HR1 is About to Double Your Medicaid Churn - Here's the Plan

HR1 is About to Double Your Medicaid Churn - Here's the Plan

COMMUNITY HEALTH COLLECTIVE — HR1 & RETROACTIVE MEDICAID EPISODE Host Jill Steeley & Guest Howard Archer HR1 isn't a someday threat - it's in implementation now, and it's about to make Medicaid billing harder than most health centers are ready for. In this episode Jill sits down again with Howard Archer, CEO of Fix Healthcare Technology and the creator of RetroCAID, to name the real problem: HR1 won't mainly make your patients ineligible, it'll make them lose coverage over paperwork - twice as often as before. Jill and Howard walk through the exact timeline coming at you (six-month redeterminations for expansion adults, 80-hour work requirements, narrowing immigrant eligibility, and a retroactive coverage window that shrinks January 1), why the churn ahead makes the PHE unwinding look like a warm-up, and the reframe every leader needs right now: your enrollment team is now your retention team. Then comes the part most centers miss - the revenue you already earned but wrote off as self-pay, still sitting recoverable in your system because Medicaid is a moving target, not a static payer. If you're a health center leader watching the coverage cliff approach and doing the mental math on what you'll have to cut, this one's for you - because there's a way through that doesn't start with cutting. Highlights: * The four HR1 changes on the calendar, and the dates each one lands * Why the danger is administrative churn - lost mail and missed deadlines - not true ineligibility * The retroactive coverage change almost nobody's talking about, and why January 1 matters * The reframe: turning your enrollment team into a Medicaid retention team * Why recovering old self-pay revenue isn't about front-desk mistakes - it's about movement * How health centers are recovering $9,000 to $35,000 a month on visits they'd already written off * What "start the application to lock the date" means, and why speed matters more now Quotes from the episode: * "This doesn't have to be the nail in the coffin for your health center if we get ahead of it. We know the dates. We can plan for it." * "Your enrollment team really has to become your retention team." * "It's all about retention, helping patients retain their coverage, and being able to capture the revenue that's already yours that you just don't know is there." * "We've never worked with an FQHC where we don't recover revenue for them month after month after month." - Howard Archer MENTIONED IN THIS EPISODE • 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. Schedule a call [https://fixht.com/meeting/retrocaid-qa-jsteeley/] with Howard Archer to talk about how RetroCaid can recover thousands of dollars in eligible Medicaid payments. Listen to Episode #11 to get a full episode about how RetroCaid works at www.jillsteeley.com/podcast [http://www.jillsteeley.com/podcast] 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!

More Visits, Less Medicaid: The 3 Changes Coming for Your Patients (and the Plan to Meet Them)

THE COMMUNITY HEALTH COLLECTIVE — EPISODE 35 SHOW NOTES More Visits, Less Medicaid: The 3 Changes Coming for Your Patients (and the Plan to Meet Them) by Jill Steeley On nearly every coaching call and inside the CEO Bootcamp, Jill hears the same question: "What are we going to do about our patients losing their Medicaid?" So in this episode - released a day early to get the word out - she answers it. HR1 (the One Big Beautiful Bill, signed July 4, 2025) isn't weather that just happens to your health center. It's a schedule. Three Medicaid changes are already on the calendar, and each one does the same thing: it turns a covered patient into an uninsured one. Same patient, same visit, a fraction of the revenue. But a schedule is something a CEO can prepare for. Jill - a former FQHC CEO who inherited an $800K deficit, turned it into a multi-million-dollar reserve, and took her center from a 42% uninsured rate down to 12% through Medicaid expansion - breaks down what's coming and the three plays to meet it. No fear-mongering. No cutting staff, services, or sites. Just a plan to protect access, protect coverage, and go get revenue that's already sitting on your table. This is a slow-turning ship. The time to get behind the wheel is now. IN THIS EPISODE * The three HR1 changes headed at your Medicaid patients: six-month redeterminations (starting late 2026), 80-hour work requirements (states running them by early 2027 — six months away), and the immigrant eligibility cliff (October 1, 2026) * Why the real danger is almost never true ineligibility — it's the paperwork, and it's predicted to be twice as bad as the COVID unwinding (up to 10 million losing coverage) * The operational kicker most centers are missing: your Medicaid managed care plans are barred from determining work-requirement compliance — so the health center that helps patients document their hours is the one that keeps them covered * Putting a real dollar figure on it: Medicaid is 40–65% of operating revenue for most centers, and the scenario to plan for is a 10–25% Medicaid shrink with uninsured rising to match (10–17 million people nationally) * Play 1 — Defense: turn eligibility & enrollment into a retention machine, and use patient-engagement technology to communicate at scale (you don't need to hire more staff — you're the trusted voice) * Play 2 — RetroCAID: turn write-offs back into paid claims by scrubbing every visit against Medicaid eligibility retroactively (365 days, rolling) — risk-free, no EHR integration, and they only bill when you collect. Urgent, because the retroactive window shrinks from 90 days to 1–2 months on January 1, 2027 * Play 3 — Offense: grow Medicare and commercial — the two payer lines HR1 doesn't touch. A Medicare or commercial patient brings 75–100% more revenue than a self-pay visit * Why "we're going to protect access, protect coverage, and go get revenue" beats "tighten the belt and pray" THE LINE TO REMEMBER "HR1 is not weather. It's predictable and it’s on a schedule — a set of dates you can already see on the calendar. And anything you can see coming, you can prepare for." 🎙️ JOIN THE LIVE WEBINAR More Visits, Less Medicaid: How Smart CEOs Are Preparing for the Coverage Cliff With Jill Steeley & Steve Weinman 📅 Thursday, July 9 · 11:30 AM MT / 1:30 PM ET · ~45 minutes + 15 minutes of live Q&A Everything in this episode — gone deep, with the actual worksheets and workflows, not just theory. Between them, Jill and Steve (who grew a health center from $3M to $30M) have lived this. You'll walk out able to put a real dollar figure on your own exposure, with a defense plan to keep patients covered, a way to recover the Medicaid dollars you're writing off, and a plan to grow the lines HR1 can't touch. 👉 Register here: https://us06web.zoom.us/webinar/register/WN_bOmGjMCTS-GJ1RxrrOXC4w#/registration [https://us06web.zoom.us/webinar/register/WN_bOmGjMCTS-GJ1RxrrOXC4w#/registration] Don't let this one ambush you in Q4. You're not doing this alone. RESOURCES & LINKS * FQHC CEO Bootcamp — the program where we go deep on this work with health center leaders: www.fqhc-ceo.com [https://www.fqhc-ceo.com] * The RetroCAID episode (Play 2) — Episode #11: $9K to $40K Monthly: How One Software Automatically Recovers Hidden Revenue for Health Centers, an interview with Howard Archer, CEO of Fix Healthcare IT: www.jillsteeley.com/podcast [https://www.jillsteeley.com/podcast] * Webinar registration: Save your seat for July 9 [https://us06web.zoom.us/webinar/register/WN_bOmGjMCTS-GJ1RxrrOXC4w#/registration] CONNECT WITH JILL Jill Steeley · Steeley Strategic Solutions 🌐 www.jillsteeley.com [https://www.jillsteeley.com] — grab free resources and take the Healthcare Leadership Style Quiz ✉️ jill@jillsteeley.com [jill@jillsteeley.com] · 📞 406.579.0887 The Community Health Collective — honest conversations about the real barriers keeping health centers stuck, and what it takes to get unstuck. If this episode helped, share it with another community health leader. That's how we grow this collective, one connection at a time.

Payer Mix, Not Encounters: The One Number To Track

COMMUNITY HEALTH COLLECTIVE — PAYER MIX EPISODE (EP. 34) Host: Jill Steeley Payer Mix, Not Encounters: The One Number To Track Most health center leaders are watching the wrong number. They track encounters - visits up, schedules full, providers slammed - and call it progress. But here's the thing: more visits won't make your health center sustainable. In this episode I tell the story of a CEO I coach who sent me his encounter count like a monthly report card, proud and rising, until I asked him to pull his payer mix by revenue instead. That one shift changed everything. Encounters are a vanity metric. Payer mix is the real one. Revenue is decided by who you serve, not how many visits you do. I walk through the math on what one insured patient is actually worth, why Medicare is the most overlooked and most stable payer you've got, and the intentional plays to grow your insured lines - employer outreach, referral engines, and showing up in your community. And I take on the discomfort head-on: watching your payer mix isn't choosing money over mission. No margin, no mission. At PureView, focusing on insured patients the whole time I was CEO is exactly how we ended up serving more uninsured patients, not fewer. This one's for the CEO who's working harder every month and watching the revenue stay flat. Highlights: * Why encounters are a vanity metric and payer mix is the number that tells the truth * The back-of-the-envelope math: how 1,000 insured patients compounds into roughly $2 million in new annual revenue * Medicare as the most overlooked, most stable payer line - and the two moves to capture it (attract them, and stop under-billing the ones you already see) * The intentional plays to grow payer mix: self-funded employers, referral engines, and community presence * The reframe: no margin, no mission - margin is what funds the uninsured patient, not the other way around * Your one-thing-this-week homework: pull your payer mix by revenue and ask if your commercial and Medicare lines are growing, flat, or shrinking Quotes from the episode: * "He really was watching and monitoring the wrong performance indicator." * "Piling on encounters when your panel isn't insured just means you're busier on your way down." * "The lever here isn't more. The lever is who." * "We took an $800,000 deficit to millions of dollars in reserve and dropped our grant dependency from 62% down to 17%. Our mission didn't shrink, it grew - because the margin is what funded it." MENTIONED IN THIS EPISODE • Revenue Diversification Guide - email me at jill@jillsteeley.com [jill@jillsteeley.com] with Revenue Diversification in the subject line and I’ll send you my free guide. • 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!

Scaling Doesn't Fix Problems - It Multiplies Them

Community Health Collective Podcast Episode #33 Scaling Doesn’t Fix Problem - It Multiplies Them Hosted by: Jill Steeley ―――――――――――――――――――― EPISODE OVERVIEW Every health center leader wants to grow - the second site, the new service line, the bigger patient panel - but far fewer talk honestly about what scaling actually does to an organization. In this solo episode, Jill Steeley makes the case that scaling doesn’t add, it multiplies: it takes your current operations, culture, finances, and leadership and runs all of it through a copy machine. Drawing on her own turnaround story - a health center that couldn’t recruit a single physician in five years and later had to turn providers away - she walks through why the first question is never “how do we grow,” but “is what we have right now worth multiplying?” She covers the leadership-bench trap, why systems have to scale before sites, how payer mix has to stay front and center, and the one gut-check question to run on your operation this week. IN THIS EPISODE, YOU’LL LEARN: • The story behind a five-year recruiting drought - and how fixing the organization, not the pitch, turned it into turning providers away • Why scaling multiplies everything you already are - your operations, culture, finances, and your dysfunction - instead of simply adding to it • The first question to ask before you grow: is what we have right now actually worth multiplying? • Why growth opportunities show up at the worst possible moment - and why two wobbling sites are worse than one • The leadership-bench trap: why you can’t scale past your team, and what mergers and inherited leadership add to the problem • Why you scale your systems before your sites - and the difference between real scale and a more expensive version of the same grind • How to keep payer mix front and center so you grow toward health, not just volume • A one-question gut check to run on your operation this week KEY TAKEAWAYS “When you scale a health center, you are not adding a site. You are multiplying everything you already are.” “You didn’t scale the organization. You scaled the number of fires and kept the exact same number of firefighters.” “The health centers that grow well are the ones that put the infrastructure in before the growth - not the ones scrambling to bolt it on after they’ve already said yes.” “Build something strong enough to last, and then grow it on purpose - not by accident, not because an opportunity showed up and you panicked.” MENTIONED IN THIS EPISODE • CEO Connect Bootcamp — Jill & Steve Weinman’s program for health center leaders working through scaling and other strategic and financial decisions | www.fqhc-ceo.com [http://www.fqhc-ceo.com] • The Untrained Leader Problem & the Island of Competence — earlier episodes on why developing leaders has to keep pace with the organization (Episodes 27 and 29 [https://jillsteeley.com/podcast]) • Past episodes on revenue cycle & technology - the infrastructure that makes real scale possible | www.jillsteeley.com/podcast [http://www.jillsteeley.com/podcast] • jillsteeley.com - schedule a call [https://calendly.com/jill-v7c/30min]to talk through whether you’re ready to scale, or email 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!

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!