Episode 32 | HR1 Could Move 10–25% of Your Patients from Medicaid to Uninsured—Here’s How to Plan for It
June 17, 2026
EPISODE OVERVIEW
HR1-the One Big Beautiful Bill-keeps coming up on the CEO Bootcamp coaching calls, with leaders asking the same question: “What are we going to do about our patients losing their Medicaid?” In this episode, Jill answers it. We’re past speculation and into implementation, and three Medicaid changes are now bearing down on health centers: twice-a-year redeterminations, new work/community engagement requirements, and a narrowing of eligibility for legally present immigrants. Underneath all of it is one financial reality - industry analysts are telling leaders to model a 10–25% drop in their Medicaid population, with the uninsured population growing by the same amount. Jill breaks down each change in plain English and gives you a six-move survival plan so the charity-care hit doesn’t ambush you mid-year.
In This Episode, You’ll Learn:
What HR1 implementation looks like and which changes are landing in 2026 and 2027
What the move to six-month redeterminations means for front-office churn and administrative coverage loss
How the 80-hour-a-month work requirements work—and why most coverage loss will come from reporting burden, not real ineligibility
Why your Medicaid managed care plans are prohibited from determining work-requirement compliance
The October 1, 2026 immigrant eligibility cliff: which lawfully present groups lose federally funded Medicaid, and what stays (emergency Medicaid)
Why a Medicaid-to-uninsured shift hits so hard when Medicaid is 35–40%+ of operating revenue
Jill’s six-move survival plan—and why cutting your way out makes things worse
Key Takeaways
“The danger here is usually not that people become genuinely ineligible. The danger is the paperwork. Double the redeterminations, and you double the chances for an eligible patient to lose coverage over a piece of mail.”
“Same patient. Same visit. Same cost to deliver the care—with a fraction of the revenue. That’s what a Medicaid-to-uninsured shift actually does to you.”
“Don’t let this surprise you mid-year. Budget charity care on purpose—before it shows up as a variance in front of your board.”
“The health centers that come through this in good shape won’t be the ones that cut the fastest. They’ll be the ones that protected access and planned for the charity care instead of getting ambushed by it.”
Free Resource
Want help with Move 1? Email [email protected] with “HR1 Plan” in the subject line for a simple worksheet to model your Medicaid-to-uninsured exposure and build charity care into your budget—or schedule a call at jillsteeley.com.
Mentioned in This Episode
Episode #31 - the revenue-cycle episode on verifying insurance and recovering leaked revenue (listen first if you haven’t)
CEO Bootcamp - Jill & Steve Weinman’s program for health center and safety-net leaders navigating strategic and financial decisions
Vital Interaction - AI-powered patient engagement for branded, multi-language reminders and outreach at scale
Rural Health Transformation Funding - covered in Episode #19; a potential funding cushion for charity care and capacity
Free planning worksheet - email “HR1 Plan” to [email protected]
Connect & Subscribe
If this episode resonated with you, please take a moment to:
Subscribe so you never miss an episode
Leave a rating and review
Share with a fellow health center leader who needs to hear this message
Have feedback or a topic request? Jill would love to hear from you!
© 2026 Jill Steeley
