Nineteen major hospital systems across the United States, including Mayo Clinic, have walked away from Medicare Advantage contracts this year, forcing millions of seniors to reconsider how they receive care. The exits reflect a deepening rift between large health systems and MA insurers over reimbursement rates, prior-authorization delays, and administrative friction that hospitals say makes treating MA patients financially unsustainable. One active dispute in Rhode Island, where Brown University Health faces a July 1, 2026 cutoff with UnitedHealthcare, offers a real-time window into how these breakdowns unfold and what patients stand to lose.
Federal rule changes and a Rhode Island deadline collide
The friction between hospitals and MA plans has intensified alongside new federal regulations. CMS published its Contract Year 2026 rule, formally titled CMS-4208-F, which introduced policy and technical changes to the Medicare Advantage program, the Medicare Prescription Drug Benefit Program, Medicare Cost Plans, and Programs of All-Inclusive Care for the Elderly. Those changes recalibrate risk-adjustment methodologies and tighten prior-authorization requirements for insurers, altering the financial math that determines how much MA plans pay hospitals for patient care.
For hospitals already operating on thin margins with MA patients, the updated payment formulas give them less reason to stay in networks where reimbursement falls well below traditional Medicare rates. The result is a growing number of contract terminations and failed negotiations. In Rhode Island, the state Attorney General has documented an ongoing contract negotiation between UnitedHealthcare Medicare Advantage and Brown University Health. If no agreement is reached, the cutoff date is July 1, 2026, meaning Brown University Health patients enrolled in UnitedHealthcare MA plans would lose in-network access to the system’s hospitals and physicians.
That deadline is not abstract. Patients who rely on Brown University Health for specialty care, cancer treatment, or chronic disease management would need to find new providers or switch insurance plans during the next open enrollment period. For seniors with complex conditions, changing health systems mid-treatment carries real clinical risk, particularly when it disrupts relationships with subspecialists who know their history and have crafted long-term care plans.
What CMS rule CMS-4208-F changes for hospitals and insurers
The Contract Year 2026 rule reshapes several mechanisms that directly affect hospital-insurer negotiations. Prior-authorization reforms require MA plans to respond faster and with greater transparency when approving or denying care, including clearer rationales for denials and more standardized timelines. Risk-adjustment changes alter how CMS calculates payments to insurers based on patient acuity, which in turn affects how much insurers can afford to pay providers. These adjustments were published in the Federal Register and apply to the 2026 contract year.
Hospitals have long argued that MA plans use prior authorization to delay or deny care, reducing costs for insurers while shifting administrative burdens onto clinical staff. The new CMS rules attempt to address some of those complaints, but they also compress insurer margins. When insurers face tighter federal oversight and reduced flexibility on risk coding, they have less room to increase hospital reimbursement, which is often the central sticking point in contract talks. The result is a cycle in which federal reforms designed to protect patients can paradoxically accelerate network departures by squeezing both sides of the negotiation.
The hypothesis that these 2026 rule changes are helping to drive contract showdowns is borne out in how systems are timing their decisions. Large hospital networks are aligning termination notices with the implementation window for CMS-4208-F, effectively using the new regulatory backdrop as leverage. By threatening to walk away just as insurers are recalibrating their bids to CMS, hospitals hope to force higher rates or more favorable prior-authorization terms. Insurers, meanwhile, argue that they cannot simply pass along higher costs without undermining the value proposition of MA plans, which often hinge on lower premiums and added benefits compared with traditional Medicare.
What Rhode Island seniors can do now
For Rhode Islanders caught in the middle of the Brown–UnitedHealthcare dispute, the most immediate task is understanding whether their coverage is at risk and what alternatives exist. The state’s Office of the Health Insurance Commissioner and the Office of the Health Insurance Advocate maintain a Medicare resource hub that explains plan options, enrollment timelines, and appeal rights. Seniors can use these tools to review whether they are enrolled in a UnitedHealthcare Medicare Advantage plan that could lose Brown University Health from its network in 2026.
Consumer advocates in the state recommend that patients with upcoming surgeries, ongoing chemotherapy, or other intensive treatment ask their doctors how a potential network change would affect their care. In some cases, continuity-of-care protections may allow patients to finish a course of treatment at in-network cost-sharing even after a contract terminates, but those protections are time-limited and vary by plan. Understanding those details well ahead of the July 2026 deadline can help patients avoid last-minute scrambles.
The Rhode Island Attorney General’s office has also urged residents to report access problems as negotiations unfold, noting that patterns of delayed care or confusion about coverage can inform regulatory oversight. While state officials cannot force either party to accept specific reimbursement rates, they can scrutinize whether insurers are meeting contractual obligations and whether communications to enrollees are accurate and timely.
A national test case for Medicare Advantage
What happens in Rhode Island will be closely watched by health systems and insurers across the country. If Brown University Health ultimately leaves the UnitedHealthcare Medicare Advantage network, it could embolden other providers to follow suit when contracts come up for renewal under the 2026 rules. Conversely, if the parties reach a compromise that addresses prior-authorization delays and improves reimbursement, it may offer a template for stabilizing relationships between hospitals and MA plans in the new regulatory era.
For now, seniors in Rhode Island and beyond are left navigating an increasingly fragmented landscape. Medicare Advantage was built on the promise of coordinated, cost-effective care. The current wave of contract disputes, amplified by the financial and operational shifts embedded in CMS-4208-F, is testing whether that promise can survive the mounting tension between insurers’ need to control costs and hospitals’ demand for sustainable payment.
