Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

Latest Resources

• West Virginia Dual Eligible System: An OPEN MINDS State Profile
• Arkansas Dual Eligible System: An OPEN MINDS State Profile
• New Mexico Dual Eligible System: An OPEN MINDS State Profile
• North Dakota Dual Eligible System: An OPEN MINDS State Profile
• Mississippi Dual Eligible System: An OPEN MINDS State Profile
• District Of Columbia Dual Eligible System: An OPEN MINDS State Profile
• CMS To Implement Mandatory Medicare FFS TEAM Model To Provide Bundled Payments For Five Common Surgical Procedures
• All 50 States Seek To Transform Rural Health With CMS
• Medicare Finalizes Behavioral Health Integration Add-On Codes For Advanced Primary Care Management
• Medicare Part B Premiums Will Increase By $17.90 In 2026
• Medicare Updates Processing Of Telehealth Claims, Will Allow Provider Organizations To Resubmit Some FFS Telehealth Claims
• Medicare Diabetes Prevention Program To Offer On-Demand Access
• Nearly Two Thirds Of Nursing Homes That Graduated From The Federal Program To Improve Nursing Home Quality Were Unable To Sustain Performance
• Medicare To Implement The New Ambulatory Specialty Model For Beneficiaries With Heart Failure & Those With Low Back Pain
• Final Medicare Physician Fee Schedule For 2026 Includes Policies To Address Undervaluation Of Time-Intensive Services

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Medicare Continues Coverage Of In-Home Behavioral Health Telehealth, With Some Conditions

Medicare continues to cover in-home telehealth services for behavioral health treatment, with some restrictions, while coverage of in-home telehealth for most other services ended on October 1, 2025, and reverted back to pre-COVID-19 policies that limited telehealth to beneficiaries in rural areas who receive the services at a designated site. Medicare will cover behavioral health telehealth services after October 1, 2025, only if the clinical professional had provided an item or service in-person without the… Read

• Vermont, Utah & Minnesota Are Top-Ranked States For Medicare Beneficiary Access To High Quality, Affordable Care
• Medicare Coverage Of Digital Mental Health Treatment Devices To Include ADHD
• Final Rule For Medicare & Medicaid Programs; CY 2026 Payment Policies Under The Physician Fee Schedule, And Other Changes
• What A Difference A State Makes
• Many Medicare Advantage & Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks, Inactive Providers

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