The future of Medicaid: How providers can stay ahead of work requirements in 2025

Christopher Wilson: ©Savista

Medicaid stands at a pivotal moment in 2025, one that could fundamentally alter coverage, funding, and access to care for millions of Americans. Among the most pressing developments is the potential expansion of Medicaid work requirements. This policy shift carries the risk of creating significant barriers for enrollees, particularly those grappling with disabilities, caregiving responsibilities, or limited resources. Recent studies by the Urban Institute and the Robert Wood Johnson Foundation indicate that these changes could result in up to 5 million adults losing Medicaid coverage by 2026—not due to ineligibility, but because of bureaucratic complexities and the challenges of meeting reporting requirements.

Medicaid, however, remains a lifeline. It provides critical access to care, improves health outcomes, and shields individuals from the financial burdens of medical debt. Research confirms that Medicaid enrollees are far more likely to receive timely care than those without health insurance, who often delay or entirely forgo necessary treatments due to cost concerns or financial insecurity.

Challenges facing Medicaid beneficiaries and providers

For many Medicaid enrollees, compliance with potential work requirements could introduce a host of new challenges. A report by MACPAC, an organization advising Congress and states on Medicaid and CHIP, found that most working-age adults on Medicaid are already employed. For those who are not, there are often compelling reasons—not readily observable—that keep them from participating in the workforce. These include pregnancy, physical or mental health conditions, caregiving roles, or involvement in job training or community service.

Even so, the introduction of formal work requirements brings confusion and complexity. Enrollees may struggle to keep track of their work status or meet stringent reporting requirements, particularly when they face resource constraints such as insufficient childcare, poor access to transportation, or limited technological know-how. The application process itself can be overwhelming for individuals who already encounter barriers to daily living.

Beyond personal struggles, Medicaid offers vital support that helps people remain employed. Access to preventive care allows individuals to manage chronic conditions, secure necessary medications, and address health issues before they escalate. For those needing mental health or addiction treatment, Medicaid provides an essential pathway to care, helping them maintain or regain the stability needed to participate in the workforce. Removing or reducing coverage risks undermining these supports, making employment more difficult for those who rely on it.

Health care providers face these challenges alongside their patients, often sharing the burden of navigating an increasingly complex Medicaid eligibility and reimbursement system. Compliance with work requirements opens providers to risks of missed verifications or lapses in coverage, leading to declines in patient access, administrative bottlenecks, and financial strain. Providers with limited resources may find themselves grappling with mounting bad debt, revenue disruption, and patient dissatisfaction, jeopardizing both financial performance and long-term relationships.

What can providers do?

With Medicaid’s evolving landscape, providers must prepare for the potential ripple effects of work requirement policies. Proactive planning is key to mitigating the impact on patients and maintaining a stable financial outlook. Here are actionable steps providers can take:

1. Educate and train staff
   Teams need to be well-versed in the nuances of work requirements and equipped to guide patients through compliance. Frontline staff can help enrollees address barriers like reporting processes and documentation requirements. Training should focus on patient-centered communication to minimize confusion and improve the likelihood of compliance.
2. Leverage revenue cycle expertise
   Providers may need to optimize other areas of their revenue cycle to recoup losses caused by lapses in Medicaid reimbursements. Streamlining administrative processes, employing predictive analytics, and identifying gaps in revenue capture can help sustain financial stability during periods of change.
3. Partner with trusted experts
   Navigating Medicaid’s complexities is no small task. Engaging with experienced partners can ease the burden, offering expertise to manage new requirements efficiently. These collaborations can help health care organizations maintain patient access, ensure compliance, and enhance revenue recovery efforts.

The value of trusted partnerships

Partnering with experts can make a significant difference in addressing the challenges presented by Medicaid’s shifting requirements. Look for a partner with a team of eligibility and enrollment specialists that work directly with patients, providing personalized support to ensure compliance and prevent coverage loss due to missed deadlines or procedural missteps. With innovative technology and process optimization, partners should help simplify enrollment, boost approval rates, and reduce the risk of revenue loss or uncompensated care.

Consider a partner with a comprehensive approach that goes beyond initial Medicaid applications, including managing recurring enrollments, resolving denials, and securing Medicaid retrospective authorization to maintain long-term coverage for patients. This collaborative approach not only enhances patient satisfaction but also improves revenue cycle performance.

Putting the focus back on care

Medicaid’s evolving policies bring uncertainty, but they also present an opportunity for health care providers to strengthen strategies, streamline processes, and build resilience. By working with expert partners, organizations can minimize administrative pressures, maximize reimbursements, and focus their energy on delivering exceptional patient care.

With the right preparation and a clear plan, health care providers can confidently face the challenges of 2025, ensuring continued access to care for their patients while securing their own financial sustainability. Through collaboration, innovation, and proactive planning, providers can create a stronger future for themselves and the communities they serve.

Christopher Wilson is manager, revenue cycle solutions, for Savista.