CMS Finalizes 2026 OPPS Rule: +2.9% Payment Update
CMS finalized the CY2026 Outpatient Prospective Payment System rule with a net +2.9% payment update. The update reflects the hospital market basket increase of 3.2% offset by a -0.3 pp productivity adjustment. Key changes include expanded ASC-covered procedures and revised payment for clinic visits. For PE-backed hospitals, the update is modestly positive but unlikely to offset wage inflation in high-cost labor markets.
Medicaid Unwinding Complete: 18.4M Disenrolled Nationwide
The post-pandemic Medicaid continuous enrollment unwinding is now complete, with 18.4M individuals disenrolled from Medicaid/CHIP. Approximately 40% of disenrollments were procedural (not loss of eligibility). Hospitals in states that did not expand Medicaid are seeing the largest increases in uncompensated care. Safety-net hospitals report 15-25% increases in self-pay volume. Payer mix shifts should be modeled in diligence for hospitals with >25% Medicaid days.