Understanding the New Medicaid Redetermination and Work Requirements

Hospitals today are already facing significant financial pressure, as the rising costs of care, labor, and materials combined with lower reimbursement rates compress healthcare margins. Now, hospitals face a new challenge: Medicaid program cuts.

How is Medicaid Changing?

The One Big Beautiful Bill Act (OBBBA) has introduced several new Medicaid requirements, two of which carry significant implications for hospitals and patients:

Under these new requirements, fewer patients will be eligible for Medicaid, which will expand the uninsured population and increase the risk of disruption of patient care and worse health outcomes.

Providers will in turn receive less reimbursement from the government and see possible increases in the cost of collections. Additionally, over time, providers may start seeing patients with greater acuity as patients delay preventive care due to high costs and lack of insurance.

Developing a Medicaid Redetermination Support Program

Hospitals need to preserve their financial health and support their patients while maintaining compliance with Medicaid requirements. To do so, providers should develop their own Medicaid redetermination support programs.

A well-designed program should incorporate the following elements:

• Patient Tracking: The program should track each patient’s Medicaid coverage status and use. The hospital can then incorporate this information into both patient communications (e.g., alerting them to a change in their coverage) and financial forecasts.
• Medicaid Application Support: Program workflows should support patients wherever they are in the Medicaid application process, including helping recently disenrolled patients apply for new coverage through the health insurance marketplace or other appropriate programs.
• Staff Training: The program should offer training for frontline and administrative staff so they are equipped to support patients through the application process and guide them to additional resources as needed.
• Compliance Support: Maintaining compliance with Medicaid requirements is a key component of any Medicaid redetermination support program. Hospitals should focus on implementing strong internal controls and preserving accurate, organized, and accessible documentation to support reporting requirements.