March 2026 in review: Sutter-Allina deal, Medicaid renewals, ACA results

A cross-market megadeal reset expectations for scale, CMS detailed six-month Medicaid renewals, and final marketplace numbers confirmed a shift to leaner plans.

March brought the year’s largest proposed combination so far, practical rules for one of H.R. 1’s most consequential Medicaid changes, and final open enrollment data with real implications for patient balances.

Sutter Health and Allina Health plan a $26 billion system

On March 18, Allina Health signed a letter of intent to join Sutter Health. The combined nonprofit would run 39 hospitals across California, Minnesota and Wisconsin, with about 18,000 physicians and more than 400 care sites, on roughly $26 billion in annual revenue. Sutter CEO Warner Thomas would lead the combined organization, and Allina CEO Lisa Shannon would head a new Upper Midwest division. The parties target a close by the end of 2026, pending regulatory review.

Because the systems do not overlap geographically, the deal may draw less antitrust attention than in-market mergers. It also tests whether scale across distant regions produces savings in purchasing, capital access and technology that boards can measure.

CMS spells out six-month Medicaid redeterminations

CMS issued guidance to states implementing H.R. 1’s requirement that most Medicaid expansion adults have eligibility checked every six months, starting Jan. 1, 2027. States must try automated, data-based renewals first; when that fails, they send prefilled forms with at least 30 days to respond. American Indian and Alaska Native enrollees and people whose eligibility is not income-based are exempt. A RAND analysis cited by HFMA estimated the policy could reduce Medicaid enrollment by 923,000 by 2034.

For hospitals, more frequent renewals mean more patients who lose coverage for paperwork reasons and then regain it, which raises eligibility screening and enrollment assistance workloads.

Final marketplace numbers: fewer silver plans, more bronze

CMS reported 23.1 million people selected or were automatically re-enrolled in exchange coverage for 2026. Fierce Healthcare noted that total was about 5% below 2025. The metal-level shift matters more for revenue cycle teams:

• Bronze: 40% of selections, up 10 points.
• Silver: 43%, down 14 points.
• Gold: 17%, up 4 points.

CMS also said it ended subsidies or coverage for nearly 1.5 million people found ineligible or enrolled without authorization in 2025. Higher-deductible plans mean more patient responsibility per encounter, even among the insured.

Sources

• Sutter, Allina Health to form $26B nonprofit system (Healthcare Dive)
• Medicaid six-month eligibility redeterminations: CMS guidance (HFMA)
• Exchange coverage remains near record high as 23.1 million enroll in 2026 (CMS)
• CMS: This year's open enrollment brought fewer signups, higher premiums (Fierce Healthcare)