HR1 Could Move 10–25% of Your Patients from Medicaid to Uninsured—Here’s How to Plan for It

HR1 Could Move 10–25% of Your Patients from Medicaid to Uninsured—Here’s How to Plan for It

Community Health Collective Podcast Episode #32 HR1 Could Move 10–25% of Your Patients from Medicaid to Uninsured—Here’s How to Plan for It Hosted by: Jill Steeley 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 jill@jillsteeley.com [jill@jillsteeley.com] 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 [http://jillsteeley.com]. Mentioned in This Episode * Episode #31 [https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149215935]—the revenue-cycle episode on verifying insurance and recovering leaked revenue (listen first if you haven’t) * CEO Bootcamp [http://www.fqhc-ceo.com]—Jill & Steve Weinman’s program for health center and safety-net leaders navigating strategic and financial decisions * Vital Interaction [https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149158294]—AI-powered patient engagement for branded, multi-language reminders and outreach at scale * Rural Health Transformation Funding [https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149177765]—covered in Episode #19; a potential funding cushion for charity care and capacity * Free planning worksheet—email “HR1 Plan” to jill@jillsteeley.com Connect & Subscribe If this episode resonated with you, please take a moment to: * Leave a rating and review * Subscribe so you never miss an episode * 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!

Stop Blaming Billing: The Real Reason Revenue Is Slipping Away

Community Health Collective Podcast Episode #31 Stop Blaming Billing: The Real Reason Revenue Is Slipping Away Hosted by: Jill Steeley EPISODE OVERVIEW Most leaders think of the revenue cycle as billing and collections - the part where you can see the money, or watch it fail to show up. But by the time a claim reaches your billing office, the win or the loss has usually already been decided. In this episode, Jill Steeley reframes where the revenue cycle actually begins: not in the billing office and not with a claim, but the moment a patient fills out their paperwork - and every single time they check in. She walks through the full cycle in plain English, explains why the front desk is the link that breaks most often, shares a sobering story about what a single unconfirmed phone number cost one health center, and leaves you with five low-cost things you can take to your team this week. IN THIS EPISODE, YOU’LL LEARN: • Why most leaders only pay attention to the last 20% of their revenue cycle — and what they’re missing • The three stages of the revenue cycle in plain English: the front end, the middle, and the back end • Why those three stages are one connected chain, not separate departments that hand off to each other • Why the weakest link is usually the front desk — and why no outside revenue cycle contractor can fix that part for you • How preventable registration and eligibility errors (a transposed member ID, a termed plan, a wrong date of birth) become denials 45 days later • The true cost of a two-second check-in mistake: staff time at every step, money aging in AR, and claims written off past timely filing • A real story of how a single unconfirmed phone number turned into a tragedy — and an FTCA claim • The wrong way and the right way to confirm a patient’s information at check-in • Five concrete, low-cost ways to strengthen your revenue cycle this week • How to answer the “my front desk is already slammed” objection — and why that bottleneck is a revenue question, not just an operations one KEY TAKEAWAYS “Your revenue cycle does not start with a bill — it starts at the front desk.” “By the time a claim hits your billing office, the outcome of that claim has usually already been decided.” “Garbage in, garbage out. If the information that goes in at the front desk is wrong, no amount of skill on the billing team is going to save that claim.” “A two-second mistake at check-in can become a permanent loss for the health center.” “Your billing team can be excellent, and you can still be bleeding revenue — because the problem was created long before the claim ever reached them.” MENTIONED IN THIS EPISODE • RetroCAID (with Howard Archer) - Software that combs 365 days of your claims against state Medicaid to recover revenue you didn’t know you were owed. No EHR integration, no upfront cost, and they only get paid if you do. Listen to the full episode: https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149148176$9K to $40K Monthly: How One Software Automatically Recovers Hidden Revenue [https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149148176] • CEO Bootcamp — Jill & Steve Weinman’s program for health center leaders navigating strategic and financial decisions, where revenue cycle is a recurring topic. http://www.fqhc-ceo.com/www.fqhc-ceo.com [http://www.fqhc-ceo.com/] • Work with Jill — Email jill@jillsteeley.com or schedule a call at http://www.jillsteeley.com/jillsteeley.com [http://www.jillsteeley.com/] to talk through where your revenue cycle is leaking. 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!

COO vs Clinic Manager: How to Know Which One Your Health Center Actually Needs

COO vs. Clinic Manager: How to Know Which One Your Health Center Actually Needs Hosted by: Brent Stutzman, TheraSaaS Podcast | Guest: Jill Steeley, FQHC Consultant & Executive Coach ―――――――――――――――――――― Episode Overview In this crossover episode, Jill joins Brent Stutzman on the TheraSaaS podcast for a practical conversation about one of the most consequential growing-pain decisions a practice or health center faces: do you need a clinic manager or a chief operating officer? Drawing on her own experience inheriting a clinic-manager-run health center as a brand-new CEO, Jill unpacks the real difference between the two roles, the warning signs that you’ve outgrown day-to-day firefighting, the true cost of the wrong hire, and why a fractional COO can be the lowest-risk way to test the water. ―――――――――――――――――――― In This Episode, You’ll Learn: • The real difference between a clinic manager and a COO—and why conflating them keeps leaders stuck in the weeds • Why promoting your best clinician into a management role so often backfires • How to diagnose your actual pain points before you write a single job description • The “you might need a COO if…” warning signs: staff turnover, operational chaos, stalled patient growth, and no systems • Why the wrong hire at this level is so expensive—emotionally and financially • What to actually look for in a COO, and how to vet for outcomes and culture fit, not just a clean reference check • How a fractional COO works—and why it’s a scalable, lower-risk way to get started • Why “even imperfect action is action” when burnout is the real symptom ―――――――――――――――――――― Key Takeaways “Culture eats strategy for lunch any time of the day.” “Even imperfect action is action.” “Your burnout is a big symptom of doing everything and not being willing to give up some of that control.” ―――――――――――――――――――― Mentioned in This Episode • http://www.fqhc-ceo.com/CEO Connect Bootcamp [http://www.fqhc-ceo.com/] — Jill’s program for health center and practice leaders on attracting patients, building systems, and leading strategically • Healthcare Leadership Style Quiz — Jill’s free quiz to identify your leadership pattern | http://www.jillsteeley.com/leadershipquizjillsteeley.com/leadershipquiz [http://www.jillsteeley.com/leadershipquiz] • https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149198276Community Health Collective episode [https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149198276] on fractional executives • http://www.jillsteeley.com/jillsteeley.com [http://www.jillsteeley.com/] — Schedule a call or find free resources | jill@jillsteeley.com ―――――――――――――――――――― Connect & Subscribe If this episode resonated with you, please take a moment to: • Leave a rating and review • Subscribe so you never miss an episode • 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!

Ok, I See The Problem. Now What?

Community Health Collective Podcast Episode #29 Title: Ok, I See the Problem. Now What? Hosted by: Jill Steeley ―――――――――――――――――――― Episode Overview Two weeks ago on Episode 27, Jill named what she calls the untrained leader problem - the pattern in healthcare of promoting strong clinicians and operators into leadership roles without ever training them to actually lead. Since then, the question she's been getting most is, "Okay, I see it. Now what?" In this episode, Jill answers that directly. She names why so many leaders freeze between awareness and action, then walks through a three-step path forward: know yourself, build the specific skills that match your gaps, and - when you're ready - transform your full leadership team together. This is a practical, no-overwhelm episode for leaders who don't want to stay stuck in seeing without ever moving to the doing. ―――――――――――――――――――― In This Episode, You'll Learn: • Why awareness without action becomes its own kind of suffering—and how to break out of it • The three reasons leaders freeze between knowing and doing: overwhelm, uncertainty about scope, and the false dichotomy of "go huge or do nothing" • Why the first move in transforming your team isn't actually about your team—it's about you • How your own leadership patterns (strengths, blind spots, defaults) quietly become the template your team imitates • Why generic, corporate leadership training rarely transforms healthcare leaders—and what to do instead • The bottleneck that develops when an individual leader grows but the rest of the leadership culture doesn't • Three predictable outcomes for the leader who becomes an "island of competence" in an untransformed organization • Jill's three-step path: know yourself, build specific skills for your specific gaps, then transform the team together ―――――――――――――――――――― Key Takeaways "Awareness without action becomes its own kind of suffering. Once you see the untrained leader problem in your organization, you can't unsee it." "You cannot lead others through a transformation you haven't started yourself." "The first move doesn't have to be huge. It just has to be in the right direction." "Individual leadership development without team leadership development creates an island of competence in an organization that hasn't transformed around you." ―――――――――――――――――――― Mentioned in This Episode • Episode 27 — "The Untrained Leader Problem" [https://www.jillsteeley.com/podcasts/community-health-collective/episodes/2149205112] — the prequel to this episode; listen first if you haven't • Leadership Style Quiz — Jill's free 2–5 minute quiz to identify your leadership archetype and the skills most likely to move the needle for you (jillsteeley.com/leadershipquiz [http://jillsteeley.com/leadershipquiz]) • Leadership Academy Masterclasses — targeted courses for healthcare leaders including Time Management for Busy Leaders, People-First Leadership, Mastering Candid Conversations, Maximum Output Minimum Effort, Mastering Recruitment and Retention, Designing and Building Strong Teams, Leading Teams Through Change, and C-Suite Ready (jillsteeley.com/leadership [http://jillsteeley.com/leadership]) • Full Leadership Team Development Program — Jill's program for organizations ready to transform their leadership culture as a team: monthly masterclasses, twice-monthly group coaching, and one-on-one coaching slots. Schedule a call here [https://calendly.com/jill-v7c/30min]. ―――――――――――――――――――― Connect & Subscribe If this episode resonated with you, please take a moment to: • Leave a rating and review • Subscribe so you never miss an episode • 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! jill@jillsteeley.com [jill@jillsteeley.com]

Section 504 & ADA Compliance: What Every Health Center Leader Needs to Do Before the Deadline

Section 504 & ADA Compliance: What Every Health Center Leader Needs to Do Before the Deadline Hosted by: Jill Steeley | Guests: Steve Weinman, FQHC Associates and Jen Garces de Marcilla, FQHC Associates EPISODE OVERVIEW Section 504 of the Rehabilitation Act has always required organizations receiving federal funding to provide equal access to people with disabilities. The May 2024 HHS final rule made it explicit: digital accessibility is part of that obligation, and FQHCs are squarely in scope. With the compliance deadline extended by one year to May 2026, health centers have a real window to act—but most leaders aren’t yet aware of what the rule requires, where the litigation risk is greatest, or what it actually takes to demonstrate good-faith effort. In this episode, Jill is joined by Steve Weinman and Jen Garces de Marcilla, both of FQHC Associates, to break down what the rule actually covers, what NOT to do, and why digital accessibility is one of the clearest patient experience opportunities health center leaders are going to get this year. DISCLAIMER Nothing in this episode constitutes legal advice. Accessibility compliance is an evolving area. The goal of this conversation is to help health center leaders understand the rule, reduce barriers for their patients, and demonstrate documented, good-faith effort toward compliance. IN THIS EPISODE, YOU’LL LEARN • What Section 504 actually requires now that digital accessibility is explicitly in scope • The new compliance deadline (May 2026)—and why “I have a year” is the wrong mental model • The specific digital surfaces this rule covers: websites, patient portals, online scheduling, mobile apps, kiosks, PDFs, EHRs, and embedded third-party tools • How AI-powered “secret shoppers” are scanning websites for noncompliance—and why even small health centers are exposed • Why accessibility widgets and overlays are NOT a compliance solution (and may make things worse) • The most common, lowest-cost, highest-impact fixes: alt text, color contrast, captions, keyboard navigation, screen reader compatibility, and accessible PDFs • Why “we’ve never had a complaint” is not a defense • What “good-faith effort” actually looks like—especially when your EHR vendor isn’t compliant • How to handle vendor contracts and renewals going forward • The patient experience angle most leaders are missing—and how accessibility supports transformational, not transactional, care • Why accessibility benefits temporary disabilities and aging patients, not just permanent disabilities • Where the budget realistically comes from—and why a properly optimized website pays for itself KEY TAKEAWAYS “It’s not just a compliance issue. It’s not even just a legal issue. It is a patient experience issue as well. Patients are looking for more of a transformational healthcare experience now rather than a transactional one.” — Jill Steeley “By making things accessible for people who might have disabilities, you’re actually making them more accessible for everyone. It’s not necessarily just for people that have permanent disabilities.” — Jen Garces de Marcilla “If you do it right, it pays for itself, because if you’re not running at peak efficiency, you are hemorrhaging visits and patients.” — Steve Weinman FREE 504 TOOLKIT To request a free 504 Toolkit, email http://jill@jillsteeley.comjill@jillsteeley [http://jill@jillsteeley.com].com with “504 toolkit” in the subject line. MENTIONED IN THIS EPISODE • FQHC Associates — Steve and Jen’s firm, available for accessibility audits and consulting at http://www.fqhc.org/fqhc.org [http://www.fqhc.org/] • Steve Weinman direct contact: http://sdweinman@fqhc.orgsdweinman@fqhc.org [http://sdweinman@fqhc.org] • CEO Bootcamp — Jill and Steve’s program for FQHC leaders (www.fqhc-ceo.com [http://www.fqhc-ceo.com/]) • Leadership Academy — Jill’s online masterclasses (www.jillsteeley.com/leadership [http://www.jillsteeley.com/leadership]) CONNECT & SUBSCRIBE If this episode was valuable to you, please: • Leave a rating and review • Subscribe so you never miss an episode • Share with a fellow health center leader who needs to hear this Have a topic request or feedback? Jill would love to hear from you.