100% of savings under some risk-sharing options. For ACO finance teams, a 10-year runway can make longer-payback care redesign bets pencil out.
CMS gives Elevance until May 30 to avert MA sanctions
CMS extended Elevance Health's Medicare Advantage sanction deadline to May 30 from March 31 while the insurer works to correct risk-adjustment data reporting. Becker's said some plans were exempted, and Healthcare Dive reported Elevance had faced severe sanctions if the faulty submissions were not fixed. The extension matters because enrollment sanctions would stall new sales and premium growth, at least for now.
Elevance ghost-network suit survives in New York
A class action against Anthem Blue Cross Blue Shield of New York and Carelon Behavioral Health can move forward. Plaintiffs allege the plans' mental health directories functioned as ghost networks, making it hard for members to obtain care. For payers, the exposure runs beyond legal fees to directory cleanup, network adequacy scrutiny, and potentially more out-of-network claims.
Significant Digit
CMS says one boring-sounding claims-attachments rule could strip roughly $781 million a year out of healthcare administration.
CMS finalized national standards for electronic claims attachments and e-signatures, replacing the fax-and-mail workflow that has somehow survived in modern healthcare. For payers and providers, that means lower admin cost per claim, faster adjudication, and less staff time spent chasing records. In a system that treats medical trend like destiny, this is a reminder that paperwork still has a very large P&L.
Other Relevant Headlines
Pharmacy & Drug Pricing
| Eli Lilly's obesity pill approved by FDA, setting up fierce competition with Novo Nordisk | STAT |
| Trump administration prepares 100% tariffs on some imported drugs | STAT |
| Express Scripts-FTC deal making matters worse, pharmacies say | Modern Healthcare |
Payer Operations
| Louisiana's Medicaid contract with UnitedHealthcare ends | Becker's Payer |
Provider Economics
| Over 130 hospitals sue HHS over DSH payments | Healthcare Dive |
ICYMI (Recent Key Stories)
- States pay Deloitte, Optum to cut Medicaid rolls -- States are hiring contractors to help review eligibility and reduce Medicaid enrollment. (2026-04-01)
- Alabama bans breast imaging cost-sharing in 2027 -- A new Alabama law will require breast imaging services to be covered without patient cost-sharing. (2026-03-31)
- AHIP sells affordability through chronic-condition management -- AHIP is promoting chronic disease management as a way to lower healthcare costs. (2026-03-30)
- Judge lets MA broker-kickback suit against Aetna, Humana, Elevance proceed -- A federal judge allowed a lawsuit over alleged Medicare Advantage broker kickbacks to move forward. (2026-03-27)
- KFF finds 19% in-network denial rate in 2024 HealthCare.gov plans -- KFF reported that 2024 HealthCare.gov plans denied 19% of in-network claims on average. (2026-03-26)
- CMS pairs Minnesota Medicaid fix with tougher federal fraud funding threat -- CMS approved a Minnesota Medicaid funding fix while warning of stricter action over fraud concerns. (2026-03-25)
- Sutter's Allina acquisition creates a $26B nonprofit across three states -- Sutter's acquisition of Allina would form a $26 billion nonprofit health system spanning three states. (2026-03-24)
- Klomp floats automatic Medicare Advantage enrollment as policy option -- A policy proposal raised automatic enrollment into Medicare Advantage as a possible reform option. (2026-03-23)