HR 1 and shifting coverage landscape five steps health systems can take now

H.R. 1, the One Big, Beautiful Bill Act, is now beginning to make its effects felt across federal health programs. The law tightens Medicaid financing and payment rules, scales back marketplace tax credits for certain populations, and in combination with Pay-As-You-Go (PAYGO) provisions, could mean Medicare cuts of up to 4% annually - roughly $45 billion in 2026 alone.

The Congressional Budget Office projects marketplace benchmark premiums will climb an average of 7.9% between 2026 and 2034 if enhanced credits are not renewed, and that the uninsured population will run approximately 3.8 million higher each year over that period - pushing total uninsured into the mid-30 million range. For provider teams managing patient access, eligibility, and revenue cycle, that is a material operational shift that requires action now.

These coverage changes compound existing pressure: labor shortages, rising pharmaceutical and supply costs, and continued reimbursement erosion. The organizations that will manage the transition best are those that apply the same outreach and eligibility strategies that proved effective during the Medicaid redetermination cycle - starting before the impact lands, not after.

Five actions to take now

1. Launch a digital outreach and education campaign. Text messages, patient portal alerts, AI-generated calls, and email campaigns alert patients to upcoming coverage changes, enrollment deadlines, and documentation requirements. Providers that ran these campaigns during Medicaid redetermination consistently saw better coverage retention and fewer gaps-in-care encounters.
2. Help patients retain coverage before gaps occur. Predictive analytics tools can identify patients most likely to be affected by eligibility changes. Financial counselors can then evaluate options including regular ACA credits, employer or spousal plan coverage, Medicaid, CHIP, or charity care - and integrate that exploration into existing clinical and administrative workflows so applications and referrals are captured in real time. Begin educating counselors and clinicians about the new Medicaid redetermination and work requirements now, so they can address questions during patient visits.
3. Include revenue cycle in H.R. 1 mitigation planning. Accurate coverage verification, eligibility discovery, and pre-registration processes will be essential to maintaining cash flow as payer mix shifts toward higher self-pay volumes. Finance, revenue management, compliance, clinical operations, and government affairs should develop coordinated strategies for managing increased volumes of uninsured patients using emergency department and outpatient services.
4. Develop processes for supporting patients through new Medicaid eligibility requirements. Beginning January 2027, states must conduct eligibility checks every six months for most adults in the Medicaid expansion population. Combined with new work requirements, these changes will generate more coverage gaps and interruptions. Providers need real-time visibility into renewal status for each Medicaid patient, continuous eligibility checks, and active outreach to state agencies and managed Medicaid insurers to partner on enrollment at time of service.
5. Use data to support ancillary benefits positioning. Outreach data can identify Medicaid-eligible patients, patients under 65 who qualify for Medicare through disability, and patients receiving Social Security disability income. These data points support disproportionate share (DSH) status maintenance required for 340B participation. Granular analyses can also quantify the financial impact of lower Medicaid or higher uninsured volumes on the organization - providing evidence for partnerships with state agencies, employers, philanthropists, and community groups who can help secure care for patients who fall outside coverage eligibility.

Applying these tactics through 2026 and into 2027 mitigates the financial impact of a shifting payer mix and rising self-pay volumes. More critically, they help ensure patients retain access to care - reducing higher-acuity presentations and the downstream costs they generate for providers and patients alike.