On the Margins -- Apr 03: Washington Medicaid creates statewide billing...
On the Margins
Your daily health economics & actuarial brief
Friday, April 03, 2026
What's happening today
| ■ | Washington Medicaid created a statewide billing code for the ElliQ robot. |
| ■ | CMS finalized its 2027 MA and Part D rule, cut star measures, and could add $18.6 billion. |
| ■ | CMS added a hemp-access incentive to ACO REACH and the oncology model. |
Key Stories
Washington Medicaid creates statewide billing code for ElliQ robot
Washington authorized a statewide Medicaid reimbursement code for Intuition Robotics' ElliQ social AI robot, allowing eligible beneficiaries to receive it through in-home care services. That creates a routine billing pathway rather than a pilot workaround and gives in-home care providers a new reimbursable technology line item.
CMS final 2027 MA rule cuts star measures, could add $18.6B
CMS published its final 2027 MA and Part D rule on April 2. The rule is effective June 1 and applies to coverage beginning in 2027; CMS also dropped the Excellent Health Outcomes for All reward. STAT reported the star-ratings changes could mean $18.6 billion more for insurers. That changes bonus-revenue assumptions and makes star-rating downside less punitive.
CMS adds hemp-access incentive to ACO REACH, oncology model
CMS said April 2 that eligible organizations in three Innovation Center models, including ACO REACH and the Enhancing Oncology Model, can use a new Substance Access Beneficiary Engagement Incentive to expand clinician-guided access to eligible hemp-derived products. That adds a specific incentive-linked activity inside total-cost contracts, but the near-term financial effect is narrow and depends on uptake and any utilization offsets.
Significant Digit
If 3 out of 4 Medicaid members sit in managed care, a near-zero improper-payment rate says more about audit scope than actual risk.
GAO says Medicaid managed care's improper payment estimate has been at or near 0% in recent years, including 2024, even though just over 75% of Medicaid beneficiaries -- about 74 million people -- are enrolled in managed care. The catch is methodological: CMS checks whether states paid plans the contracted capitation amount, not whether plans paid providers for phantom or unsupported services. A clean scorecard is nice when you do not grade most of the test.
Other Relevant Headlines
Policy & Regulation
| How health care could gum up Trump's reconciliation push | STAT |
| Digital rights advocates sue CMS over WISeR, Democrats urge House appropriators to repeal model | Inside Health Policy |
Payer Operations
| State-run insurance plans for foster kids leave some of them without doctors | KFF Health News |
| Memorial Hermann Health System, Blue Cross Blue Shield of Texas fail to reach contract deal | Fierce Healthcare |
Provider Economics
| CHS closes sale of Alabama hospital | Healthcare Dive |
Pharmacy & Drug Pricing
| Trump announces 100% tariffs on brand-name drugs, with plenty of carveouts | STAT |
Digital Health & AI
| AI scribe adoption linked to modest reductions in EHR and documentation time, study finds | Healthcare Dive |
ICYMI (Recent Key Stories)
- Medicaid immigration rechecks find few ineligible enrollees -- State immigration-status reviews of Medicaid members identified relatively few people who were ineligible. (2026-04-02)
- States pay Deloitte, Optum to cut Medicaid rolls -- Some states are hiring contractors like Deloitte and Optum to help review eligibility and remove Medicaid enrollees. (2026-04-01)
- Alabama bans breast imaging cost-sharing in 2027 -- Alabama approved a law eliminating patient cost-sharing for breast imaging services starting in 2027. (2026-03-31)
- AHIP sells affordability through chronic-condition management -- AHIP is promoting chronic-disease management as a way health plans can address medical costs. (2026-03-30)
- Judge lets MA broker-kickback suit against Aetna, Humana, Elevance proceed -- A judge allowed a lawsuit alleging broker kickbacks by Aetna, Humana, and Elevance in Medicare Advantage to move forward. (2026-03-27)
- KFF finds 19% in-network denial rate in 2024 HealthCare.gov plans -- A KFF analysis found 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 tied approval of Minnesota's Medicaid correction to a sharper warning over federal funding and fraud oversight. (2026-03-25)
- Sutter's Allina acquisition creates a $26B nonprofit across three states -- Sutter's acquisition of Allina would form a nonprofit health system with about $26 billion in revenue across three states. (2026-03-24)