How to Navigate Medicaid Policy Changes for Healthcare Access

Looming #Medicaid changes jeopardizes margin and sustainability for substantially every healthcare organization, either directly or indirectly. Looming MCD cuts will impact seniors and people with disabilities across all 50 states in substantially every #MA contract. Transcending "membership and margin," changes will impact the real members, real providers and real care which are the foundation of #Medicare success. While we await details on spending cuts and regulatory changes, here are 3 key risks to examine in depth now: 1️⃣ #MedicareAdvantage members who lose Medicaid coverage will likely see reduced #accesstocare (i.e. #CAHPS) and increased OOP costs, creating confusion (i.e. #MemberExperience) and gaps in needed services (i.e. #HEDIS and #HOS). Thought most will stay in their current plan during the initial months of lost coverage, many #SNP members will have to switch plans. #StarRatings will be impacted. 2️⃣ Providers will face new financial pressures. Providers who lose MCD revenue will face tough decisions about patient care and staffing. Change to their payor mix will shift profit pressures increasingly MA contracts to fill the gap. MA plans may face more terminations. And the simultaneous loss of indirect cost revenue from research grants will compound disruption in academic medical centers. 3️⃣ Many vendors, particularly those delivering #supplementalbenefits and #SDOH supports, will struggle as #MCD revenue shrinks. Most will have to revise business plans, revisit rates/fees and manage investors’ expectations. MA plans need to assess business continuity risks among their vendors, identifying areas where shuttered vendors may result in failed #CMS #Compliance. What Can You Do Right Now? ✅ Instead of waiting for clarity from Washington before taking the next steps, use the next few months for accelerated preparation. ✅ Identify At-Risk Members who may lose Medicaid coverage. - Create outreach and education plans to guide them through the transition. - Customize support for those you can retain and those who will have to switch. - Tailor 2025 #RiskAdjustment and Stars activities accordingly. ✅ Strengthen Provider Alignment. - Talk with providers and create collaborative contingency plans. - Prepare to amend 2025 and 2026 contract terms, incentives and #VBC criteria as soon as the 2026 #FinalRule and MCD cuts are known. - Ensure adequate staffing in provider-facing and contracting teams to execute quickly. ✅ Scrutinize Your Vendor Network. - Communicate to all vendors the expected impact within your membership. - Request operational response plans from all critical vendors. - Collaborate with key vendors on rapid solutions, focusing on those who can align with Dr. Oz’s vision of sustained engagement using #AI and digital tools. ✅ Act now. Find wasteful, redundant and low-ROI spending that can be repurposed rapidly to protect your members, your providers, and your performance. #WhatGotYouHereWontGetYouThere #LetsRoll ⭐

If I were running an FQHC today (and I work with dozens across the country), I’d be doing five things right now: 1. Get a seat at the table – Call your Medicaid agency and say, “Put us in your rural transformation plan.” Don’t wait for them to come to you. 2. Prepare for the wave of uninsured – Revisit your sliding-fee scale, train your front desk team, and streamline patient onboarding. 3. Educate your patients – Use texts, flyers, and community partners to explain the new rules and help people stay covered. 4. Get creative with partnerships – Workforce boards, job training sites, churches—anybody that can help patients meet their 80 hours/month requirement. 5. Apply for every damn grant you can – There’s money in motion. Don’t leave it on the table.

As policymakers advance Medicaid work requirements—which mandate at least 80 hours/month of work, volunteering, or job training for able-bodied adults to maintain eligibility—the fallout for health systems could be substantial. Per a recent analysis from The New York Times, the 2025 Reconciliation Bill wouldn’t just require millions of Americans to verify employment status; it would also require states to build complex new eligibility-tracking systems with little lead time. 🔍  Why this matters for health systems: 1. Gaps in enrollment will grow, and systems will bear the cost: Millions of patients who are eligible for Medicaid may still lose coverage due to the complexity of new verification requirements. Many won’t complete the paperwork or meet digital access needs in time. Health systems will need to proactively screen and enroll these patients, or risk absorbing the cost of care. 2. Chronic care disruptions = more acute events: Coverage gaps interrupt regular care—diabetes screenings, cancer prevention, behavioral health check-ins—which can quickly escalate to costly ED visits and hospitalizations. 3. Early rollouts have shown real harm: In Arkansas, over 18,000 people lost coverage within months of work requirements taking effect in 2018. In Georgia, a similar policy launched in 2023 covers just 2,300 people, despite 90,000 being eligible, drastically reducing access and reimbursement for providers. 4. Disproportionate impact on vulnerable populations: Caregivers, people with fluctuating work hours, those without reliable internet, and marginalized communities are most likely to fall through the cracks. This drives deeper health inequities and higher downstream costs. 💡  What health systems should do now: ▪️ Prepare for a surge in uncompensated care, especially in rural and safety-net settings. ▪️ Implement proactive digital communication strategies to stay connected with at-risk patients between visits. ▪️ Invest in financial navigation and digital screening tools to help patients check and maintain eligibility across Medicaid, ACA plans, charity care, and other programs. ▪️ Monitor real-world outcomes in other states to inform outreach, capacity planning, and policy response. If you are a provider leader concerned about the pending changes, please reach out - happy to share the work we have done to model anticipated impacts and necessary changes.