Oregon to Increase Payments to Medicaid MCOs 

November 13, 2025

medicaid

The Oregon Health Authority (OHA) announced that it will be increasing payments made to Medicaid Coordinated Care Organizations (CCOs) by an average of 10.2% in 2026. The increase is meant to help stabilize the Oregon Health Plan and support CCOs as they face increased financial strain due to higher utilization. OHA will also take targeted actions in policy to contain Medicaid costs and ensure program sustainability. Some cost containment measures already taken by OHA include requiring CCOs to refund OHA if behavioral health costs are low in 2026, reducing funding for the CCO Quality Incentive Program, and narrowing eligibility for enhanced directed behavioral health care to providers that offer team-based care, pending federal approval.

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June 19, 2026

EGWP marketplace medicaid Medicare

legislation

Bicameral Patients before Monopolies Act reintroduced

On May 13, bipartisan lawmakers in the House and Senate reintroduced the Patients Before Monopolies (PBM) Act (S.4509/H.R.8779), legislation that would prohibit common ownership of PBMs, insurers, and pharmacies. Sponsored by Sens. Warren (D-MA) and Josh Hawley (R-MO) alongside Reps. Diana Harshbarger (R-TN) and Jake Auchincloss (D-MA), the bill would require impacted organizations to divest […]
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June 10, 2026

EGWP marketplace medicaid Medicare

legislation

CMS announces ePA acceleration initiative, democrats seek to repeal WISeR Model

The Centers for Medicare & Medicaid Services (CMS) is advancing its electronic prior authorization (ePA) efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements. To date, 29 health care organizations – including health systems, electronic health record developers, physician practices, networks, and digital health […]
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June 10, 2026

EGWP marketplace medicaid Medicare

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