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DHS outlines nursing-home cost drivers and new MCO network rules to hold underperforming facilities to account
Summary
DHS told lawmakers it expects higher nursing-home enrollment and per-client costs in FY26 and described a July 1 policy shift allowing MCOs to de-network chronically underperforming nursing facilities under strict criteria while maintaining continuity of care for current residents.
Department of Human Services officials told the Senate Budget & Appropriations Committee on May 6 that FY26 projections show increased nursing-home enrollment and higher per-client costs and explained a forthcoming policy change affecting managed-care plan networks.
DHS cited an anticipated average monthly enrollment increase of about 1,605 nursing-home enrollees per month for FY26, a rise it attributed in part to effects from the Medicaid unwinding and higher acuity among…
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