Preparing for Medicaid Eligibility Changes Under the One Big Beautiful Bill Act

This episode of the Becker's Healthcare Podcast explores the far-reaching implications of the One Big Beautiful Bill Act on Medicaid eligibility and hospital revenue, featuring Chad Wallace, President of the Eligibility Services Division at MedMetrics. Wallace outlines two major revenue cycle impacts: six-month redeterminations for the adult Medicaid expansion population and new work or community service requirements. He emphasizes that these changes, combined with funding cuts to provider taxes and state-directed payments, will pressure hospital margins and threaten critical programs like DISH and 340B drug discounts—especially for rural hospitals. A major concern is the underutilization of care by immigrant populations due to fear of deportation, leading to delayed, more severe health issues and higher treatment costs. Wallace advocates for proactive strategies, including investing in AI-driven eligibility verification, EHR-integrated renewal reminders, patient outreach via SMS and portals, and partnerships with community organizations to help patients meet work requirements. Early adopter states like Nebraska and Montana are already testing six-month redeterminations, offering valuable lessons for other systems. Success, he concludes, means having a comprehensive, technology-enabled plan in place before December 31st to retain patients, maintain revenue, and ensure equitable care access. Key takeaways include: (1) Prepare for six-month Medicaid redeterminations and work requirements for adult expansion populations; (2) Invest in AI and EHR-integrated technology to automate eligibility checks and patient outreach; (3) Proactively engage patients 90–60 days before renewal to prevent coverage loss; (4) Partner with community organizations to help patients meet work requirements; (5) Address the growing crisis of immigrant patients avoiding care due to deportation fears; (6) Protect 340B eligibility by maintaining sufficient Medicaid patient volume to meet DISH thresholds; (7) Monitor early-adopter states for best practices; and (8) Treat outpatient and ED encounters as critical revenue points, not just inpatient care.