The Senate Finance Committee released its version of President Trump’s “Big Beautiful Bill,” but social safety net providers and managed care organizations (MCOs) are holding their breath, anticipating how potential changes to Medicaid eligibility and funding might impact their operations and vulnerable individuals.
According to the Congressional Budget Office, some 7.8 million people could lose Medicaid coverage under the bill, adding nearly 11 million more people to the roster of uninsured Americans by 2034. In addition, the proposed reduction in federal funding would reduce Medicaid spending by up to $800 billion over the next decade, leaving states with massive shortfalls in caring for vulnerable populations.
While the bill’s final form remains uncertain, understanding its key provisions and preparing for potential implementation can help organizations navigate whatever changes may come. In fact, regardless of what happens with the bill, digitizing eligibility, referral, and care coordination workflows can make care delivery more efficient, more accessible, and less costly, meeting the administration’s stated goals without adding burden on providers and MCOs.
‘Community Engagement Requirements’ a Key Sticking Point
The Senate Finance Committee’s newly-released version of the proposal establishes work requirements of 20 hours per week for able-bodied adults starting at age 19 who do not have dependent children or elderly parents in their care. Adults with dependent children older than 14 will have to prove they work, attend school or perform “community engagement” for 80 hours per month to maintain their eligibility. (Pregnant women and individuals with disabilities are exempt.)
As a result, states would need to verify completion of these requirements as part of eligibility redetermination twice a year—a process previously completed just once annually. This would create new administrative workflows that many states haven’t previously managed at scale.
Implications for Managed Care Organizations
The verification burden will fall primarily on individual beneficiaries, who would need to demonstrate they’ve met the monthly requirements. However, MCOs would likely be on the front lines of facilitating this process, given their existing relationships with members.
This naturally has MCOs concerned about the logistics, time, and expense of this process, especially in light of proposed funding cuts. And rightfully so: the increased frequency of eligibility verification alone could lead to higher member turnover, making it more difficult for MCOs to conduct the financial projections that inform business planning. While member churn already exists, work requirements could exacerbate the issue, especially considering that the current disparate infrastructures and lack of integration between workforce programs and MCOs would make this a mostly manual process.
Not to mention, if proving compliance becomes too difficult, some eligible individuals may simply bow out, creating hardships for untold numbers of families and communities while also reducing MCO enrollment and revenue.
Preparing for Potential Implementation
Fortunately, MCOs are also well-positioned to help members navigate these requirements through their existing community networks and member engagement systems. While the bill’s final form remains uncertain and could face legal challenges even if passed, organizations can take several proactive steps to prepare:
- Map community resources. MCOs can start now to formalize relationships with employment, training, and volunteer programs and opportunities in their service areas. Knowledge of these programs likely already exists with individuals based on their work in the field, but now is the time to document it and leverage resource databases that can be shared across the safety net ecosystem.
- Strengthen existing relationships. Most MCOs and healthcare organizations already have established relationships with community-based organizations, like food banks, clothing resources, transportation support, housing assistance, and other nonprofit services. Strengthen these relationships now to create more seamless pathways between Medicaid eligibility, workforce development, and assistance services.
- Leverage lessons learned. This won’t be the first time states and MCOs have undertaken a massive verification effort. When Medicaid redetermination resumed after COVID-19, states and MCOs managed a complex, large-scale eligibility verification process. Revive those member communication, data management, and care coordination strategies to handle any future verification requirements.
- Focus on member engagement. Launch campaigns early to confirm member contact information and that existing communication channels are effective. The post-COVID redetermination effort demonstrated the importance of maintaining strong member outreach to keep eligible individuals from falling through the cracks.
Digitization Saves Time & Money
While previous work requirement pilot programs raised concerns about administrative costs, the key to cost-effective implementation lies in leveraging digital infrastructure rather than relying on manual systems.
If organizations haven’t yet digitized their care coordination workflows and resource network navigation systems, now is the time. Digital intake, verification, and closed-loop referral systems that integrate with workforce, care management, and electronic health record (EHR) platforms can help individuals more easily navigate job training programs and document work activities for verification.
This modern, integrated approach can ensure that administrative costs don’t outweigh potential program savings.
Prioritize Efficiency Regardless of Legislation
Even if the Big Beautiful Bill passes into law soon, implementation may unfold over time. Federal agencies will need to issue guidance, states must then develop implementation plans, and there may be legal challenges that affect timing and scope.
All of this might take months or even years. That’s why, regardless of specific policy outcomes, organizations should focus now on improvements that make sense—strengthening member engagement, streamlining care coordination, and making safety net services more accessible and easier to navigate.
The ultimate goal shared across the ecosystem remains the same: supporting economic mobility and prosperity and connecting individuals to meaningful opportunities for employment and training. By focusing on this shared objective and building on existing strengths, organizations can prepare for whatever budget and logistics changes may come while continuing to serve their communities effectively.
Digitizing the social safety net does just that by maximizing efficiency in service delivery while dramatically reducing logistical burden and administrative costs for MCOs and providers.
As the Medicaid administration landscape evolves, organizations that focus on member-centered service delivery, leverage technology effectively, and maintain strong community partnerships will be well-positioned to adapt to whatever change comes next.
About Carla Nelson
Carla Nelson, MBA has more than 20 years of experience in healthcare operations and policy, where she has focused on improving the care experience and whole-person care. Carla is currently the Senior Director of Healthcare and Public Policy at Findhelp, where she analyzes federal and state policies and translates them into actionable Findhelp strategies that support marketing, product development, and customer and community success.
Prior to Findhelp, Carla was Vice President of Ambulatory Care & Population Health at the Greater New York Hospital Association (GNYHA), a trade organization representing more than 160 member hospitals and health systems. There she worked closely with hospital leaders and government agencies on regulatory matters in a variety of healthcare delivery areas, and led the organization’s social determinants of health portfolio. Before GNYHA, Carla worked in ambulatory care operations at a large academic medical center where she was responsible for project management, patient-centered medical home implementation, and quality and process improvement initiatives across primary care and specialty practices.
