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

Summary

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

Podcast: Becker’s Healthcare Podcast
Date: May 5, 2026
Host: Brian Zimmerman
Guest: Chad Wallace, President, Eligibility Services Division, MedMetrics

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Episode Overview

This episode focuses on how hospitals and health systems should prepare for major changes to Medicaid eligibility and hospital revenue under the "One Big Beautiful Bill Act." Chad Wallace, a Medicaid policy veteran, shares actionable insights on eligibility and enrollment reforms, financial implications on hospital programs (notably DSH and 340B), the critical role of technology, and strategies for proactive preparedness, all in anticipation of transformative Medicaid regulation changes effective December 31.

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Key Discussion Points and Insights

1. Immediate Impact of the Bill’s Provisions

[01:09–03:49]

• Biggest Changes:
  • Six-month redeterminations for the Medicaid expansion (adult) population.
  • New community engagement/work requirements for this same group.
• Financial Impact:
  • Reduction in provider taxes and state-directed payments will create “downward pressure on margins and operational costs.” (Wallace, 02:31)
• Program Ramifications:
  • Reduced Medicaid coverage will lower the number of Medicaid days, impacting hospital Disproportionate Share (DSH) and 340B drug discount programs. Loss of 340B access is especially concerning for rural and safety-net providers.
    • Quote:

    “340B specifically too, for some organizations in certain parts of the country, that’s crucial for them, correct?”
    — Brian Zimmerman [03:40]

    • Quote:

    “You’re either in it or you’re out of it… If you get there, you get into that program. DSH… not nearly as much as the differential between what the drug discount programs will be. I think that is really a hidden area in this bill.”
    — Chad Wallace [03:49]

2. Shifting from Reactive to Proactive: Hospital Planning

[05:03–08:17]

• Historical Reactivity: Hospitals have often been forced into reactive postures by policy changes, causing last-minute adjustments to staffing and workflows.
• Proactive Checklist:
  • Run stress tests for reductions in Medicaid revenue.
  • Invest in technology for enrollment support and renewal reminders, especially targeted at high-risk groups.
  • Use EHRs to alert staff and patients about upcoming redeterminations (90-, 60-day reminders).
  • Partner with community organizations to help patients meet work/community service requirements.
  • Pay close attention to the needs of immigrant populations, particularly as their coverage and utilization patterns change.
  • Quote:

    “Meeting them where they’re at to assist them in getting the redeterminations and their enrollments done on time, creating alerts in your EHRs… and reaching out to those patients 90 days, 60 days prior…”
    — Chad Wallace [07:08]

3. Role of Technology and Automation

[08:17–11:46]

• AI & Automation: Advancements in AI enable more effective eligibility verification and retention. Automated reminders and patient engagement tools are essential.
• Outpatient & ED Focus:
  • Technology makes it easier to capture Medicaid status for all encounters, not just inpatient—vital due to DSH/340B calculations.
• Patient Outreach:
  • SMS and portals for document uploads, automated employment and insurance info gathering.
  • Integrate work requirements and renewal tracking directly into the EHR.
  • Quote:

    “AI eligibility verification is much better today than it’s ever been, and it’s improving as we speak.”
    — Chad Wallace [09:03]

    • Quote:

    “Ensuring that you get credit for treating every Medicaid patient in your system is important.”
    — Chad Wallace [10:05]

4. Geographic and Demographic Strain; The Immigrant Population Challenge

[11:46–15:58]

• Disproportionate Impact:
  • Effects will vary based on hospital location, payer mix, and demographics.
• Immigrant Care Concerns:
  • Restrictions mean coverage for undocumented immigrants will be limited to emergency services, leading to delays in care and increased acuity/cost.
  • Quote:

    “Immigrant populations are delaying care. So when they do seek care, they’re going to be sicker and it’s going to be more costly to care for them.”
    — Chad Wallace [13:42]

• Success Metrics:
  • Hospitals that thrive will have proactive plans targeting: the expansion population and immigrants, revenue loss prevention, and systems in place to help patients maintain coverage and fulfill requirements.
  • Quote:

    “Success looks like… having had done the work prior to protect those streams and seeing yourself being able to assist patients after we get through December 31.”
    — Chad Wallace [15:32]

5. Learning from Early-Adopter States

[16:04–17:18]

• Some states (Nebraska, Montana) are implementing six-month renewal processes earlier (starting May 1); others (Arkansas, Iowa) will initiate work requirements sooner. Observing these states offers a learning opportunity for others.
  • Quote:

    “We can start to see and learn from how other states are doing things in the coming months to adjust how things can look like in the future.”
    — Chad Wallace [16:39]

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Notable Quotes & Memorable Moments

• On 340B's hidden risk:

  “The large effect that could take place in losing 340B drug discount programs simply because of the fact that you’re unable to treat the number of Medicaid patients that you have in the past to be able to reach that DSH formula.”
  — Chad Wallace [04:33]

• On technology’s core role:

  “Tech is going to allow you to get a larger and better understanding of your Medicaid patient population and then better enable you to reach out and proactively engage in the Medicaid process as opposed to sitting back and having to react to what comes in.”
  — Chad Wallace [11:06]

• On immigrant patient acuity:

  “That stomach ache could turn into a perforated ulcer or stomach cancer or something much more serious… when they do seek care, they’re going to be sicker and it’s going to be more costly to care for them.”
  — Chad Wallace [13:42]

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Timestamps for Key Segments

| Segment | Timestamp | |------------------------------------------------------------------|------------| | Introductions and Chad’s background | 00:00–01:09| | Overview of bill’s big impacts | 01:09–03:49| | 340B and DSH financial pressure | 03:49–05:03| | Moving from reactive to proactive planning | 05:03–08:17| | Leveraging technology for eligibility & retention | 08:17–11:46| | Challenges by hospital/geography and immigrant population focus | 11:46–15:58| | Early adopter states and closing advice | 16:04–17:18|

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Key Takeaways

• Prepare proactively: audit revenue streams, invest in technology, and formalize community partnerships.
• Use tech to automate, monitor, and support patient eligibility and work requirements.
• Watch early-adopter state rollouts for lessons that can inform your approach.
• Prioritize support for immigrant patients and Medicaid adults most at risk for churn or loss of coverage.
• The organizations that prepare now—especially those who focus on at-risk populations and technology adoption—will weather the coming changes best.

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For more information or to hear the full interview, visit the Becker’s Healthcare Podcast page.

Transcript

[A]

Hi everyone. This is Brian Zimmerman with Beckers Healthcare. Thank you so much for tuning into the Beckers Healthcare podcast. Today we're going to talk about preparing for Medicaid eligibility changes under the one big beautiful Bill Act. Joining me for today's discussion is Chad Wallace, President of Eligibility services division at MedMetrics. Chad, thank you for being here.

[B]

Thank you for having me. It's a pleasure to be here.

[A]

Chad, great to have you on. And before we get into our conversation today, why don't you give listeners just a quick sense of of your background and the work you're doing now.

[B]

Sure. Thank you. Currently, I'm the president of the Eligibility services division at MedMetrics. I'm responsible for overseeing the operations of all of our entitlement programs. I have 25 years experience in health care, 18 years of which have been directly involved in Medicaid. I have a lot of experience with professional organizations in providing talks and information, educational sessions for lots of groups, and I participate in a lot of state and federal stakeholder meetings related directly to Medicaid policy.

[A]

Excellent. Well, you're a great person to have on for this topic. Let's dive in here. And of course, the one big beautiful Bill act has a lot of moving parts, but December 31, not for new Year's Eve parties, but it should be on everyone's hospital leaders radar. For leaders that haven't had time to sort of dig into the details here, what are the provisions that will have the most immediate and significant impact on Medicaid eligibility and hospital revenue? Of course. Chad, can you unpack that for a little bit? I know it's a big question, but hoping to get some sound advice out there for folks.

[B]

Yeah, it's a great question and there's a lot, as you said in this bill, and when you think about what are the most important aspects of it, I think I would narrow it down into two areas from a revenue cycle perspective, and that's eligibility and enrollment reforms. And in those particular areas, there are two items that are most important which are redeterminations for the Medicaid expansion population or adult expansion population at six months and community engagement and work requirements that will be needed for that population as well. In addition to that revenue cycle, leaders should be taking into consideration the larger picture too. With this bill. There are big pieces into this that affect not just revenue cycle, but high finance and funding aspects of the bill. And what that will do is translate into downward pressure on margins and operational costs through reductions in provider taxes and state directed payments. The combination of Those two elements of Medicaid enrollment and engagement and the funding cuts are going to also create an additional concern that everyone should be aware of and thinking about, which is its effect on dish and 340B programs. With the reduction of the number of individuals across the country that will have Medicaid coverage, the available market of Medicaid days for treatment and disproportionate share formula of DISH is going to be decreased, which will put the potential for risk of several facilities, many facilities, of receiving DISH payments. Even more important to that DISH payment is the effect it could cause on their ability to reach the 340B drug discount program, which has significantly higher revenue implications than. And even the DISH side of things.

[A]

Yeah, that's a big one, right? I mean, I mean, 340B specifically too, for some organizations in certain parts of the country, that's crucial for them, correct?

[B]

Absolutely. And particularly in rural health hospitals. From that standpoint, you know, discount drug 340B programs is a Take it. You're either in it or you're out of it. Right. You get to 11.75 in dish payments and you get into the discount drug 340B program, which offers and affords health systems tens of millions of dollars in reimbursement. Right. It doesn't matter what you get above 11.75, you just have to get there. And if you get there, you get into that program. Dish, on the other hand, is a situation where you can increase the number of days and your additional supplemental payments can increase, but not nearly as much as the differential between what the drug discount programs will be. I think that is really a hidden area in this bill that's exposure to healthcare facilities. From a finance standpoint is the large effect that could take place in losing 340B drug discount programs simply because of the fact that you're unable to treat the number of Medicaid patients that you have in the past to be able to reach that DISH formula.

[A]

So, Chad, it might be, I guess you could characterize hospital responses here historically to policy changes like this, to Medicaid as being traditionally reactive, which causes some scrambling to really adjust and get staffing right. Workflows right on the fly here. But given how much is really going on here and how significant the implications are, what does it look like for health system to be proactive here and not reactive? What are the most important steps folks should be taking right now to prepare?

[B]

Yes, it's a great question, and I think I could add a couple of thoughts to that. First of All, I'm sure most health systems are running their own stress tests on their systems on what they think the reductions in Medicaid reimbursements will be. And that's very important to look at and take. But in the areas of enrollment and eligibility, health systems really need to be taking this time to focus on improving their technology in the areas of helping and assisting patients with Medicaid enrollment and retention of their Medicaid services, and also investing in technology to provide automatic renewal notices and reminders via their EHR to when patients are going to need to be redetermined. Right. We're going through a period where patients that are approved under the Medicaid expansion population, those are individuals that are aged 19 to 64, typically single working adults, and that population is really at risk in terms of losing coverage. That's the population that will need to be redetermined every six months. That's the population that will need to demonstrate 80 hours a month of work or community service engagements. And it's a big focus. So the things you can do to help those patient populations is meeting them where they're at to assist them in getting the redeterminations and their enrollments done on time, creating Alerts in your EHRs to identify when patients are going to be coming up for a renewal and reaching out to those patients 90 days, 60 days prior to when that happens so you can get that process started and prevent that loss of coverage. Also partnering with community organizations and other outside groups so that you can channel individuals that need to meet work requirements to organizations that can help them do that. Right. So if you partner with other, with community organizations that provide volunteer work or things that individuals can do to meet those requirements and you can help direct patients to those, those locations to meet those requirements, it would help to go a long way. In addition to that, though, there is a large concern around the immigrant population. And healthcare leaders really need to be taking consideration and putting some focus around the impact of immigrant populations and their finances that they're contributing to their organization.

[A]

So Chad eligibility determination has always been labor intensive. This is going to be, you know, a challenge for folks to get their arms around, for sure. But perhaps one, I guess one good thing, one really positive is sort of the technology that's available today, whether that's automation, AI or better data integration, to really help hospitals manage these changes and help, you know, their patients, their communities as well, navigate these changes. So I guess what are you seeing from a technology perspective that can be beneficial here?

[B]

Sure, yeah. I mean, in a lot of ways tech is what's the thing that's going to make health systems go from being reactive to proactive, like we discussed earlier. But the important areas to understand from a technology standpoint is that the advancements in AI modules and learning modules has made it so that AI eligibility verification is much better today than it's ever been, and it's improving as we speak. Healthcare leaders need to really be thinking about investing in eligibility verification and retention technology, which is coming online now. There are organizations that are implementing them, is bringing them into speed. Additional technology uses could are there for patient outreach, particularly in outpatient and ED settings. Right. As we talked about, there is a reduction in the number of individuals that will be qualified for Medicaid as a result. Ensuring that you get credit for treating every Medicaid patient in your system is important. And that now makes it important to understand every treat and release patient that you've had in the ed, every outpatient encounter that a Medicaid patient has received. You need to make sure that you're capturing those right. Those are areas that have often in the past been missed. Inpatient Medicaid work has traditionally been the focus, and that's where most of the dollars, almost all of the dollars, are from a reimbursement standpoint. And those changes to the inpatient side of Medicaid eligibility and enrollment are going to be helped and advanced with technology, but the real benefits are going to be seen in the outpatient and ED side of things, where we can start to get to patients where we haven't been able to get to in the past. Being able to reach out to patients with technology, using SMS technology, using phone calls to get patients to patient portholes to upload their documents themselves, allowing us to use AI to reach out for insurance information and employment verification information. Setting technologies in your EHR system for reminders of when patients are going to be coming up for the renewal dates are vitally important, particularly for that population. Having technology integrated into your ehr, which helps to coordinate and identify and track the work requirements and work engagements that are going on with your patients, is also important. And in general, tech is going to allow you to get a larger and better understanding of your Medicaid patient population and then better enable you to reach out and proactively engage in the Medicaid process as opposed to sitting back and having to react to what comes in.

[A]

Chad, I think that was a useful sort of sort of summary there of some of the great technology that's available for folks to really help them get their arms around this situation. So let's close here with sort of a big picture question. Two parter. These provisions are going to land differently depending on a hospital's geography, payer mix, patient population. Where, in your honest take, is the greatest strain going to be? And for a leader that gets this proactive preparedness right, what does success look like on the other side of December 31st?

[B]

Yeah, sure, that's a great question. And the strain is going to be all over the place. But right now, when I look at things, my biggest concern is compensation for immigrant populations. There is a lot of pressure in our society about immigration policies which are concerning for individuals that are afraid to come in for care because they're afraid that they're going to be turned over into immigration services and be deported. What that means is there are changes to how reimbursement is being done for the immigrant population. We're only going to be. It's going to be strict reimbursement to emergency use only. Absolutely. We'll follow EMTALA guidelines, but they're going to be very strict and only reimbursing for emergency care services only, no ongoing services or things along those lines. Which is important to understand why that's a factor. Is you have the immigrant population right now that, as we said, is very concerned about coming into healthcare facilities to seek care. Why? They're concerned that their information is going to get turned over to immigration services and that's going to cause them to be deported. What that's causing is immigrant populations to not seek health care services. So individuals that may come into the emergency room with a stomach ache or some type of problem, they're not showing up with a stomach ache, but they are going to show up later with severe issues. And that stomach ache could turn into a perforated ulcer or stomach cancer or something much more serious. And if you play that out in a lot of different areas, a lot of different product or service lines, you can see that what's going to happen and is happening is immigrant populations are delaying care. So when they do seek care, they're going to be sicker and it's going to be more costly to care for them. So the big concern from what I stand for right now that's not necessarily being talked about, which really should be, is this immigrant population and the effects it's going to have on our system, not just reimbursement, but the ancillary effects of preventing these patients from seeking care and then also having them be at a much higher acute level when we do need to treat them for care because we are going to have to treat them. And at the point that we will treat them though, it'll be much more expensive.

[A]

Yeah. That higher acuity just places a big strain on systems in terms of just what is needed from the workforce, what is needed from just administrating all that. That correct? That's just going to put an added strain on everything.

[B]

Yes, that's correct. And what I would say from a health system looking at the other side of this, what does success look like? Success looks like that you've had put together a plan in place to address the major populations that are going to be affected, which we talked about, the Medicaid expansion population and immigrant populations plans need to be taken right now and implemented to make sure that your organization is protected from revenue loss from those specific populations. And if success is going to look like when we're done this, having had done the work prior to protect those those streams and seeing yourself being able to assist patients after we get through December 31, success is going to look like being able to functionally proactively assist patients in getting coverage, meeting work requirements and retaining their coverage.

[A]

Some really important points. And of course it's going to look different for every organization, right?

[B]

Absolutely. Absolutely, yes. And you know, it's about taking the time now to make the plans for the future that we do have a little bit of time before this happens, but it needs to be addressed right now. We are going to have some advantages of looking at what some states do. The requirements are taking place December 31, but there are some early adopter states. Nebraska, Montana and Arkansas are starting sooner than some other states. Nebraska and Montana are going to be initiating on May 1, six month renewal processes. Work requirements won't go into a place then, but they're going to start doing redeterminations at six months and we can start to see and learn from how other states are doing things in the coming months to adjust how things can look like in the future. Other states like Arkansas and Iowa will be implementing some work requirements later in the year and we'll also be able to see and learn from some of those examples of things that take place. So those are some good positive things that we may be able to look at. There are some states that are going to be doing some early adoption of some of these programs and we'll be able to identify and look at that and see what's working and what's not working.

[A]

Yeah, for sure. It's important to be having these conversations and Chad I'm grateful for you coming on the podcast today to spread the word, so I truly appreciate you taking the time.

[B]

Well, I thank you very much. It's been a pleasure and I appreciate the opportunity to speak with you.

[A]

Absolutely. Thank you, Chad. We also want to thank our podcast sponsor, MedMetrics. You can tune to more podcasts from Becker's Healthcare by visiting our podcast [e-mail].