5 Key Takeaways on Medicaid Policy Changes From Savista’s Chief Strategy Officer

Author(s):

Fact checked by:

Laxmi Patel, chief strategy officer at Savista, outlines major impacts of the “One Big Beautiful Bill” Act on Medicaid and what hospitals can do to prepare for these changes.

Sweeping changes to Medicaid eligibility and coverage are on the horizon if proposed actions under the federal Budget Reconciliation Act take effect.¹ According to Laxmi Patel, chief strategy officer at Savista, the reforms under the “One Big Beautiful Bill” Act signed into law July 4, 2025, will significantly alter the way hospitals, health systems, and patients interact with the program, with ripple effects likely to be felt most by vulnerable communities.

From new work requirements to reduced retroactive coverage and stricter documentation, Patel emphasized that these provisions will not only impact patient access but also hospital operations and financial stability.

Below are 5 major takeaways from Patel’s discussion with The American Journal of Managed Care^® (AJMC^®) on the potential effects of Medicaid reforms.

1. Medicaid Eligibility and Coverage

The proposed legislation introduces new work requirements—80 hours per month of work or community engagement—to maintain Medicaid eligibility, cuts retroactive coverage from 3 months to 1 month, and doubles the frequency of eligibility redeterminations from annually to every 6 months. Stricter documentation would also be mandated, including proof of residency, citizenship, and income.

“These changes will bring significant shifts to Medicaid,” Patel explained. “It’s going to limit hospitals’ ability to recover costs for uninsured patients and increase the administrative load required to keep patients covered.”

2. Vulnerable Populations Will Face the Greatest Risk

Families with low incomes, older adults, individuals with disabilities, and immigrant communities are most likely to experience coverage disruptions, according to Patel. Newly expanded Medicaid states such as North Carolina and Missouri could face delays in eligibility processing, while states with large immigrant populations, such as California and Texas, may see substantial disenrollment as patients lose eligibility.

Paper saying Medicaid eligibility | Image credit: Vitalii Vodolazskyi – stock.adobe.com

Proposed changes include new work requirements and stricter documentation. | Image credit: Vitalii Vodolazskyi – stock.adobe.com

“The proposed reforms really are expected to affect what we classify as vulnerable populations… and really exaggerating this kind of inequality within the health care ecosystem that we have, because this is the group that really is served by Medicaid,” Patel told AJMC.

This will especially affect patients with chronic conditions like diabetes and heart disease who are on medications and have regular check-ins with their providers.

“These are the areas I think will have the biggest impact because patients are going to avoid going to the doctor,” Patel said. “We're going to start seeing these cases worsen and usage of the emergency room continue to go up because the preventative nature is going to go away.”

3. Operational and Financial Strain on Hospitals

Community hospitals, rural providers, and safety-net facilities could face complex billing processes, delayed payments, and an increase in uncompensated care, Patel told AJMC. To manage this increased frequency of eligibility redetermination, she said providers may need to overhaul some of their operational workflows. Implementing new systems for documentation and eligibility checks may require costly investments in information technology (IT), staffing, and workflow redesign—changes that smaller providers may not be able to afford without outside partnerships that can help shoulder the burden.

“For smaller practices and community health centers, these investments are probably prohibited from an expense perspective, so it's going to limit their ability to, over time, maybe serve that Medicaid population,” Patel said. “Their only option may be to outsource this fundamental process that many community hospitals maintain currently, because they can't take on that technology operational process for themselves.”

4. Proactive Strategies to Support Patients

CMS Administrator Mehmet Oz, MD, MBA, recently talked to AJMC about the growing need for modern IT infrastructure in rural hospitals, pointing to the $50 billion Rural Transformation Fund as a chance to rebuild essential health care infrastructure in areas struggling to keep up with rising patient demand.²

While specific requirements for applying have yet to be defined, Patel advised hospitals to prepare now by assessing technology gaps, drafting pilot projects such as telehealth hubs or mobile clinics, and aligning leadership on strategic priorities.

“Don't wait until you're filling out the application to get alignment at the leadership level,” Patel said. “Have those conversations ahead of time and understand what the strategy is, and then really start to prepare some high-level logic models that show how some of this investment can translate into the outcome that the bill is supposed to have, whether it's access or equity or that financial viability of improvements.”

Patel emphasized that hospitals should build core infrastructure to make patient financing and charity care a standard part of care delivery, especially as continuous coverage churn increases. She recommended embedding financial screenings at the first patient contact, offering zero- to low-interest payment plans, and ensuring staff can clearly explain options in under 2 minutes.

Additionally, community-based outreach such as mobile enrollment events and multilingual assistance can help reach patients with limited digital access. Patel cited examples where emergency department–based charity approvals cut bad debt by 40% over 2 years and financial navigators in high-volume clinics reduced uncompensated care by double digits.

“These are universal strategies that can be deployed right away,” she said.

5. The Role of Education, Resources, and State-Level Analysis

Patel emphasized that media outlets and medical journals like AJMC have a role to play in helping providers and the public understand the true scope of the bill—and separate fact from assumption or narrative.

“I say this because well-educated people saw the bill, read it, and they thought, ‘This is not a big deal, because undocumented citizens are the ones who are losing coverage,’ and it was like, ‘No, that is not what this is; this is beyond that,” Patel explained, calling for continued education about the bill and how it can impact patients.

She also noted that because implementation will vary by state, localized analysis and information sharing will be critical.

“If we can have a guide in how to manage through some of this, do it, because it's not just about us,” Patel told AJMC. “It's really a bigger thing over the next 10 years that we, in any shape or form in a health care perspective, should be doing all we can to support this population that is going to be significantly impacted.”

References