Medicaid Eligibility Under the OBBBA: Upcoming Key Dates and Changes Hospitals Need to Know

Kevin Chmura

Hello, and welcome to this episode of Panacea’s podcast Beyond the Bottom Line. I’m your host, Kevin Chmura, CEO of Panacea Healthcare Solutions. Today, I’m joined by my colleague, Lucia Lucas, our Director of Medicaid Eligibility. With so much changing right now as a result of the One Big Beautiful Bill Act and a lot of these changes already coming into play and more in the future, we thought it would be a good time to get Lucia and Mike to walk us through what providers need to know and what they should be thinking about right now. So Lucy, welcome to the show.

Lucia Lucas

Hi, Kevin. Thanks for having me on. I’m happy to be here. And I appreciate the time that everyone’s taking out to listen in on this topic.

Kevin Chmura

Great, cool. So let’s hit a few things. First, timeline is always super important. So I know you guys are immersed in this. Your team live this every day. So, how has the timeline for changes to the Medicaid or to changes to Medicaid changed or has it? And when will we start to see some of the impacts of those changes?

Lucia Lucas

That’s a great question. We get asked that a lot. The timeline has not shifted. Redeterminations are here to stay. That redetermination process is going live effective January 1st, 2027, but before then there are actually some changes that are happening on October 1st that not a lot of people are talking about and I think that needs to be taken into consideration because it’s the first set of changes. That’s actually happening and that’s going to be to that non-citizen population. So if you think of your refugees and your asylees, they’re going to be the first sets of individuals who are going to lose coverage. And so if you’re in a state that has a high population, if you think of states like Texas and California and New York, where they have high populations of those non-citizen Medicaid members, they’re no longer going to be eligible for Medicaid as of October 1st. So you’ll see the biggest impact in those states starting later in this year. As we kind of start to shift towards the beginning of January, January 1st, you won’t necessarily see such a big drop-off yet also in coverage for the other populations that are going to be affected. Those changes will start to come mid-year or in the later part of 2027 as those redeterminations really kind of start to kick in. So we are kind of watching that, But as far as the timelines, October 1st, you’re gonna see some changes in January 1st of 2027 is when everything else kind of falls into place.

Kevin Chmura

That’s sooner than everybody realizes, right? You get through the summer and suddenly you’re there. Can I ask a quick follow-up question on the non-citizen population, the October 1st, 26 change. Does the coverage, will the coverage for those individuals just cease or will they not be given eligibility on their next redetermination?

Lucia Lucas

It will terminate. Their last day of coverage will be, I’m sorry, their last day of coverage will be September 30th and they will no longer be eligible as of October 1st.

Kevin Chmura

Wow. Okay. So yeah, hard deadline. So you said it a few times in there. The thing that people talk to me about a lot. I know you get a lot of it is redeterminations. That’s that’s a big one. Do we have any clarity yet on how individual states are going to handle redeterminations?

Lucia Lucas

So from our understanding, the first thing that they’re going to do is similar how they did with the PHE is kind of look at ex parte. Can they validate work requirements with the information they already have. A lot of states will be looking at Department of Labor, you know, work history, social security, things that they may already have access to and can they validate these work requirements for these patients and they’ll be updating the requirements that way, updating the profiles that way and guaranteeing continued coverage for these patients. Other ways will be that they send out renewal notices ahead of time to patients and letting them know your renewal date will be coming up in 60 days, here are the information that we’ll need. I know that some states are also looking to update their IT and see if they can have some kind of compliance engines in place where they can validate this information one time, keep it on file, utilize the patient’s authorization so that coming, when the next redetermination phase comes about, they’ll have that authorization on file and again, it kind of rolls into that They’ll be able to update the information automatically for the patient as well. So they’re rolling it out. One thing to kind of keep in mind as we go into the redeterminations is that not everyone is getting dis-enrolled at the same time. This will be done in phases. So for instance, someone who applies for Medicaid in December of this year of 2026, they will fall under that annual renewal policy and they would not need to recertify until December of 2027. Whereas someone who’s applying for Medicaid in January, then that person would be subject to have the recertification done in July at the six-month mark. So again, it’s going to kind of be a shift and we’re monitoring that and working to see how each state is going to handle the volume of dealing with the applications, it’s gonna be interesting.

Kevin Chmura

Yeah, it sounds like a, effectively a doubling up of the administrative burden, which is largely falling on to providers to help their patients navigate the world of eligibility. Is it fair to look at it that way? I mean, I guess if I’m thinking about it, if somebody is deemed eligible on January 1st, 2027, And six months later, they’re likely to still be eligible, but you’ll still need to have the redetermination. It’s not really about getting people as much off the Medicaid rolls as just raising the bar to keep them on. Is it a fair way of looking at it, you think?

Lucia Lucas

Yes, yes. Something that’s going to be really critical is the partnerships with the local Medicaid agencies and making sure that they have the resources that they need to be able to handle the applications and the workload. I know that certain states are now starting to kind of implement certain practices where they’re monitoring the response time to these applications are coming in. They’re in a sense grading them. Are they prepared? Are they trained? Can they handle the volume? And so that’s gonna be really critical also and making sure that each state, the Medicaid office is able to handle the workload that’s being provided and that they can manage, and they have all the resources that they need to be able to help out the communities and the patients.

Kevin Chmura

It’s good to hear that they’re getting ahead of it because that same doubling of administration happens to them as well. So next question, we covered this a little bit, but maybe we can zero in on it. So what’s the population that’s going to be most affected by these changes? And I guess in addition to that, are there any exemptions that people should be aware of?

Lucia Lucas

Yeah, that’s another great question. Generally, the population that is going to be most affected is that able-bodied adults that are aged 19 to 64 in that expansion population. So these are individuals who are not disabled, who are not blind, who are not parents. They’re that, again, 19 to 64 expansion population that’s going to be subject to the community engagement or the work requirements. Now, as far as exemptions, again, anyone that’s over 65, anyone that’s considered a minor, under 19, pregnant individuals, they’re all exempt. You can also consider disabled individuals or medically frail as exemptions, as well as if you have a parent again for children under the age of 14 will also be exempt. One thing I do wanna mention is we’re kind of seeing this on and off with some states, there will also be some hardships that will be allowed. And so I urge you to kind of get engaged with your state and see if this is something that your state is participating in because in the one big beautiful bill, does allow for certain hardships such as admissions to an inpatient psychiatric stay or an inpatient hospitalization. If a patient has had that type of hardship within the month prior to applying for services that might be in a sense disregarded and where they don’t have to provide that income requirement or that work requirement for that particular month because of that hospitalization, that inpatient hospitalization. So we’re kind of monitoring that to make sure that that’s an option as well when helping patients out. But definitely focusing in and zeroing in on that population, again, 19 to 64, that’s going to be most affected.

Kevin Chmura

So, but what’s, I guess, comforting for more of a lay person like myself, sounds as though some of the more vulnerable populations will still have the opportunity to get some exemptions, even if they fall into the working-aged population, which is good. Those are the folks who really need the help the most. So that’s comforting. Not really a question, more of a comment. So, all right, so Lucy, the $10 trillion, $1 trillion question, I guess, is that, so you’ve worked with hundreds of hospitals. You’ve probably helped tens of thousands of people gain Medicaid eligibility. So drawing from your experience, let me ask you this question. What if I’m a provider right now, if I’m a hospital or a health system, what should I be thinking about doing right now to stay ahead of the curve, understanding that the timelines are gonna get really tight as this year progresses?

Lucia Lucas

Yeah, so the first thing is education. Finding out what’s going to happen and educating your staff, your front end workers about what’s about to come, what’s about, you know, to come down the pipeline. Education and letting your staff know what’s happening, getting prepared and making sure that if you have staff that is patient facing, how to best answer their questions. How can we ensure that the enrollment process continues? Do you have staff on site that’s currently assisting your patients with the enrollment process? If not, something to consider. Do we want to do it internally? Do we want to have someone help us out with that that can better answer the questions for our patients? That’s something to consider and I think if you have providers that are Listening to these podcasts and looking for information. I think that’s a good start right because they’re concerned um The impact to the population is really going to depend upon what that medicaid volume looks like at your site at your facility or that self-pay population education, educating your team, educating your patients as they’re coming in and doing some kind of outreach to the patients you know that may be affected is also going to be important. If there are any community days or resource days or health fairs that are in the pipeline for this year, getting out and spreading the word to the communities is going to be vital so that patients are also aware of the changes that are to come and that they’re prepared of what additional requirements they’re going to have to bring or more so the frequency of how often they’re going to have to provide that information. I think that’s going to be critical. In addition to work requirements, if someone’s not working, they can also do some kind of volunteer work. And so if organizations have volunteer departments and they’re in need of someone getting those eligible vacancies out to the community and letting them know of the listings that are out there so that in a sense it kind of kills two with one stone, the organization can fill those volunteer positions as well as someone can then continue their Medicaid enrollment because they’re now fulfilling that obligation for community service. I mean education is a big thing, outreach to the communities is a big thing, trying to identify which populations are going to be affected and taking action and just kind of being prepared for what’s to come. I think that’s pretty essential at this point. Once we get closer to the end to the year and we see how each state is going to really tackle this change head on what IT infrastructure they’ve implemented is going to be available towards the end of the year. That’s really going to be key also because then we can be in compliance with what the requirements that they’re really setting in stone.

Kevin Chmura

Yeah, so as we wrapped, first of all, that was super informative and your insights are invaluable everybody. I think it comes down. I’m taking notes here to three words, education, preparation, and then ultimately execution. So Lucy, thank you very much for all your insights. We appreciate your time.

Lucia Lucas

Thanks, Kevin. Happy to be on and happy to help answer any questions also.

Kevin Chmura

Sure. For our listeners, thanks for listening. As always, follow us on social media and we will I’ll be back with another episode soon. Thanks.