New Medicaid work requirements will create significant new administrative burdens for patient access teams, increase self-pay volumes, and lead to a rise in retroactive denials.
The One Big Beautiful Bill Act (OBBBA) is set to create new operational hurdles for revenue cycle leaders with Medicaid work requirements for expansion group populations in states that have expanded their programs.
These policies are set to create significant new friction at the front end of the revenue cycle, threatening to increase administrative burdens and uncompensated care costs. See the infographic below to see how these new rules will impact hospital operations and financial stability by creating complex new verification challenges for patient access teams to driving a costly surge in retroactive denials.
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Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Patient access teams could face complex, monthly verification processes to confirm if patients have met the 80-hour work requirement for Medicaid eligibility.
A surge in self-pay patients is expected to increase uncompensated care costs and hurt hospital operating margins, while "look-back" policies could lead to a spike in retroactive denials.
Patient confusion over the new rules has been a primary driver of coverage loss in past state experiments, signaling a need for proactive patient education.