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Medicare Advantage Denies 13% SNF Transfers, Regulators Call for Transparency

6/12/2026

Summary

HHS Finds Denials

Department of Health and Human Services (HHS) inspector general found Medicare Advantage insurers denied 13% of requests to transfer patients to skilled nursing facilities.
The probe focused on UnitedHealth Group, Humana and CVS Health, which cover 35 million enrollees and use contractors like NaviHealth for prior-authorization, though oversight is insufficient.
Lawmakers and patient-advocacy groups are calling for transparency and regulation of the denial algorithms, citing incentives to limit costly stays.

Summary

Kennedy Jr. Cuts

Health Secretary Robert F. Kennedy Jr. announced insurers pledged to cut and streamline prior-authorization requirements after the HHS inspector-general report.
AHIP said the reports omit serious cost and quality concerns, noting for-profit insurers deny requests more often than nonprofits.
An HHS report showed 95 % of skilled-nursing denial appeals were reversed, prompting lawmakers to propose penalties and the inspector general to urge CMS to collect prior-authorization data on Medicare Advantage denials.

History

Historical Context

The Balanced Budget Act of 1997 let Medicare beneficiaries choose private Medicare+Choice plans, a model renamed Medicare Advantage by the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. UnitedHealth, Humana and CVS Health now enroll about 24 million people, and an HHS inspector-general report found they denied 13 % of skilled-nursing transfer requests, reviving oversight debates.

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HHS Finds Denials

Department of Health and Human Services (HHS) inspector general found Medicare Advantage insurers denied 13% of requests to transfer patients to skilled nursing facilities.
The probe focused on UnitedHealth Group, Humana and CVS Health, which cover 35 million enrollees and use contractors like NaviHealth for prior-authorization, though oversight is insufficient.
Lawmakers and patient-advocacy groups are calling for transparency and regulation of the denial algorithms, citing incentives to limit costly stays.

1 / 3