At A Glance
The One Big Beautiful Bill Act (OBBBA) overhauls federal healthcare funding, coverage and eligibility verification, with major implications for revenue cycle performance. The first webinar in Experian Health’s three-part series focused on the key policy changes and what healthcare organizations should do now to prepare.
Key takeaways:
- The OBBBA introduces sweeping changes to healthcare funding and coverage, particularly for Medicaid, which could see an estimated $914 billion reduction in federal spending and millions losing coverage.
- New eligibility and verification rules are likely to increase coverage churn, denial risk and operational pressures.
- Providers should begin planning now by strengthening patient access workflows and using automation and artificial intelligence (AI) to protect revenue.
New federal healthcare reforms under the One Big Beautiful Bill Act are starting to take effect. But according to Experian Health research, only 10% of providers feel they have a solid grasp of how the policy changes will affect Medicare, Medicaid and the Affordable Care Act (ACA).
To help them make sense of the One Big Beautiful Bill healthcare changes, Experian Health launched a three-part webinar series with insights from leading experts. In the first session, Joel White, national healthcare policy expert and Partner at Monument Advocacy, discussed the policy landscape, examining regulations already issued, guidance still to come, and what this means for teams, processes and the revenue cycle. This article recaps the key points.
Webinar 1: OBBBA policy in action
National policy expert Joel White shares an insider’s look at what’s really happening on the Hill and how revenue cycle teams can prepare before reforms hit. From payment updates to shifts in enrollment, the bill is expected to affect reimbursement, payer mix and cash flow at never-before-seen levels.
Why the One Big Beautiful Bill is a turning point for healthcare
“This is the biggest change we’ve seen since the Affordable Care Act was enacted in 2010.”
Joel White, Partner at Monument Advocacy
“It’s going to create increased regulatory complexity and financial pressure, and that’s going to lead to a lot of friction in eligibility, enrollment and insurance,” said White.
Those pressures will add to an already challenging environment. Providers are facing reductions in drug reimbursement and coverage policies, Medicaid program cuts and the expiration of ACA COVID subsidies.
White said that higher uncompensated care, increased denials and fewer operational resources mean “a more sophisticated strategy on revenue cycle management is now absolutely critical.”
Medicaid impacts
Much of the One Big Beautiful Bill healthcare impact falls on Medicaid. White referred to Congressional Budget Office estimates that federal Medicaid spending will fall by more than $914 billion between 2025 and 2034. Most reductions will land between 2030 and 2034.
| The bulk of Medicaid cuts comes from four key changes: |
| 1. Community engagement requirements, which reduce enrollment among certain Medicaid expansion adults who do not meet work, service or education thresholds |
| 2. Provider tax reforms, which restrict how states finance the non-federal share of Medicaid spending |
| 3. State-directed payment reforms, which cap certain Medicaid payments relative to Medicare rates |
| 4. Eligibility and verification changes, including more frequent redeterminations and tighter enrollment checks |
Around 7.8 million people are expected to lose Medicaid coverage as these updates take effect.
Eligibility and verification impacts
Patient access teams must understand and prepare for the following eligibility and verification changes, rolling out soon:
More frequent eligibility redeterminations (applies to renewals on or after 31 Dec 2026)
Medicaid eligibility checks will move from annual to every six months. This increases the likelihood that coverage status changes between scheduling and the date of service, raising the need for real-time eligibility checks.
The OBBBA impact on healthcare will place greater pressure on patient access and registration teams to confirm coverage earlier and more accurately in the patient journey. Tools such as Patient Access Curator™ (PAC) and Patient Financial Clearance can help automate eligibility verification and support more accurate financial clearance before services are delivered.
Stronger enrollee data verification (varying effective dates)
States must obtain enrollee address information using reliable data sources. A federal system will be established to prevent individuals from being enrolled in more than one state Medicaid program, and states must submit enrollee Social Security numbers monthly to that system.
Narrowed immigrant eligibility (effective 1 Oct 2026)
Effective October 1, 2026, Medicaid and Children’s Health Insurance Program (CHIP) eligibility will be limited to a narrower group of lawfully present immigrants, which may reduce coverage and increase uninsured volumes in some markets.
Delayed implementation of eligibility and enrollment Final Rule (delayed until 1 Oct 2034)
OBBBA delays implementation of earlier rules that would expand enrollment, renewals and eligibility for Medicaid, CHIP and the Basic Health Program.
Expanded Medicaid provider screening requirements (effective 1 Jan 2028)
The changes will require states to regularly check whether providers have been terminated from Medicare or another state’s Medicaid or CHIP program, and to verify records against the Social Security Administration Death Master File.
What the OBBBA means for RCM
In a live poll, webinar participants identified revenue loss as their top concern by far. White outlined the pressure points to address at each stage of the revenue cycle to help mitigate that risk:
| Front-end: |
| On the front end, providers need to account for what White calls ‘coverage in motion,’ where patients see their insurance status change between scheduling and service. Real-time eligibility checks, coordination of benefits and coverage discovery can help prevent avoidable denials. |
| Mid-cycle: |
| Mid-cycle, it’s likely that the increased pressure on payers will translate to greater scrutiny of claims. Accurate coding and documentation will help prevent disputes. |
| Back-end: |
| Growing patient responsibility will push the focus to bad debt recovery and denial management. White said that using automation, AI and predictive analytics will be critical to improve collections as the changes roll out. As an example, Collections Optimization Manager uses advanced analytics to prioritize accounts, segment patients and help revenue cycle teams focus collection efforts more effectively as patients shoulder more of the cost of care. |
OBBBA strategic planning for healthcare providers
“Start now. Reassess and revisit your strategic plan.”
Joel White, Partner at Monument Advocacy
White encouraged providers to begin planning now rather than waiting for regulations to take full effect, noting that “each state will implement the provision of this law differently… You need to be paying attention to state and federal rules.”
When it comes to improving operational efficiency and addressing workforce issues, White again pointed to technology. “You’ve got to be able to manage your claims and your denials and your bad debt, and that requires using those new tools, updating your workflows to protect that revenue, and then improving coding and documentation to prevent revenue leakage.”
As providers look to do more with fewer resources, AI and automation are likely to play an increasingly important role in supporting efficiency and protecting financial performance. White noted that outsourcing can help manage costs, adding: “I can’t think of a lower cost expert than AI.”
FAQs
OBBBA’s biggest risk is revenue pressure from increased coverage churn, tighter eligibility verification and changes to Medicaid financing. Providers may experience higher denial rates, more uncompensated care and added administrative costs. Strengthening eligibility processes, documentation accuracy and denial management will be critical to protecting margins.
The OBBBA took effect on July 4, 2025, with specific healthcare provisions rolling out in stages. Some eligibility and verification changes took effect upon enactment, while others begin in 2026 and 2027. Early changes to look out for are more frequent Medicaid eligibility redeterminations, which will apply to renewals on or after December 31, 2026, and narrower rules for immigrant eligibility beginning on October 1, 2026. Additional provisions will roll out over the following years.
Find out how Experian Health is helping healthcare organizations prepare for the OBBBA impact on healthcare with solutions such as Patient Access Curator, Collections Optimization Manager and Patient Financial Clearance.
