HR 1, known as the One Big Beautiful Bill Act, will make significant changes to Medicaid in January 2027, including work requirements for certain enrollees to maintain eligibility. It is estimated that millions of people could lose coverage due to these work requirements.
But is it possible that the implementation of these changes will be slow, in terms of removing people from coverage? A health care expert says it might be necessary.
“I really struggle to see the policy being launched in its full form, with its full effectiveness on January 1 and in an enforceable way,” said Matt Salo, founder of Salo Health Strategies. “And I continue to believe that with all the changes that need to happen because of government systems and decisions, planning partnerships, outreach, engagement and member activation, we’re going to see a bit of a soft opening of a restaurant on January 1st.”
Salo made the comments during a panel discussion Wednesday at AHIP Forum Medicare, Medicaid, Duals and Commercial Markets in Washington, D.C. He added that if changes are not implemented slowly, it could look bad for the government. He said negative news is likely as coverage losses occur due to gaps in systems and insufficient member awareness.
“It’s a very, very bad message,” Salo argued. “And I don’t think there’s a state in this country that wants to see that, and I don’t think the administration wants to see that either.”
Beyond technical hurdles, Salo cautioned that reaching the right enrollees with the right information will be a challenge for states and health plans. He noted the end of the Covid-19 public health emergency, when states ended continuous enrollment provisions that allowed beneficiaries to remain covered during the pandemic without undergoing a redetermination of their eligibility. Meanwhile, states had only one message to send to all enrollees: be redetermined to maintain coverage.
But there is no single message to send to all Medicaid beneficiaries when it comes to the HR 1 changes.
“It’s going to be a little different this time, because we’re not going to give the same message to everyone in the Medicaid program,” Salo said. “There are some people we don’t necessarily want to communicate with — the job requirements won’t apply to them, and we don’t want to confuse them unnecessarily. … There will be different messages for different affected populations.” For example, job requirements generally do not apply to pregnant people or people with disabilities.
Other panelists disagreed that implementation of HR 1 Medicaid changes will be slow. Kate McEvoy, executive director of the National Association of Medicaid Directors, noted that there was a “Herculean effort” underway between CMS and states around the functionality of the system. For example, there has been a focus on improving ex parte renewals, which verify Medicaid eligibility using existing data such as income records, without requiring documentation from patients.
“I don’t subscribe to Matt’s version, where there will be a smooth rollout. We have no indication from the administration that that will be their approach,” McEvoy said.
Another panelist echoed McEvoy’s comments.
“I think we will have made a lot more progress than I think possible in this period, [with] some of the new technology, some of the new outreach methods that I’m seeing,” said Darin Gordon, former director of TennCare, Tennessee’s Medicaid program. “I think we’re going to take another leap forward here where we’re really going to significantly improve our overall eligibility process, our member engagement significantly.”
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