https://youtu.be/xBP6Teap7SI
GetixHealth Podcast
One Big Beautiful Bill Webinar
Alex Oey · October 16, 2026
Transcript — follow along with the video
- Shawn Gretz(0:03) Good morning and good afternoon everyone when welcome to Jetix Health webinar on One Big Beautiful Bill or HR 1. (0:11) I'm Sean Gress, Jetix Health's President and Head of Sales and I appreciate you taking the time to join us today. (0:18) Before we get started I have one housekeeping item and that is if you want to ask any questions during this event you can.(0:25) All you have to do is put it in the chat box on the side, enter that question and we'll try to ask those of Jorge at the end of the session. (0:34) Also this webinar is being recorded. (0:36) We're going to include it on our website so you can take a look at it afterwards or share it with people in your organization, friends, family, whoever else wants to learn about the One Big Beautiful Bill, HR 1.(0:46) We'll send you a direct link afterwards as well. (0:50) Now it's my pleasure to introduce Jorge Rodriguez. (0:53) He is the Vice President of Operations for our ePALS team, our Medicaid eligibility services offering at Jetix Health.(1:02) Jorge is going to walk us through the upcoming Medicaid changes, what they mean for hospitals and health systems and key considerations for organizations should keep in mind as they prepare. (1:13) We expect today's discussion to provide a lot of value. (1:16) We also have a lot of value to give afterwards as well as an organization as you navigate the landscape.(1:23) With that I'm going to turn it over to the great Jorge Rodriguez. (1:28) Jorge take it away sir.
- Jorge Rodriguez(1:30) Thank you John. (1:31) Hello everybody and thank you for joining us today. (1:36) I've been involved in the Medicaid eligibility services world since 1991.(1:41) I think I was about five years old when I joined and I've seen many many changes on Medicaid policy throughout my career. (1:50) Many of you guys on this audience remember before the ACA, the Affordable Care Act, when for the most part your families with dependent children, pregnant women, and certain disabled individuals that were eligible for SSI were the only ones that were getting Medicaid. (2:09) And talking about SSI, what a cumbersome program.(2:13) Sometimes it will take you two years to get somebody approved on SSI at the fair hearing level. (2:19) Then it came the ACA. (2:21) Most of the states that expanded to Medicaid and expanded coverage to a single adult, childless adults, and also HPE was implemented during HPA.(2:32) Then came COVID. (2:33) Who can forget COVID, right? (2:35) With COVID the federal side dictated to states, mandated states to simplify the Medicaid enrollment processes, less applications, and remember automated certifications, recertifications.(2:51) Every year they were getting automatically certified. (2:54) We got so used to it. (2:56) There were actually some revenue cycle management companies that did not specialize in Medicaid eligibility services and they started offering this service because the learning curve was much shorter, right?(3:08) It was a little bit easier to help people with Medicaid. (3:11) As a matter of fact, some hospitals internalized Medicaid eligibility and they created a hybrid team between their financial counselors also doing eligibility because again it was a little bit easier. (3:25) Now sit down and buckle up because the road to eligibility is getting much tougher.(3:32) So the one big beautiful bill, HR 1, was signing to loan July 4, 2025. (3:39) This is a massive budget reconciliation package with hundreds of pages covering changes in certain taxes, border security, defense spending, and the most important to us, some significant policy changes to Medicaid mainly intended to reduce Medicaid expense. (4:03) So today I'm going to speak about what is changing in Medicaid eligibility.(4:08) We'll review the four most impactful provisions on the one big beautiful bill and the impact this could have on Medicaid enrollment and applicants. (4:18) We will also be talking about the early signs we're seeing today as some of these provisions, some of these changes are already affecting eligibility. (4:28) We'll review the potential operation and financial impact hospitals and other providers might be exposed to and then I'm going to give you some pointers on how to evaluate if you're ready for these changes and boy you know we better be ready because this is coming to us very very soon.(4:45) At the end of the presentation I'm going to provide you with a few important next steps and tools that could help you to prepare for these changes if you're not ready but hopes are you know you're halfway there right because these changes are coming and they're coming quick. (5:03) So with that being said, what is changing on today's world? (5:12) These are the four most impactful changes to Medicaid enrollment from the one big beautiful bill.(5:21) Number one, eligibility changes for some immigrants. (5:25) Number two, shorter retroactive Medicaid coverage. (5:29) Three, the implementation of community engagement requirements.(5:34) Most people know these as the work requirements. (5:37) And then the last one but not least, more frequent recertification for adults. (5:42) Yeah that's right okay we're not going back to the automated recertifications and now recertifications for certain groups they're going to happen every six months.(5:58) So let's look at the first one. (6:01) Eligibility changes for certain immigrants. (6:05) This rule already started this month effective October 1st the one big beautiful bill limits Medicaid eligibility to lawful permanent residents and few other non-citizen groups.(6:18) Okay the rest are only going to be eligible for emergency Medicaid services only. (6:24) Refugees and other humanitarian groups who were previously eligible for Medicaid coverage, full Medicaid coverage, now they only qualify for emergency Medicaid. (6:34) Also low-income immigrants no longer qualify for subsidies to buy market health insurance.(6:41) Most of them cannot afford full premium so likely they're going to end up uninsured and at some point they're going to end up at your hospital with no coverage. (6:51) Now most states provide emergency Medicaid assistance for certain undocumented immigrants but there are a few states that provide full coverage Medicaid while effective October 1st that changed because Medicaid for non-citizen and certain groups are only going to be for emergency services. (7:13) This rule is probably the least impactful the least impactful however okay everybody is going to be affected.(7:22) I don't care if you are on an expansion or non-expansion state you're going to be affected. (7:26) I mean think about some of those individuals that were enrolled in the marketplace or some of those those individuals that were eligible right for coverage and today they're going to be insured across the nation. (7:37) Okay not only you want to be affected financially but think about it these individuals they're not going to have an opportunity to go and get preventive care and they will normally end up your hospital when they're very very sick.(7:52) The second one is the changes on Medicaid retroactive coverage so typically Medicaid programs are required to provide retroactive coverage for three months preceding the individual's Medicaid application. (8:06) That is changing and again everybody is going to be affected by this rule whether the state expanded or not expanded on Medicaid. (8:15) So effective January 1st those expansion states and adults that are qualified for the expansion Medicaid okay they will be able to get Medicaid retroactive to only one month prior to the application date.(8:30) The rest of the world will be two months. (8:34) We were used to three months before the application date that is only only two months even for pregnant women. (8:41) We did an analysis on data for a group of acute hospitals and out of all of the own injuring patients we assisted with the application process and we got approved for Medicaid.(8:52) Listen to this 40 percent were expansion adults that will be impacted by the one month retroactive rule. (9:01) 40 percent that translates to millions and millions of dollars on potential Medicare reimbursement to some of our hospitals. (9:09) So if you don't have already in place a good solution this is a huge risk.(9:16) Now states like Arizona they have waivers in place that changes the rule a little bit. (9:22) So Arizona has a waiver for their Medicaid that has been in place for years on where the expansion adults have retroactive Medicaid only to the first day of the application date. (9:34) So what this means is if an individual got admitted gets admitted on October 31st okay and that individual is an expansion adult and you file an application on November 1st the admit date charges of October 31st will not be covered okay.(9:56) So when this rule was announced implemented years ago we adjusted our processes in Arizona to expand our coverage until late 11 12 p.m. the last day of every month just to make sure that we were able to assist these patients on that same day with the application process. (10:17) Otherwise there will be a loss of coverage. (10:20) So you know that said let me ask you do you know what the potential impact this new rule will have on your facilities and are yourselves ready for this?(10:34) Ask yourselves these questions. (10:36) Do you know what's the average number of expansion adults you'll help applying for Medicaid every month? (10:42) You need to know this to be able to know if you're ready or you're not.(10:47) Have you conducted an analysis to determine the average time it takes your team today to find Medicaid applications and the potential financial impact your current processes will have under the new regulatory requirements? (11:01) You might be doing good today okay but what you're doing today if it's been the same process that you've been doing for years it's not going to work once these rules kicked in. (11:14) Do you have the correct process in place?(11:17) The correct team or the experienced eligibility partner to make sure that 100 percent of your applications are submitted timely right? (11:27) You're going to have less time. (11:29) It's going to be very important to think about it.(11:32) This is something you'll need to know so you can be prepared for these changes.
- Jorge Rodriguez(11:36) Now let's move to the next slide.
- Jorge Rodriguez(11:46) Community engagement requirements also known as the work requirements. (11:51) This rule starts January 1st. (11:53) This regulation requires that certain Medicaid expansion adults work, go to school, volunteer, participate in another fine qualified activity for 80 hours a month or that they have earned at least 580 dollars a month to be able to enroll or maintain their Medicaid coverage.(12:16) This could be one of the most impactful changes that this will increase the complexity on Medicaid enrollment, potentially increasing the risk on application processing and delays and coverage disruptions. (12:29) Now there are some federal mandated exemptions and there are some state optional exemptions to the work requirements. (12:37) If an applicant or a Medicaid enrollee qualifies for one of these exemptions then they don't have to meet the work requirements.(12:45) You have to have a solid experienced patient advocacy team and enrollment support strategy to make sure that effectively you can identify and apply these exemptions. (12:58) This will be key to help your patients maintain or obtain Medicaid coverage and keep their access to care while you're protecting your health system from potential reimbursement loss. (13:10) Based on our analysis, 25% of volunteer inpatient expansion adults that we help applying for Medicaid reported zero income and therefore will need to meet either a federal or a state exemption to qualify for Medicaid under the new rules.(13:28) 25%. (13:29) Again, this rule puts millions of dollars in Medicaid reimbursement at risk if the right process and experience team are not already in place at your facilities. (13:40) So we all know that today if an inpatient is discharged from your hospital before your eligibility team screens that patient, interviews that patient and asks whether this patient qualifies for Medicaid and helps this patient with the Medicaid application process.(14:01) If this patient is discharged before that happens, you lose over 50% chances on resolving those cases. (14:10) With the new rules, it's going to go even tougher than that. (14:16) So it's going to be very important that your eligibility team, whether it's your internal team or your current partner, has a success rate of not less than 98% on bedside screening before that patient gets discharged.(14:32) Think about it. (14:34) The best opportunity you have to assist the patient and ask is whether they meet the work requirements or whether they qualify for one of the exemptions. (14:45) Your best opportunity to do that is while the patient is still in-house, which is also going to help you to work with the patient or the family members to gather the verifications they need to support either the work requirements or to help them to meet one of those exemptions.(15:03) So the question is, do you know what are the federal exemptions and if your state has opted for the optional exemptions and what these are? (15:14) Do you have a process in place, the tools, the tracking system, the technology, et cetera, and an experienced vendor to help your patients with application processes and supporting documentation that satisfies the new requirements or an experienced team that is going to be able to help the patient and ask whether they qualify for one of these exemptions or not. (15:44) The next one is the renewals every six months.(15:50) We wish that we had the automated recertifications every month, right? (15:54) Not any longer. (15:55) So effective January 1st, the One Big Beautiful bill will require certain Medicaid expansion adults to renew their Medicaid coverage every six months.(16:05) Now, this new rule directly correlates with the new community engagement requirements. (16:13) So not only they have to recertify every six months, but every time they recertify, they need to meet the requirements for the work rule or they have to meet one of their exemptions. (16:27) So states today are implementing a process to remind Medicaid enrollees when their coverage is about to expire.(16:37) However, we see it today, right? (16:39) They do the same thing today with the one-year recertifications. (16:43) They get the reminders, but every day we get a hospital, a patient at our hospitals where their Medicaid just lapsed a month ago, two months ago, because they just didn't re-enroll.(16:54) We're going to continue seeing this at a higher frequency, which is going to increase your uninsured population at your facilities. (17:03) We did an analysis and of all of the uninsured patient expansion adults that we converted to Medicaid, 33% were re-enrollees. (17:15) So think about it.(17:16) In theory, the number of re-enrollees can double in the future. (17:23) Now with more frequent Medicaid re-enrollments and increasing requirements, we can see also that there is a potential problem in approving those cases fast at your county offices. (17:36) Your county office is going to have a higher intake of applications, more applications to process, more verifications to collect, right?(17:44) So likely it's going to take them longer to approve the cases, and this can definitely have an impact on your discharge planning, length of stay, et cetera. (17:55) So ask yourselves, do you have a strategy in place to manage the potential increase on uninsured patient visits? (18:04) And how will you mitigate the anticipated impact on patient length of stay, discharge planning, and post-acute placements due to the delays in the Medicaid application processing?
- Jorge Rodriguez(18:23) So what are we seeing today?
- Jorge Rodriguez(18:30) These are some changes that we are experiencing nowadays related to the one big beautiful bill already. (18:38) We're already seeing a steady increase in uninsured patient volumes, which is placing additional strain on county eligibility offices, and they're extending the time it's taking them to approve Medicaid applications. (18:51) It's not that bad today, but we're seeing it.(18:55) We're seeing cases where instead of 30 days, it's taking them 34 days to approve. (19:00) Still pretty good, but believe me, it's going to get much worse. (19:05) These days directly impact the timeline.(19:07) The delays impact directly the timeline from application submission to reimbursement, right? (19:13) I mean, you cannot bill until the case gets approved for Medicaid. (19:16) So if it is going to take longer, that is going to slow down your cycle times.(19:21) It's going to slow down and delay the time that it takes for you to be able to bill and get Medicaid payment. (19:29) Several health organizations are taking proactive steps now to address these challenges and mitigate the impact of the one big beautiful bill related changes on coverage, access, financial performance, and the ability to deliver high quality care. (19:47) States have the option to implement some of these provisions early.(19:52) We already seen states like California earlier this year, January 1st, they started restricting the coverage to emergency services only for certain individuals that don't have a satisfactory immigration status, when before they were eligible for full scope Medicaid. (20:12) This new rule also created a change on billing processes because now every single of those cases that is approved for emergency Medicaid, it better be billed with supporting medical records to substantiate emergency. (20:27) Otherwise, they're going to get denied and they're going to, again, further delay reimbursement to your facility.(20:34) Admitting patients approaching their Medicaid expiration date have always been a concern. (20:41) These scenarios will potentially increase again with shorter redeterminations. (20:45) You're going to see more patients in-house overlapping to the next month and the Medicaid expires this month.(20:52) What are you going to do about it? (20:53) So an example of what we are doing with some of our clients is identifying future lapses in coverage for those in-house Medicaid patients to proactively support them with their re-enrollment while they are in-house and avoid coverage disruption. (21:10) Having a well-established process around these provisions will provide your patients with a deeper level of support and it will help minimize the potential impact that these rules might have on your facilities.(21:38) Okay, so now that we reviewed the most impactful changes on the one big beautiful bill, let's do a little recap. (21:50) So we have less qualified immigrants and that can increase your own insured patient volumes, potentially impacting charity or bad debt write-offs. (22:01) The restricted Medicaid coverage could have an impact on reimbursement, discharge planning, length of stay.(22:09) The shorter enrollment windows could also negatively impact hospital revenue and charity or bad debt write-offs. (22:18) The reduced time available for individuals to apply for Medicaid will increase the risk of applications being filed late, leaving the hospital visits charges on cover. (22:31) The work requirements, again, one of the most impactful changes.(22:35) They're going to increase enrollment complexity, making it more difficult for individuals to successfully complete the Medicaid application process and this could increase the volume of uninsured patients. (22:47) And the more frequent recertifications also requiring beneficiaries to meet work requirements increases the risk of coverage disruptions. (22:57) Individuals who lose Medicaid coverage during the redetermination can potentially return to your hospitals as uninsured, creating a big financial burden to your facilities.(23:08) Now I'm also sure we are going to see sicker patients. (23:13) Normally, uninsured individuals do not seek preventive care and they end up hospitalized when their medical condition worsens. (23:22) So remember this, if you are not on an expansion state, you will still be impacted by the new two-month retro coverage and by some changes also in coverage to non-citizens.(23:36) These individuals, again, had prior coverage, now they're going to end up as uninsured. (23:42) If you are on an expansion state, however, all of these changes could have a huge impact for your patients and hospitals. (23:51) Just remember, our numbers don't necessarily reflect what everybody is going to see, but it's going to be pretty close.(23:59) 40% of expansion adults affected for these rules. (24:05) 25% meeting work, they're going to have to meet the work requirements because they had zero income. (24:13) 33% of our expansion adults were re-enrollees, so multiply that by two, right?(24:21) Your number is going to increase significantly with the new rules. (24:25) It's so important that you have the best processes in place or the best eligibility partner in place. (24:31) So laser focus has to be on making sure that your team is screening 98% to 100% of your in-house inpatients before they get discharged.(24:45) You need to make sure that 100% of your applications are submitted timely within your timelines. (24:53) And there's just too much at risk, starting with patient care and the financial impact. (25:00) Nowadays, we're talking about inpatient average total charges between $80,000 to $140,000.(25:08) And if you are a trauma facility, we're talking about $200,000 and over for a single inpatient account. (25:16) So before the upcoming changes, you were able to do okay on your eligibility processes with the basic processes, basic technology, and not a very experienced eligibility team or financial counselors hybrid team. (25:37) Before or today, that was okay.(25:39) Tomorrow, it's just not going to be good enough. (25:43) There's too much money at risk, too many patients that are going to lose their care. (25:50) Your healthcare system and your patients definitely deserve the best possible processes.(25:58) So we know that the Medicaid enrollment changes. (26:03) One big beautiful bill is bringing my costs, changing processes. (26:07) But the question is where hospitals can be exposed today in the revenue cycle.(26:13) So let's take a look at those. (26:22) So it is expected an impact on operational and staffing. (26:28) There is a potential increase in operational cost.(26:31) Hospitals or their eligibility vendors, as they will likely need to invest in additional staff or new technology to properly handle the expected increase on uninsured patients and efficiently assist them with the Medicaid application process. (26:47) Now, there will be an impact on patient flow and discharge planning. (26:52) So the more frequent recertifications and especially the work requirements, this could cause Medicaid application processing delays impacting discharge planning, length of stay, and possible delays in post-acute placement causing unnecessary and potential uncovered charges.(27:11) We see it today, right? (27:12) We see it every day. (27:13) When you have an inpatient and this patient is now stabilized and needs to be transferred to a nursing home, but nursing homes don't take pending Medicaid.(27:23) So you need to wait until the case is approved. (27:25) So if there is a slow process today, tomorrow is going to be way more difficult. (27:33) Financial and revenue cycle impact, rising operational costs associated with the eligibility enrollment and patient advocacy efforts, increase your exposure to bad debt, uncompensated care, and charity write-offs.(27:49) The eligibility and application processing impact, it's a big exposure for hospitals if they don't have in place today a good Medicaid eligibility process already aligned with the new requirements for the One Big Beautiful Bill. (28:05) Also, the longer application processing timelines, it could cause potential coverage and reimbursement delays. (28:21) So now that you know all of the stuff that is changing, how do you know if your team is ready for these changes, right?(28:30) How do we evaluate readiness? (28:36) To prepare for these upcoming changes, you should perform an analysis to understand where do you stand today? (28:45) How are your processes today in comparison to the changes that we're going to be seeing with the new rules?(28:51) For example, community engagement and the six small renewal changes are especially relevant to the adult expansion population. (28:59) So if you are at an expansion state, you need to run an analysis. (29:04) You need to know approximately how many from your total uninsured patients fall under this group.(29:11) Remember, these are your 19 to 64-year-old non-disabled individuals. (29:16) Once you know this number, then you need to determine how long it's taking your team today to file Medicaid applications for the same group. (29:26) What percentage of those applications are filed after the month following the admin date?(29:32) This result is your current exposure and potential impact to the retroactive Medicaid changes. (29:41) So you're finding applications late today when we have three months to do it. (29:45) Again, what you're doing today is not going to work with these new rules.(29:50) You really have to implement new processes or bring the new partner in-house. (29:56) So next, if you currently document your system with information on whether your patients had prior Medicaid coverage and then the later lapse, then you can determine how many of these patients you help to re-enroll. (30:11) In theory, the number will double, right?(30:15) So multiply that for two, okay? (30:17) And that's going to be your potential increase on re-enroll is due to the next six-month recertification rule. (30:25) It's very important that you know if and what short-term hardship exemptions your state is planning to adopt.(30:34) These exemptions can play a big role on whether a patient could be eligible or not. (30:39) So make sure that you are aware what exemptions your state is adopting. (30:44) Once you know your analysis results, then you can determine how your current process looks in comparison to what is coming and what new processes you need to establish to mitigate the potential impact that these rules might have on your operations.(31:21) To assess the potential impact these rules changes will have in your operations, you must know whether your state expanded or not for Medicaid. (31:31) You also need to keep track on whether your state is adopting or not the optional exemptions to the work requirements. (31:40) And very important, how are they interpreting these exemptions and what documentations will they require to satisfy these requirements?(31:48) We have, we've been meeting with the counties. (31:51) We have a couple of meetings next week with two different counties, precisely talking about how are they going to implement this work requirement. (31:59) These changes, what verifications will are going to be acceptable or not.(32:05) Even though we're very close to the goal I date on these changes, again, states are trying to implement. (32:13) We see changes every day. (32:15) Okay.(32:15) So you need to stay on top. (32:17) You need to make sure that you're meeting with your county officers, with your Medicaid offices to try to understand where are they today in terms of these new rules implementation and what verifications are we're going to be acceptable to satisfy requirements or exemptions. (32:41) So now that we know how these new rules can really impact us, okay, what do we need to do next?(32:56) So as we prepare for these upcoming changes to the Medicaid, along with the financial uncertainties that we follow, having in place a concrete readiness plan will put you and your organization in the best possible position to mitigate the potential impact. (33:14) So start by assessing your business. (33:19) We're going to be providing you with a list of all of the readiness checklists that we created, and this is going to help you to track your progress.(33:26) Then you need to prioritize where your time and focus is allocated to address any process gaps that exist today. (33:35) You need to identify where staffing and technology enhancements are needed, and believe me, for the most part, on every facility, you're going to need to ramp up. (33:46) You need to be able to track the specific implementation timing for every stage.(33:54) We are going to provide you with a matrix, okay, that we have developed and that we update every month, and this is going to be a helpful tool for you. (34:01) And then finally, you know, you need to act now to prepare yourself for some of those drastic changes. (34:17) This preparedness checklist is going to help you to track your progress towards the One Big Beautiful Deal changes and preparedness, and it will be part of a couple of tools that we're going to be providing to you on the next slide.(34:38) We're going to be sending this presentation to all attendees, and from this slide, you can actually click on the link on every one of these three sections, and you can access the tools that are going to be a little helpful for you to make sure that you are prepared. (34:56) So, we'll go to the first one. (35:04) I hope you all can still see my screen.(35:06) So, this is our readiness checklist, okay, and right here, you're going to be able to track, whether you have done your analysis and know what your exposure is or not, right, whether this is in progress or you have completed it. (35:23) Same thing, you have determined the potential coverage losses, the needs, some staffing. (35:30) If you have tools in place to help your patients with the community engagement requirements, okay, we broke it down by high priorities and then medium priorities to evaluate.(35:43) Again, you can access this one from the site that is going to be on the presentation that we're going to send you.
- Jorge Rodriguez(35:59) On the state matrix, I'm trying to access it.
- Jorge Rodriguez(36:02) So, state matrix tracks state-by-state expansion status, implementation timing, and Medicaid policy changes relevant to your organizations. (36:14) I'm going to provide you to this tool. (36:16) We update these changes on a monthly basis.(36:22) There you go. (36:24) We update these changes on a monthly basis, but I'll suggest you to get to your state websites also, you know, for real-time updates, and again, you know, try to make sure that your teams are meeting with county officers to make sure how they're implementing these changes and what decisions are making on whether they're going to accept exemptions or not. (36:50) So, in this matrix, you can go to your state, you know, example right here on the first one is, you know, let me do…you can sort it by many ways and you can filter it on many different ways.(37:05) For example, we have Alabama. (37:07) Alabama is not an expansion state, okay? (37:09) So, on the retroactive coverage, they will be affected, but they will be affected by the two-month retroactive rule, right?(37:17) Not by the one month because they don't have expansion adults. (37:20) They didn't expand it. (37:22) Okay, work community engagement, this likely not going to affect Alabama as they did not expand it, but all expansion states will be affected by the work community engagement unless they adopt one of the exemptions.(37:40) So, getting to this tool, right, get familiar with it, and again, you know, it's going to give you good information and it's going to be a good indicator, right, for you to actually going to your hospital…I'm sorry, to your state's websites and check for more detailed information if needed.
- Jorge Rodriguez(38:04) Also,
- Jorge Rodriguez(38:07) if you like to review your findings after your analysis or you need help, right, with thinking (38:13) about how the analysis should be done or any questions that go unanswered after this session, (38:19) you can schedule a session with our team, okay, by just clicking on that link, (38:26) completing your contact information right here, and we'll be more than happy to meet with your (38:31) teams and, you know, do the best we can to help you with providing a solution. (38:42) So, now that we ended with the slides on our presentation, I would like to open the session for questions and we'll try to address those questions the best we can.(38:57) Sean, do we have any questions?
- Shawn Gretz(38:58) Yeah, first off, Jorge, thank you so much for a great presentation. (39:02) Always engaging, always a whole wealth of knowledge, especially I love the idea to quantify how the impact is going to happen to you as HR 1 rolls through. (39:13) Same thing with the ability to go to your county offices and have conversations.(39:17) Those are really good recommendations. (39:19) So, the first question comes from me. (39:21) You mentioned this and so I got to ask the question.(39:24) You said you got to find the best Medicaid eligibility partner out there. (39:28) Jorge, who is the best Medicaid eligibility partner to work with?
- Jorge Rodriguez(39:37) Look, look, okay, this is important, right? (39:42) I mean, there are good eligibility companies out there, but as I mentioned before, when the Medicaid processes were simplified, super simplified during COVID, okay, people brought their guard down. (39:57) You have companies that have no expertise, they have no experience on eligibility services, but they included those services because the learning curve was much easier, okay?(40:10) If they don't have the prior experience on Medicaid, if they don't have the SSI program knowledge, right? (40:19) Remember, you know, before the Affordable Care Act, field visits, you know, was part of our daily bread. (40:25) You're going to patients' homes, you know, and helping them gather all of these verifications.(40:30) After the simplification and the automated recertifications, all of that went away. (40:37) So, companies that don't have that experience, they're not going to be ready to do a good job with these new changes. (40:43) So, that's something that you need to take into consideration.(40:47) We've been on this business for over 25 years and we've seen many of those changes. (40:52) We retain all of the knowledge that we had prior to these changes. (40:56) We still, today, we still do SSI cases, okay?(41:00) We still go and do some home visits when necessary, but the most important thing that we do today is we make sure that no patient, no inpatient, leaves your facility before our team screens that patient. (41:16) Now, to be able to do this, you have to have the right systems, you have to have the right technology. (41:24) We have representatives at over 80 hospitals across the nation.(41:30) How do I know that my representatives were able to screen every single patient today? (41:36) The only thing you can know that is if you have the right tools, if you have the right experience management team. (41:43) We're looking at that every single day.(41:46) And once we screen the patient, did we do a good assessment in screening that patient for eligibility? (41:52) Are we working on those verifications? (41:55) Are we following up timely on those cases?(41:58) Again, if you don't have the right process, the right technology, the right systems, and the right team, things are going to fall through the cracks. (42:07) And one single account, one single inpatient account can mean a lot of money and reimbursement to your facilities. (42:15) Plus, it wouldn't be fair to your patients.(42:17) I hope that answers your question, Sean.
- Shawn Gretz(42:20) Thank you. (42:21) It's a humble way to say it of your experience, your knowledge, and everything that went into GenX Health and the ePALS team. (42:29) But I'll say it, we are by far, you got to call us to have a conversation at GenX Health in regards to the Medicaid eligibility services.(42:37) That's my role as well. (42:39) But we do have one question. (42:42) And I think this one's going to be a softball for you.(42:44) The qualifications for anybody that has Medicare as primary and Medicaid as secondary, do the redeterminations happen in the same way?
- Jorge Rodriguez(42:54) The redeterminations do happen in the same way unless these individuals are qualified for SSI. (43:01) That's going to be a long-term application. (43:03) If they are aged or disabled, now for the most cases, your Medicare patients are aged or disabled.(43:08) Any individual that is receiving Medicare or that is eligible for Medicaid today, I mean for Medicare today or receiving Medicare today, they do not have to meet the work requirements. (43:24) If this is a new case, the retroactive Medicaid new rules will apply. (43:30) They don't have Medicaid today.(43:32) But again, the recertification service every six months and work requirements are not applicable.
- Shawn Gretz(43:39) Perfect. (43:40) Well, thank you very much, Jorge. (43:42) That's the only question we had.(43:44) I also like to give a big shout out to the entire team that put together the checklist, the PowerPoints, the work requirements available online as well. (43:54) So thank you, Jorge. (43:56) And then also thank you to the attendees for joining us today.(43:58) We hope you enjoyed this webinar series and we're going to hope to have many more coming soon of valuable content. (44:05) So please make sure you sign up and register to see our content from time to time.
- Jorge Rodriguez(44:10) Thank you, everybody. (44:11) And don't forget, you're going to be receiving this presentation, links to your tools, and very important, again, if you'd like to set up a session with our team, we'll be more than happy to help you out. (44:24) Thank you, Sean.(44:24) Thank you all.
Executive summary
The One Big Beautiful Bill cuts retroactive Medicaid coverage, adds work requirements, and forces six-month renewals starting January 1. Here is what hospitals need to change now.
Jorge Rodriguez, VP of Operations for GetixHealth's ePALS team, walks RCM, PFS, patient access, and finance leaders through the four most impactful Medicaid provisions in the One Big Beautiful Bill and the operational redesign hospitals need before the January 1 effective date. Drawing on data from more than 80 hospitals, Jorge quantifies the exposure, from the 40% of expansion adults affected by the one-month retro rule to the 33% of Medicaid conversions that are already re-enrollees.
Key takeaways
- How the four HR 1 provisions (immigrant eligibility, retro coverage cut, work requirements, six-month renewals) each hit reimbursement differently.
- Why bedside screening at 98% or higher becomes a reimbursement safeguard, not a best practice.
- How to quantify your 2026 exposure by segmenting uninsured patients into expansion adults, re-enrollees, and late filers.
- Why same-day, end-of-month filing capability can preserve entire inpatient admissions in states like Arizona.
- What questions to ask your current eligibility team or vendor before January 1.
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