The new administration brings opportunities and challenges for the healthcare industry. While final regulatory guidance has not yet been released, health plans and providers will need to respond quickly when changes are finalized. An agile strategy, with the ability to rapidly deploy an expert workforce, is critical.
Some Medicare Advantage (MA) regulations were relaxed in 2017 during the last Trump administration. In 2025, Medicare Advantage may experience some positive regulatory changes, while Medicaid and ACA enrollment and rates will be under review. In January, CMS proposed a 2.2% Medicare Advantage rate increase, compared to a 0.2% decrease in 2024. Several Medicaid managed care plans have reported that they expect states to increase rates, which may somewhat improve the overall outlook for these plans. Medicaid managed care enrollment is expected to continue to decrease due to reauthorization, and potential eligibility changes and work requirements. According to the Kaiser Foundation, states lost an average of 15% of peak COVID-era Medicaid enrollment between March 2023 and June 2024.
The new administration has prioritized reducing and/or eliminating what it considers costly and burdensome regulations. The January 31, 2025, executive order, Unleashing Prosperity Through Deregulation, requires a 10-to-1 ratio of eliminated regulations to new regulations.
Another factor that may contribute to uncertainty is the 2025 executive order requiring all agencies to implement a regulatory freeze, which may impact rules finalized or issued in the previous administration. While the past three administrations have implemented regulation review, the timing is especially critical in this cycle. The Trump administration must finalize the previous administration’s final MA notice—unlike past transitions, where prior administrations either completed final notices before the new administration took office (Trump 2021) or chose not to issue them at all (Obama 2017).”
The freeze will likely affect several healthcare-related rules finalized or issued late in the previous administration, including proposed 2026 Medicare Advantage and Part D policies, the rate notice, and the final 2026 Notice of Benefit and Payment Parameters for public insurance marketplace coverage. Advance notice comments are due February 10, 2025, and the final notice must be released by April 7, 2025. MA bids for 2026 are due June 2, 2025.
One example of pending proposed rules affecting Medicare Advantage is the CMS proposed rule issued December 10, 2024, which includes the following:
- Revising network adequacy exception reasons
- Making MA directories accessible through the Medicare Plan Finder, with changes reported within 30 days of notice from provider
- Attestation of Medicare Plan Finder directory accuracy to align with data submitted with application
- Defining in-home services and community-based organization services and directory requirements
Regardless of the final regulations and statutory guidance, it is expected that states, health plans and providers will have a short runway to respond to changes —which could further strain resources.
Contact ATTAC to rapidly deploy our expert provider network management team to support your efforts within a condensed timeframe. We’re here to support your network development (new market, expansion or gap fill), operations and compliance needs.
