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Medicaid changes could shrink coverage and strain your revenue. This post outlines practical ways to maintain access to care and keep your practice stable.
The July 4 passage of Public Law 119-21, known as the One Big Beautiful Bill Act, creates concerns for healthcare practice owners and clinicians who have a high percentage of patients who rely on the Medicaid program for health insurance. In addition to substantial budget cuts, the act allows for higher out-of-pocket costs, new eligibility restrictions for some immigrant groups, and updated work requirements, changes that will likely reduce the number of people eligible for Medicaid.
Many healthcare professionals recognize that Medicaid is a critical benefit that provides vulnerable populations with much-needed health care. The Congressional Budget Office projects that approximately 10 million more people will become uninsured by 2034 as a result of the act, with roughly 7.5 million of those tied directly to Medicaid.
To prepare for these changes and help Medicaid-eligible patients continue care, consider steps that expand their access to healthcare.
Financial Assistance Policies
Sliding Scales
Sliding scale fee structures are designed to increase the affordability of health care services by considering the patient’s income to determine the fee paid for the service. Generally, the lower the income, the lower the fee. Sliding scale fee structures typically use public data sets such as the federal poverty guidelines to set reduced costs for healthcare services based on a patient’s income (i.e., the “sliding scale”). These fee structures can ease costs for patients who already face financial hardship. If you implement a sliding scale fee structure, document it in your practice’s written policies to ensure uniform application for those who qualify.
Charity Care Plans
Another option to reduce the cost of healthcare services is implementing a charity care plan. Charity care plans are written practice policies that waive or discount the costs of healthcare services for patients with documented financial hardship. Charity care plans often use a uniform patient application to determine whether patients qualify for free or reduced-cost healthcare. For example, a charity care plan may state that an individual who earns less than $10,000 per year, or who qualifies for other public assistance benefits such as the Supplemental Nutrition Assistance Program (SNAP, formerly known as “food stamps”), may receive a 100% discount on healthcare services.
Before implementation, it’s imperative to review sliding scale and charity care policies to ensure compliance with federal and state laws.
See our related article, “Implementing Charity Care: What You Need to Know”.
Re-Enrollment and Outreach Initiatives
Practice owners can also launch campaigns to help individuals and families apply for Medicaid. Through staff training or partnerships with local navigators, advisers, and counselors, you can help individuals and families learn whether they qualify for Medicaid. These campaigns can also cover eligibility criteria and renewal requirements, bringing in individuals who were previously unaware that Medicaid coverage is an option. Those who do not qualify for Medicaid may be eligible for other low-cost health insurance options available through their state’s health insurance marketplace.
For solo clinicians and small practices, it may not be feasible to organize full campaigns to educate and assist people in applying for Medicaid. However, you can still engage in outreach to inform patients about the upcoming changes to Medicaid. For example, you could contact them ahead of the changes to Medicaid to discuss their current eligibility, explain the new rules, and talk through options if the changes would make them ineligible. Creating a list of local community resources can also help patients find resources to find health insurance and stay connected to care.
Duty of Care: Can You Stop Treating Medicaid Patients?
Many physicians are weighing whether to continue treating Medicaid patients amid concerns about reimbursement. In private practice, you generally may choose your payer mix and may stop accepting new Medicaid patients or terminate participation in Medicaid programs or managed care networks, as long as you follow applicable program and contract rules.
Once you establish a clinician–patient relationship, your duty of care calls for a safe, orderly termination to avoid abandonment. A defensible process typically includes reasonable advance written notice, continued urgent care during the notice period, referrals to other clinicians, and prompt record transfers on request.
See our related video, “What Is Patient Abandonment in Healthcare?”
State law, medical board guidance, and payer contracts may also impose additional steps or timelines. If you have hospital privileges or work in a hospital-affiliated setting, hospital policies may apply as well. Be sure to apply your internal policies consistently and without unlawful discrimination.
If you plan to change participation or end care for current Medicaid patients, consider reviewing those requirements and consulting an attorney before making changes.
Get Legal Help
Our experienced healthcare attorneys can help you review sliding scale fee policies, charity care plans, Medicaid re-enrollment outreach, and patient communication strategies to ensure your patients stay connected to care. We can also help you plan a compliant transition that honors your duty of care when changing your Medicaid participation or ending care for established patients. If you operate in any of the states where we have licensed attorneys, schedule a complimentary consultation to determine if we’re a good fit.
This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.
