New Medicare & Medicaid Changes Could Affect Your Chronic Care

The federal government is making big changes to Medicaid and Medicare—and if you rely on these programs, you need to be aware of what’s coming. The Centers for Medicare and Medicaid Services (CMS) recently issued nine new announcements, and some of them will directly affect families with low incomes, seniors, and people with chronic conditions.

Here’s a straightforward breakdown of what’s changing, what it means for you, and how to protect your benefits.

Medicaid Changes

Duplicate Enrollment Crackdown

In 2024, CMS discovered that 2.8 million people were enrolled in more than one health program at a time—like being signed up for Medicaid in two states or having both CHIP and a subsidized marketplace plan. That kind of overlap wastes more than $14 billion a year in taxpayer money.

Here’s what they’re doing to stop it:

• States must check for duplicate enrollments at least twice a year.
• Waivers that allowed states to skip these checks will be discontinued.
• If you’re enrolled in both Medicaid/CHIP and a subsidized ACA plan, you’ll be asked to choose one.
• If you don’t respond to the notice, your subsidy will be removed after 30 days—and you’ll be responsible for the full cost of that insurance plan.

If you get one of these letters, don’t ignore it. Make a decision, or you could be left without coverage or face large bills.

Shorter Coverage Periods Are Coming Back

Some states had waivers that let children or adults stay on Medicaid for a year or more without reapplying. CMS is ending that practice.

Once those waivers expire, everyone will need to renew Medicaid or CHIP eligibility every six months.

This could lead to more people losing coverage due to missed deadlines, so it’s important to keep your contact information updated with your state’s Medicaid office.

No More Medicaid-Funded Job Programs

CMS will no longer allow states to use Medicaid funds to pay for job training or employment support programs. Existing programs will be allowed to finish, but new ones will not be approved.

New Medicaid Coverage for Sickle Cell Disease

CMS is launching a new program to bring advanced cell and gene therapies for sickle cell disease to 33 states, Washington DC, Puerto Rico, and other territories. This is a big deal because:

• Payment is tied to whether the treatment actually works.
• If the treatment fails, Medicaid gets the money back—a first-of-its-kind approach.

Medicare Changes

Cost Savings Through Transparency and Reform

Medicare is changing how it pays for services in order to save an estimated $11 billion over the next decade.

Some of the biggest changes include:

• New price transparency rules: Starting January 1, 2026, hospitals will be required to post the real prices patients pay—not just estimates or inflated billing rates.
• End of the “inpatient-only” list: Medicare will start covering many procedures outside the hospital, making care more accessible and affordable over the next three years.
• Equal payments for clinics: Hospital-owned clinics will no longer receive extra payments just because they’re part of a hospital system.

Medicare Will Cover More Preventive Care

If a new proposal is finalized:

• People with prediabetes may qualify for free lifestyle coaching, nutrition help, and peer support.
• Medicare will focus more on preventing chronic illnesses before they become costly.

Crackdown on Medicare Fraud

CMS is targeting abuse in the use of “skin substitutes,” which have been fraudulently billed at up to $2,000 per square inch. Spending on these treatments has exploded—from $256 million in 2019 to more than $10 billion in 2024.

New Rules for Chronic Conditions

One of the biggest—and most controversial—changes is the proposed ASM (Accountable Specialty Care) payment model. This would affect people on original Medicare who are treated for chronic low back pain or heart failure.

Here’s how it works:

• Doctors and specialists will be financially rewarded or penalized based on how well their patients improve and how much Medicare spends on their care.
• In 2027, providers could receive 10% more or less pay depending on their performance. That could increase in later years.
• The goal is to reduce “low value care,” like unnecessary tests or procedures, but there are concerns this could make it harder to access certain types of care.

If you have a chronic condition, this could change how you’re treated—or even what kind of care is available.

What You Can Do

• Watch your mail carefully. If you get a notice about duplicate coverage or eligibility, respond quickly to avoid losing benefits.
• Make sure you’re on the right plan. If you’re on Medicare and have a chronic condition, now’s the time to review your plan options.
• You can get free help from our sponsor Chapter Medicare. They offer expert advice, and they’re giving away a free copy of their Amazon bestselling Medicare book to our readers.

Relief Recap

These changes to Medicaid and Medicare are designed to reduce waste and improve care, but they may also bring new challenges—especially for low income families and people with chronic health needs. From shorter coverage periods to stricter eligibility rules and performance-based care models, it’s more important than ever to stay informed and proactive.