Health Policy
Medicare, Medicaid, value-based care models, and long-term care regulation. The rules that determine how care gets paid for — and who delivers it.
Five Policy Forces Shaping the Continuum
The regulatory and legislative categories that matter most to post-acute, home health, and value-based care operators.
Medicare & Medicaid Policy
CMS rulemaking touches every care setting simultaneously. Final rules on SNF staffing minimums, home health payment updates, and Medicare Advantage risk adjustment directly affect margins, operations, and patient access across the continuum.
Value-Based Care Models
CMMI is running over a dozen active payment models designed to move providers from fee-for-service to outcomes accountability. ACOs, bundled payments, and episode-based models are reshaping how post-acute and home health providers get paid.
HCBS & Long-Term Care
The shift from institutional to home and community-based care is accelerating — 67% of Medicaid long-term care spending now flows to HCBS settings. Olmstead obligations, Medicaid waiver expansions, and the HCBS Access Rule are the legal and policy framework behind that shift.
Drug Pricing & Coverage
The Inflation Reduction Act gave CMS authority to negotiate drug prices directly with manufacturers for the first time. Part D redesign is already shifting formulary structures. Biosimilar penetration and prior authorization reform are moving through CMS simultaneously.
Workforce & Staffing Policy
CMS finalized the first-ever federal minimum staffing standards for nursing homes in 2024 — requiring 3.48 hours of total nurse staffing per resident per day. Compliance timelines are phased by facility type, and enforcement mechanisms are still taking shape.
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Policy Data Snapshot
CMS spending, HCBS shift, and value-based care adoption. All figures from CMS and CMMI public data.
Annual spend by program · *2025 estimated
Share of long-term care spending · *2024 estimated
Number of participating organizations by model
Economic & Cost-of-Living Indicators
The economic signals that shape health policy decisions — national debt, energy costs, grocery prices, and agricultural commodities. These numbers drive Medicaid budgets, SNAP benefit levels, CMS payment updates, and the financial pressure on care delivery.
Includes employment rate, jobs added per month, consumer prices, national debt, commodities, and state minimum wage — the economic signals that shape Medicaid budgets, CMS payment updates, and care delivery.