Changes to Medicaid: What clinics should watch and do now

The Center for Medicare & Medicaid Services (CMS) influences nearly every part of healthcare delivery. Medicaid alone covers almost 50% of U.S. births, provides care for 40% of children and 60% of nursing home residents, and supports millions of people with disabilities and chronic conditions¹. Its programs also play an outsized role in sustaining access to care in rural and underserved communities.

For providers, this reach means Medicaid is not just another payer —it underwrites staffing, sustains preventive programs, and supports essential services. When CMS adjusts eligibility or funding levels, the effects cascade through clinics, hospitals, and health systems across the country.

Steps clinics can take now to prepare 

Prioritize coverage stability  

Keep patients connected to care and avoid revenue loss by reducing churn: 

• Streamline eligibility verification processes.
• Train front-desk and billing teams to flag upcoming coverage expirations.
• Use reminder tools to help patients complete redeterminations on time. 

Protect financial sustainability 

Build flexibility into your financial systems to manage uncertainty: 

• Forecast revenue scenarios based on changes to Medicaid reimbursement and enrollment.
• Create adaptive budgets that allow for quick changes to staffing, hours, or services.
• Reassess low-margin services and renegotiate payer contracts where needed.

Invest strategically  

Investments that improve efficiency can protect your bottom line and staff bandwidth: 

• Automate administrative tasks to reduce overhead.
• Improve reporting to align with Medicaid quality programs and bonus structures.
• Diversify revenue through value-based models or new payer contracts.
• Train staff on scripts and workflows for helping patients with Medicaid renewals, referrals, or financial assistance.

Preventing unnecessary coverage loss is one of the most immediate ways to protect both patient access and clinic revenue.

What other practices are doing 

Contingency planning in action  

According to KLAS Research, 86% of providers are already implementing contingency plans, including: 

• Cutting services that are no longer financially viable
• Tightening billing policies to reduce bad debt
• Reviewing Medicaid participation status, especially in high-impact states

Structural and operational shifts 

In response to the CMS policy shifts, many clinics are making bigger changes:

• Focusing on higher-revenue service lines
• Automating workflows and adopting AI to reduce admin burden
• Strengthen revenue cycle processes
• Sharing administrative functions across multiple practices 

Stay nimble as Medicaid policy evolves  

Medicaid rules and reimbursement models will continue to evolve. Staying informed and proactive can help minimize disruption: 

• Assign a staff member or external advisor to monitor policy changes.
• Join provider coalitions or advocacy groups to stay connected and influence change.
• Equip staff to communicate clearly with patients about coverage or service changes.
• Review your state’s Medicaid waiver activity and proposed changes to eligibility, reimbursements, or coverage.
• Develop patient-facing materials (scripts, emails, signage) to explain upcoming Medicaid changes and how to stay covered. 

Don’t wait to react—plan to adapt  

Whether your practice relies heavily on Medicaid or not, being unprepared isn’t an option. Operational resilience starts with planning, communication, and strategic investment. 

Explore how athenahealth helps practices navigate funding shifts with confidence.