Major shifts to Medicaid eligibility and financing set to take effect under the One Big Beautiful Bill Act in 2026 and beyond are emerging as a top concern for revenue cycle leaders, who say the changes could further intensify financial pressures.
“We used to talk about try[ing] to make a 3% operating margin on Medicare book of business, but post-COVID, with the inflation that we’ve seen in labor and supplies, that’s a really difficult thing to achieve,” said Stephen Rinaldi, senior vice president and chief revenue officer at Chapel Hill, N.C.-based UNC Health. “When you add on top of that the headwinds with the impact of Medicaid enrollment, the likely reduction of covered beneficiaries, it becomes even more challenging.”
Mr. Rinaldi told Becker’s that for most organizations to survive this type of disruption, “you really need to focus on both topline revenue integrity while working to control the cost footprint across your enterprise to the extent possible.”
“Most organizations cannot reduce the cost quickly enough to offset a loss of revenue,” he said. “This creates what is commonly known as a financial structural weakness. So you really have to be excellent at converting clinical services into that revenue. From a revenue cycle perspective that means strong front-end processes and financial clearance, really connecting the scheduling process to making sure that the scheduled service will be covered from a reimbursement perspective, and then also that the patient won’t have any surprises from a liability perspective.”
At Falls Church, Va.-based Inova Health, leaders are starting to think about roles differently, particularly around financial counseling and front-end capacity, Vice President, Revenue Cycle Erin Hodson, MSN, told Becker’s. They are also thinking about what kind of white-glove service they’re offering patients to help them better understand what’s ahead.
“That includes not just Medicaid changes, where we’ll need to hand-hold patients more than we have in the past, but also shifts in patient liability outside of Medicaid,” she said. “High-deductible plans, changing premiums — all of that is evolving.”
Staying aligned with the changes and understanding how they will affect health systems is a top priority for Sarah Ginnetti, chief revenue cycle officer and vice president of clinical revenue at Farmington, Conn.-based UConn Health, told Becker’s.
“We are collaborating with our regulators in the state, but also leaning on some of the professional associations that we’re closely aligned with,” Ms. Ginnetti said. “[The Healthcare Financial Management Association], for example, is one that we are very plugged into and [we’re] working with them on trying to model some of these impacts. And then also leaning on even Epic and some of our other vendor partners to help us with some of the modeling and understanding the implications.”
