By Steve Crane | Editor-in-chief
"If I’m being candid, I think what everybody is waiting and watching on all sides is what is the other side going to do. If hospital anxiety gets too high and they decide that they’re fearful of what the new system looks like – the system only works because hospitals affirmatively agree to participate in the model. So we’re watching them – like that game of chicken – to see, ‘Are the hospitals comfortable? Are the hospitals staying in?’ And I think they’re watching on the other side. Where are the payers? And where is the state? Is the state still committed?" – Kim Robinson, vice president of state government affairs for CareFirst BlueCross BlueShield, on changes under the coming AHEAD healthcare model for hospital rate-setting.
It wasn't planned, but there seemed to be a game theme permeating the Maryland Association of Counties convention yesterday with speakers pulling questions out of a hat and comparing their situations to king of the hill and Jenga, among others.
Project AHEAD is the new model for hospital rate-setting from the Trump administration, which replaced a different AHEAD model from the Biden administration which replaced the Total Cost of Care Model, all within the span of two years. Prior versions gave the state greater authority to set hospital rates, but no one's quite sure what the new model will do, and that uncertainty bring the threat of the whole interdependent system collapsing like a Jenga tower, in the words of one industry official. Danielle J. Brown has that story.
Fiscal problems tend to flow downhill, and county officials feel like they're at the bottom of the hill most times. That's why counties are looking for more flexibility to raise revenues next year, when the state again faces a $3 billion budget gap and a new goals in its ambitious education reform plan, the costly Blueprint for Maryland's Future. Bryan P. Sears has that story.
There's also news about the Conowingo Dam settlement, political notes and more headlines for you below. Enjoy!
Kim Robinson, vice president of state government affairs for CareFirst BlueCross BlueShield, leads a panel on the AHEAD model. (Photo by Danielle J. Brown/Maryland Matters)
By Danielle J. Brown
State officials, hospitals, and insurance companies need to tread carefully as Maryland transitions into a new hospital rate-setting system -- or else it could topple over like a Jenga tower.
That’s according to Kim Robinson, vice president of state government affairs for CareFirst BlueCross BlueShield, in an informational panel about the AHEAD model at the Maryland Association of Counties summer conference Thursday. Insurance companies like CareFirst are watching Maryland officials navigate a multiyear transition into a new structure that will ultimately remove the state’s authority to set hospital rates for services covered by Medicare, an authority it’s had for decades.
It’s the existential challenge facing Maryland’s healthcare system, as the state transitions to a new framework to set hospital rates, called Achieving Healthcare Efficiency through Accountable Design – the AHEAD model. The previous model, called the Total Cost of Care, expired at the end of 2025. That system gave Maryland officials authority to regulate hospital costs across all payers in the system, which include private insurance, Medicaid and Medicare. The Health Service Cost Review Commission determines those rates.
Local government leaders are looking to Annapolis for flexibility in revenue generation and praying that a solution for a projected structural budget gap next year does not mean that the state will cut aid or require counties to pay more for services covered in the state budget. (File photo courtesy of the Executive Office of the Governor)
By Bryan P. Sears
County leaders said they need more options to help weather mounting budget pressures driven by reductions in state aid coupled with costs shifted to local governments and mandated education spending.
Those same leaders are understandably edgy as they wait for signs of how state government will resolve its own fiscal crisis. Past solutions have frequently come at the expense of county governments who rely on billions in state aid to balance their books and deliver key services.
"The feds kick things down to the states. States kick things down to the counties, and then we turn around and there's nobody to kick it down to," said Harford County Treasurer Robert Sandless. Sandless, speaking to a packed room of local government leaders attending the Maryland Association of Counties summer convention in Ocean City, warned of an additional concern involving volatile income tax payments to the counties. All of this comes at a time when the state has pushed down additional costs to the counties and mandated beefed up education spending.
At the state level, there is a projected structural budget gap of about $3 billion for the coming fiscal year. Lawmakers and Maryland's governor will face tough decisions including budget cuts that reduce spending in future years and the potential for tax increases.
IN OTHER NEWS
Conowingo kumbayah: Rural county leaders, state officials and Constellation Energy representatives -- at odds a year ago over issues at the Conowingo Dam -- sat down to discuss the settlement agreement in a new collaboration Thursday.
Bills targeting immigration were popular: Democratic lawmakers proposed nearly 250 bills in state capitals this year to limit federal immigration efforts as they sought to push back against what they see as federal government overreach.
Political notes: The Green Party adds a data center opponent as a campaign adviser, Sen. Cheryl Kagan literally pulls questions out of a hat to quiz election officials and longtime environment official Horacio Tablada retires, in political notes.
MATTERS YOU MAY HAVE MISSED
Childcare at a 'crossroads': States need to streamline requirements for childcare providers, improve access and affordability and invest in childcare workers to strengthen the system for the future, according to a recent national report.
Moore cruising in early poll: Gov. Wes Moore leads GOP challenger Dan Cox by 27 points in the early going of their gubernatorial rematch, according to a new poll that also shows support for nuclear and natural gas power in the state.
Loudoun lowdown: Michael Turner, a supervisor in Loudoun County, Virginia, which has some of the s, brought advice from the frontlines to Maryland county officials facing the issue.
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