According to the nonpartisan Congressional Budget Office (CBO), 93% of non-Medicare spending goes to the Medicaid and Children's Health Insurance Program (CHIP). Over the next decade, these two programs will cost over $8.2 trillion. The proposed federal plan is expected to cut $880 billion. This is over 10% of Medicaid and chips. Broadcut provides strip care from millions of people.
Medicaid is suitable for the community, but hospitals operating under the thin razor rims are even more tense with these cuts. People who do not have access to Medicaid or similar programs may not receive the care they need until their health concerns become more severe and more expensive care options are needed.
By adopting a fresh approach to placing the right people in the right programs, including AI-enabled registration, health plans, the healthcare industry is in a better position to survive the imminent federal cuts.
Medicaid cuts hit hard
Simply cutting $880 billion and hoping “states to understand it” is not a viable solution, adding management overhead in the form of betting the system more aggressively or hiring people to compensate for registrations and claims. The people most likely to be affected are those who have the least resources to obtain health insurance elsewhere, such as private employers and the federal market.
An analysis by the Urban Institute and the Robert Wood Johnson Foundation found hospitals in 41 states that could lose around $800 billion in 2026 after Medicaid fund cuts that expanded Medicaid eligibility. Safety net providers, including federally qualified health centers (FQHCs), are most affected as they are already working on tight or negative margins and rely on this fund to maintain this fund.
The consequence to avoid is to inappropriately kick individuals out of the program, but recent data shows the states doing just that. The state's Medicaid redecision process created an environment in which around 72% of dismissals are due to procedural reasons, including not actually not eligible, but not receiving update notifications.
Medicaid budgets should be balanced in a delicate way that puts the right people in the right program. A more effective way to save money for everyone is to set up a better data system for member eligibility and registration.
The challenges of the registration process are already intentionally inefficient
The two Medicaid plans are not the same. There is no registration process either. Not only do these plans rely on federal funding, but states run their own plans. It's a unique registration process that's inefficient and difficult to navigate. Registration is complicated enough to create an entire company to handle just that.
With margins and Medicaid reductions, operations must be as efficient as possible. This means reducing costs while increasing revenue for healthcare organizations. For health plans, increasing member retention and lower churn are paramount. Most Medicaid plans do not have visibility into how they support member updates. Changes in regulations will increase the importance of understanding where churn occurs.
A better process to improve effectiveness
The hospital is the perfect place to intervene as patients are already using care and trusting the organization. Beyond your initial registration, you will guide your members throughout the renewal process. Technologies such as smartphones, API registration websites, and AI simplify the entire program-wide registration process, reduce the cost of registration from organizational costs, and detect coverage revocation.
Patients want a first mobile experience. This helps streamline registration and reduce manual steps. Offering mobile options gives you more control and allows patients to navigate the processes that work for them. It's still a good habit to have skilled people on hand to help or answer questions, but there's less to be needed.
Registered counselors are more efficient thanks to AI-enabled tools that enhance accessibility and unlock additional revenue. AI features can communicate with patients, work on the backend and interact with registered websites. This is a new field that will expand as technology is adopted.
Conclusion
The challenges of Medicaid registration are not new. With thin margins and reduced razors to Medicaid, it is more important than ever to improve registration efficiency. This blend of technology and skilled people gives us confidence in the process.
New technology and fresh approaches, including recognizing total value with even smaller wins, create better systems for member eligibility, registration and renewal. The industry benefits by reducing costs, increasing captured revenues and keeping people in the right planning.
Photo: Designer491, Getty Images
Dr. Pedram Afshar, MD, is the founder and CEO of Escher Health, a leader who makes enrolling in Medicaid and government benefits programs easy for staff and patients. During medical training, he was frustrated with meeting patients who were eligible for programs like Medicaid but not registered. Dr. Afshar noticed many issues with the standard registration process and set out to create a solution.
This post will be viewed through the Medcity Influencers program. Anyone can reveal Medcity News' healthcare business and innovation perspectives through Medcity influencers. Click here to find out how.
