As Medicaid cuts loom and administrative costs soar, CFOs are turning to AI to protect margins, streamline operations, and expand access for vulnerable populations.
Uncertainty is an understatement for healthcare right now. From general economic instability to looming Medicaid cuts, CFOs are looking around every corner for any stabilizing financial strategy.
At Saint Peter's University Hospital, that strategy surfaced through a partnership that increased Medicaid enrollment by 162% and improved the health system's revenue by $13.4 million.
Since implementing this program with Escher Health's AI platform, the health system has seen three- to four-times more self-service by patients, 40% greater staff efficiency, and shorter follow-up time. Medicaid's increased administrative burden, like work requirements and biannual eligibility checks, stand in the way of many new eligible members.
Saint Peter's found a way around this through an AI-enabled, personal financial counselor. The platform allows for proactive engagement, helping patients navigate enrollment, redetermination, or alternative coverage options before they need care. The program supports placement into Medicaid, ACA plans, charity care, or zero-interest payment programs.
This approach is designed to bad debt and days in accounts receivable for health systems.
Garrick Stoldt, CFO of Saint Peter's, and a HealthLeaders Exchange member, acknowledges that Medicaid enrollment is complex and reactive, often triggered by an emergency or clinic visit. Patients usually arrive without knowing application requirements, making manual enrollment difficult and time-consuming. With the recent policy change reducing the redetermination period from 90 to 30 days, meeting deadlines is even harder.
In 2024, roughly 13,000 patients arrived at the hospital with no coverage, often qualifying for Medicaid or charity care. Typically, enrollment was manual, labor-intensive, and lacked visibility, leading to missed opportunities, especially during Medicaid redetermination cycles.
- Stoldt shared some of the benefits of using AI to tackle this pain point: It improves visibility into every uninsured patient's enrollment status, across all system locations, giving the health system a better view of the patient's financial situation
- Automation has replaced manual follow-ups, allowing patients to receive daily text prompts and use their smartphones to upload documents.
- Staff now focus on educating patients rather than chasing paperwork, leading to greater job satisfaction, faster processing times and even greater staff retention.
- The health system is meeting the new 30-day Medicaid timeline, and proactive text alerts are helping patients prepare for redeterminations under the new six-month cycle.
More Than a Revenue Boost
Stoldt emphasized the toll manual Medicaid enrollment once took on both revenues and revenue cycle staff. Previously, the hospital relied on Excel spreadsheets to track thousands of uninsured patients, an approach he called "nearly impossible to keep up with."
"It's out of date within 24 hours of the date it was created," he said, highlighting the shift from static spreadsheets to dynamic digital workflows. "Now we have continuous tracking."
Staff are now able to assist 20 to 40 patients a day, he said, with clear visibility into outcomes, a major morale boost.
"It's almost immeasurable how much the staff appreciates the change in their role," he added.
Stoldt says employees now feel both more effective and more fulfilled in helping patients secure coverage. The move to automation has not only strengthened revenue recovery but also transformed the culture of the revenue cycle team by making their jobs easier.
More To Come
Stoldt sees automation not just as a tool for efficiency but as a catalyst for restructuring his finance team and unlocking new patient engagement strategies. He said he is now evaluating a shift from outsourced enrollment services to an in-house solution, estimating $1.2 to $1.3 million in net cost savings annually.
"We're going to substantially reduce [vendor use] and insource it," he said.
The automation-driven boost in staff efficiency is also opening doors to innovation around new Medicaid policies, particularly work requirements. With volunteering now counting toward Medicaid eligibility in some states, Stoldt is planning to integrate a volunteer placement feature into the enrollment software, linking applicants directly to his hospital's existing volunteer office.
"If we get patients enrolled… and they become volunteers for us, they'll get the inside of the operation," he explained, noting the potential for long-term impact.
Volunteers could gain job exposure, build skills, and eventually move into employment, potentially transitioning from Medicaid to employer-sponsored insurance. The approach promises a triple benefit: lower administrative costs, increased Medicaid enrollment, and workforce development for underserved patients.
As Stoldt framed it, "It's a win-win in multiple aspects."
The Future of Enrollment
Stoldt stresses that without efficiency gains, especially amid anticipated funding losses, many hospitals won't remain viable. He also argues that automation must extend beyond eligibility and touch every part of the revenue cycle (including non-revenue functions) to offset payer denials, labor costs, and administrative friction.
"There isn't a single thing that we do that we can't do better, more efficiently, at a lower cost without impacting patient care," he said.
Marie DeFreitas is the CFO editor for HealthLeaders.
KEY TAKEAWAYS
With two-thirds of some health systems' Medicaid margins at risk, AI solutions are helping CFOs cut administrative costs and maintain fiscal sustainability.
Saint Peter's University Hospital CFO Garrick Stoldt shares how an AI-driven platform saved the organization millions and boosted Medicaid enrollment exponentially.
CFOs must see automation as essential across the entire revenue cycle and beyond, helping systems navigate payer denials, labor shortages, and rising costs without compromising care delivery.