#top .hr.hr-invisible.av-lp0dm4z0-ecbd31d22a8f649a0b55c5e684e7f0bc{ height:15px; } .avia-image-container.av-lp0ehts2-4651558e3615e819bf1aaa2b983f5b55 img.avia_image{ box-shadow:none; } .avia-image-container.av-lp0ehts2-4651558e3615e819bf1aaa2b983f5b55 .av-image-caption-overlay-center{ color:#ffffff; } Medicaid Eligibility Under the One Big Beautiful Bill Act: Our Expert Breaks it Down With Host Kevin Chmura, CEO of Panacea Healthcare Solutions and Guest Brian Herdman, Director, Financial Reimbursement Services, KA Consulting Division #top .hr.hr-invisible.av-46zq5v-ac3d0c5b9ed47d8f3785414847690b8c{ height:15px; } In this episode of Beyond the Bottom Line, Kevin Chmura is joined by policy expert Brian Herdman to discuss how the One Big Beautiful Bill Act is set to impact Medicaid eligibility, what this critical issue means for hospitals and healthcare providers, and how these changes can affect your bottom line. Kevin and Brian dive into not only what changes providers can expect to see right away, but also those changes which will be coming into play in the next few years, and how to best prepare before they happen. They also explore what challenges hospitals can expect to see as a result of this bill’s passage, as well as if there are any positives for healthcare systems or providers. Episode transcript available below. Kevin Chmura Hi, and welcome back to Beyond the Bottom Line, Panacea’s Podcast exploring the business and policy issues that matter most to healthcare organizations. I’m your host, Kevin Chmura, CEO of Panacea Healthcare Solutions. In this follow-up episode, we’ll continue our conversation with Panacea’s policy expert, Brian Herdman, about Medicaid funding, a critical issue for hospitals and healthcare providers, and take a closer look at how the latest developments in Congress and the administration could impact your bottom line. We’ll also revisit some of the practical steps you should be thinking about today to strengthen your organization’s financial position now that we’ve seen how these policy issues have unfolded. So Brian, welcome back to the podcast. Brian Herdman Great to be here. Kevin Chmura Great to have you back. So, Brian, the One Big Beautiful Bill Act, the OBBBA has now been signed into law and we did a podcast on this topic in March, at which point we were really looking at the versions of the bill that were being kicked around. We were really probably going more off of what we were seeing in the press, in the media, and less what we really knew. Now we’re getting a real look at it. You’ve had an opportunity to spend some time with the text and do your analysis. You are by far our best regulatory expert here at Panacea, so interested in in what you’re saying now, we can spend a lot of time going through the individual provisions as they relate to Medicaid and those things that will be deeply impactful. If we went through all of them, this would be a three hour podcast and I think we lose a lot of the audience. I thought maybe what would be better for everybody, given your expertise in this area? Probably crafting it a little to our target audience, which is probably mostly hospitals and health systems, wondering if you might just spend some time talking about those provisions and those elements that you’re paying the most attention to, the things that you think will be most impactful. And maybe we just take the conversation from there. Brian Herdman Sure. Sure, Kevin. So, you know, after all that back and forth and all those, you know, 4th of July deadline to get the bill passed and whatnot, there is a lot of, you know, what’s going to stay in, what’s not going to stay in between the House and Senate reconciliation process. And now that that has shook out, you know, as I’m looking at the Medicaid specific provisions, because I think that’s where the big change is going to be for our clients, on that Medicaid provisions, you know, there’s kind of two kind of two way, two sets of issues our clients are going to have to look at, you know, the things are going to affect which specific claims are going to be eligible for Medicaid and at what amount. And just generally speaking, the environment that the state, that the provider operates in the state with the state’s Medicaid program, what’s happening with FMAP, what’s happening with state directed payments and how is that going to all unfold? So as I’m looking at those two kind of main themes, you know, what’s happening like, you know, soon what’s happening soon-ish and then, you know, what’s kind of pushed out far ahead. And when I look at the things that are coming up soon, it’s not anything that’s like, you know, hair on fire, oh, my gosh, we have to do a lot of things differently. There was that immediate elimination of some moratorium on some things that would get you streamline applications into Medicaid. That’s going away. And, you know, there is that reduction in FMAP percentage to states when they have done that expansion. But, you know, on the margins, none of those things are going to be a dramatic change to how our clients, you know, get how many of those claims go through and how much they really get paid by the state. When you really start to see that happen is around January 2027. That’s when we’ll start to see a lot of big changes. And looking at those kind of changes right away our of the gate, that’s when you have the introduction of co-payments for enrollees that are at 100% or more of the federal poverty limit. That’s when that six-month redetermination process with that much tighter limits on retroactive coverage and work requirements, that’s coming into play in January of 2027. So, you know, up until then, I don’t think the kind of claims that get paid by Medicaid, there’s going to be a lot of change. But once you hit January 2027, all bets are off and you’re going to have to really have yourself organized. And then there’s those state directed payments. You know, that’s going to be much more difficult to foretell. There are a number of things that are going to affect how states are paid. There’s a couple of different dimensions that they’re tweaking the FMAP percentages on. But generally speaking, it’s that expansion population and how various undocumented beneficiaries are treated or allowed to be covered. Once states, you know, start to deal with the change in how that money is coming in from the feds, then that’s when you might start to see states start paying providers differently, whether it’s, you know, maybe a perhaps in margin on the erosion, on a on a payment or if you’re relying on those state directed funds to make up your margin, you know, you’re really going to be limited in what you can get from it. Kevin Chmura Okay, that’s excellent. Maybe double click on a few of these. I think it’s difficult for you and I as we sit here to comment on individual states, because depending on where people are listening in from, it could be very, very different scenarios. You and I are both in New Jersey right now. We don’t want to make this too New Jersey centric. A couple of things that really jumped out at me that I think that you touched on and just curious what your thoughts are. For instance, the work requirements for Medicaid, for those that are in the expansion population aged 19 to 64. That provision doesn’t start until December 31st, 2026, I believe, which is effectively January 1st, 2027. Is that right? Brian Herdman That is correct. So when I was talking about like in the short term, you know, the kinds of patients that you would expect to get paid and covered under Medicaid isn’t going to change a whole lot. But once you hit January 2027, that’s where on the margins there’s going to be some very difficult cases to get through. Kevin Chmura Right. Likely then flowing out and up to another year later as things flow into state budgets as well. So that might not be directly budgetary impact. That’s a that’s a process issue, one that matters. The other process issue that jumped out at me as I think about our eligibility enrollment business at Panacea, is the increased eligibility redeterminations down to six months from a year. Any thoughts on that? Brian Herdman Well, that’s, you know, that’s going to challenge, you know, your systems and how you’re usually interacting with patients. You know, when it’s when it’s a year in between these cycles, you are often dealing with someone who if they had an encounter that was a that was a spate of illness that got them on to Medicaid and had some follow-up care, you still might be in touch with them six months down the road, whereas twelve months down the road they might not need any care. And so in that case, you’re going to you’re going to be much more interested in making sure that care continues and you’re going to have to be more engaged with your patients. As you look at what services those patients that are trailing off and receiving, and how you reach out to them to make sure that their coverage continues without a break. Kevin Chmura Yeah, that’s great. So the other thing to think about is the other side of a of an application. So at a hospital you work with a patient, you have them fill out the application, you gather up their documentation that then goes to a county office who just doubled up the amount of work that is potentially flowing through and probably not one-for-one doubling, because you’re right, if a patient doesn’t need care six months out, they may not get that redetermination. But the good chance they’re still in an episode of care and need to do that and the depending on where you are, those county offices can be well back-logged to begin with. Brian Herdman And now they’re looking at the work requirement portion of it, too. So that’s ano
