Navigating the Impact of Federal Medicaid Reforms
Part 1: Why What You Do Now Matters for Your Members
Medicaid is entering a pivotal period, one that presents both real risks and urgent opportunities. During the June 4 webinar on navigating the impacts of the federal Medicaid reforms in the budget reconciliation bill, Ali Rizer, John Gorman, and Morgan Craven explored the larger context of what’s happening now, why it matters, and where we go from here.
At the heart of the conversation was a clear message: This moment is about far more than administrative updates. It is an all-out attack on the social support of our nation. With the end of the pandemic-era coverage protections and the return of more frequent Medicaid eligibility redeterminations, states and Managed Care Organizations (MCOs) face enormous pressure to get it right or risk Medicaid disenrollment of eligible individuals over procedural paperwork. The consequences for communities, particularly those that are historically marginalized, could be severe.
According to the Congressional Budget Office (CBO), an estimated 7.8 million people are projected to lose Medicaid coverage under the current federal reform proposals. Over 5.2 million will lose coverage due to new work and verification requirements alone. These losses are not primarily due to ineligibility, but because of administrative barriers like paperwork errors, communication failures, and missed deadlines.
Ali Rizer, executive vice president of ATI Advisory, emphasized that redetermination is not just a technical challenge. Rizer stated, “Redetermination is a wake-up call. If we don’t fix the way we communicate and share data now, we’ll keep repeating the same mistakes and people will pay the price.”
Redetermination is just one of the many tests of how well the Medicaid system can continue to serve people equitably and effectively within updated CMS expectations.
For many, losing Medicaid coverage won’t stem from ineligibility. It will result from paperwork delays, language barriers, or missed notices. And while states are working hard to manage this massive shift, they can’t do it alone. MCOs are essential partners in making sure people stay connected to the care they need.
Rizer, Gorman, and Craven underscored that this is also a critical moment to focus on health equity. Too often, communities of color and low-income families are the first to fall through the cracks. But with better data sharing, stronger outreach strategies, and systems built with users in mind, there’s an opportunity to prevent harm and build lasting improvements. These efforts support both community engagement and long-term retention.
Gorman, founder of Nightingale Partners, noted that: “This is the moment to get serious about equity and not just talk about it.”
We agree. This is the time for bold, equity-centered leadership and managed care reform.
While the Medicaid reforms will increase compliance requirements, it also requires a shift in mindset. Medicaid must be more than a safety net. It should be a platform for meaningful healthcare access, stability, and improved outcomes, shaping more effective Medicaid operations and Medicaid policy.
As the conversation closed, panelists left us with a powerful reminder: Medicaid reform isn’t about fixing systems in isolation. It’s about designing them to better serve the people at the center of it all and strengthening community health through more inclusive policies.
As your organization navigates this critical time, ask yourself:
Are your systems prepared for a seamless redetermination process?
Are you proactively reaching the people most at risk of losing coverage?
Are you designing with real-world equity (not just operational efficiency) in mind?
This moment offers a chance not just to update the Medicaid system, but to transform it.
In Part 2, we’ll dive into what it takes for MCOs to operate without leaving anyone behind.
Missed the webinar? Click here to watch the replay and download a summary of key insights and concrete actions MCOs can take right now.