Medicaid coverage rules are changing. Is your hospital ready?
H.R. 1 is now law. Help your patients stay covered while protecting your revenue.
H.R. 1 changes the rules. Your patients will feel the impact.
The largest Medicaid restructuring in decades is already in motion
Six-Month Redeterminations
Previously annual renewals will now happen every 6 months. More frequent eligibility checks mean more chances for missed deadlines and preventable coverage loss. Most beneficiaries are unaware of the change.
New Work Requirements
Medicaid expansion adults will need to document 80 hours of qualifying activity each month, verified twice a year. Patients who don't understand the requirements or can't navigate the documentation process may lose coverage despite remaining eligible.
A Shorter Retroactive Window
The retroactive Medicaid coverage window drops from 90 days to 30 for expansion adults and 60 for other populations, starting January 1, 2027, leaving less time to recover revenue for care already delivered.
More Demanding Verification
Presumptive eligibility accuracy becomes even more important to maintaining state compliance. Determination errors can trigger disenrollment and disrupt patient access.
What does this mean for your hospital?
The answer isn't simply managing new rules. It's helping patients navigate them.
Most patients who lose Medicaid won't lose it because they're ineligible, they'll lose it because the process was too hard to navigate.
That hits hospitals too: shrinking back-billing revenue, compliance risk from verification errors, and added operational complexity.
Protecting patient access means acting now: identify affected patients, educate them, and help them complete required steps before coverage is at risk.
Our Solution
Coverage for patients. Stability for your hospital.
H.R. 1 is reshaping how patients qualify for and keep their coverage. We help you manage that shift across the entire patient lifecycle: identifying at-risk patients early, engaging them proactively, and providing a coordinated process for Medicaid screening and work requirements submission, so coverage doesn't lapse.
Reach patients before coverage deadlines hit.
Multi-channel outreach reaches patients at scale before their coverage deadline, with state-specific messaging explaining exactly what's changed and what action is required.
Multi-channel outreach reaches patients at scale before their coverage deadline, with state-specific messaging explaining exactly what's changed and what action is required.
Gather documentation before the state asks for it.
Trained navigators help patients document qualifying activity and track eligibility data and work-requirement evidence before deadlines arrive.
Trained navigators help patients document qualifying activity and track eligibility data and work-requirement evidence before deadlines arrive.
Keep enrolled patients informed so coverage doesn't lapse.
Ongoing outreach keeps enrolled and re-enrolled patients informed of renewal timelines, work requirements, and process changes, reducing future churn and the cost of repeat outreach.
Ongoing outreach keeps enrolled and re-enrolled patients informed of renewal timelines, work requirements, and process changes, reducing future churn and the cost of repeat outreach.
Decades of Medicaid Expertise, Built for This Moment
40+ Years
of Medicaid and patient access expertise
500K+
Medicaid enrollments processed annually
$7.75B
in approved funding value recovered
800+
facilities nationwide relying on our operations
50 States
Experience across all 50 state Medicaid programs
How we deliver
Maintain coverage. Reduce operational burden. Protect revenue.
Proactive by design
We help you identify patients at risk before they self-identify, and before it becomes a revenue or compliance issue, giving your teams more time to intervene.
One connected operation
Eligibility, outreach, work-requirement documentation, and denial management work together, rather than across disconnected vendors and workflows.
Outcome-led accountability
We measure success by what truly matters: sustainable coverage, revenue recovered, and compliance achieved - not activity metrics or contact counts. Our commercial model aligns with yours: you only pay for results.
Deep industry expertise, embedded
Decades of experience are built directly into how we operate, through trained advocates, real-time guidance, and continuous learning at scale.
contact us
Build your H.R. 1 action plan
H.R. 1 readiness starts with understanding your exposure.
Schedule a consultation with our experts. We'll help you assess your Medicaid risk, estimate uncompensated care exposure, and identify where targeted interventions can deliver the most value.
- Evaluate gaps between your current processes and new 6-month redetermination cycles, work requirements, and shrinking retroactive coverage periods
- Get clarity on your organization's strongest levers for improvement