The Medicare Environment in 2024

Presentation to the Association for Community Affiliated Plans (“ACAP”)

This webinar provides a general overview of the Medicare environment in 2024, including the regulatory and enforcement environment, the new risk model v28, dual eligible environment, model of care, health equity index, key Star Rating changes, and more.

Medicare Advantage

Medicare Part C High-Risk Diagnosis Codes Tool Kit (Revised - 2024):

2023 Released toolkit focus on 8 categories of high-risk codes
Update the toolkit

Audits of Medicare Part C Health Risk Assessment Diagnosis Codes (2025):

Focus is on enrollees whose diagnoses, reported only on HRAs
Also updating 2023 report on HRAs (2024)

Medicare Advantage Organizations' Efforts To Reduce Racial and Ethnic Health Disparities (2025):

Identify the actions that MAOs have developed to reduce racial and ethnic disparities in access to care, quality of care, and health outcomes

Medicaid Managed Care

States' and MCOs' Compliance With Mental Health Parity Requirements (2024)

States and their MCOs conducted the required analyses and met MH/SUD parity requirements

Medicaid Managed Care Organizations' Denials

Two prior reports focused on MCOs and states
Update focused on denying access to requested medical and dental services, behavioral health services, and associated drug prescriptions that required prior authorization

State Medicaid Agencies' Perspectives of Managed Care Plans' Referral of Fraud (2025):

“OIG and CMS have ongoing concerns about States' and plans' efforts to combat fraud, including a lack of fraud referrals.”
Volume and quality of the fraud referrals made by MCOs, incentives for MCOs to refer fraud

Maternal Health Care (2025):