Medicaid Coverage Disruptions: Preparing Your FQHC Now
Aired: September 24, 2025
About the Webinar
Rethinking Medicare: Turning Data Into Action for Underserved & Aging Populations
Hosted by Alcar Health this webinar focused on how community health centers can prepare for upcoming Medicaid changes in H.R. 1, which will add work requirements for certain adults and require patients to renew coverage twice a year starting in 2027.
Led by Alcar Health’s Senior Medicaid Enrollment Consultant Joseph Rivera, the session broke down what FQHCs can do now to get ahead:
Analyze uninsured patients, especially children and low-income adults.
Update sliding-fee and intake processes to avoid missed enrollments.
Launch strong in-reach campaigns to connect eligible patients to coverage.
Build a staffing plan that supports enrollment and retention long term.
Drawing lessons from the Medicaid unwinding—where many patients lost coverage simply because notices were confusing—the webinar stressed why the next 15 months are critical. By securing and retaining coverage now, health centers can protect access for patients and create a financial cushion before the new rules take effect.
“Obtaining and retaining coverage for the next 15 months will give health centers a cushion—a revenue buffer to offset losses after 2027. Patient data is the key. By analyzing uninsured children and adults below 138% of the federal poverty level, centers can spot red flags and act now, instead of leaving money on the table.”
Joe Rivera
Senior Medicaid Enrollment Consultant
Alcar Health
Joe Rivera brings 32 years experience in health center operations and outreach and enrollment functions with a passion for patient access to care and health center financial sustainability. After 27 years with a Colorado community health center, Joe founded Enroll IQ Consulting and began supporting health centers and PCAs nationwide. In 2021 Joe began partnering with ALCAR Health to build both virtual and onsite enrollment teams that led to thousands of new Medic-Cal and Medicaid enrollments. He now services as Senior Medicaid Enrollment Consultant for ALCAR Health.
Johanna Cazares
Chief Growth Officer
Alcar Health
Johanna Cazares is a distinguished healthcare professional with over a decade of experience in sales, marketing, and business development, specializing in FQHCs. As the Chief Growth Officer at Alcar Health, Johanna delivers solutions rooted in empathetic care, driving growth and savings for FQHCs. A MAGIC Certified Facilitator, Johanna is committed to breaking barriers to quality healthcare, especially for underserved communities. By embodying the patient perspective, she ensures that Alcar Health's contact center augmentation and training programs optimize patient interaction and service delivery. Recognized as a thought leader and change-maker in the healthcare industry, Johanna's innovative approach and passion for service drive her mission to make a lasting impact. Her background includes key roles in national health plans, care delivery organizations, and her entrepreneurial venture which optimizes Medicare Advantage growth, and enhances patient experiences. A Southern California native, Johanna credits her diplomacy and adaptability to growing up as one of twelve children. She is a dedicated mother to three children and a much-loved fur baby named Leo. Johanna is keen to connect with professionals who share her passion for improving healthcare outcomes and experiences. Guided by the mission to empower purposeful leaders, she helps realize Alcar Health's vision of driving a positive impact in healthcare for future generations.
Transcript
WEBVTT
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Annalissa Santoemma: Hello, everyone! Thank you. We are going to get started right at the hour, so we'll give everyone a couple more minutes to join.
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Annalissa Santoemma: Okay, we're gonna go ahead and get started. Just a reminder that this is being recorded, and then if anyone would like to post any Q&A in the chat, those will be answered at the end of the webinar.
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Johanna Cazares: Thank you so much, Annalisa.
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Johanna Cazares: Well, welcome, everyone. Good morning, and thank you for joining us today.
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Johanna Cazares: I am excited to introduce our presenter, Joseph Rivera.
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Johanna Cazares: Joe brings 32 years of health center experience and out from operations and outreach and an enrollment function, with a deep passion for patient access to care and financial sustainability for the health center.
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Johanna Cazares: After spending 27 years with the Colorado Community Health Center, Joe founded EnrollIQ Consulting, where he began supporting health centers and PCAs nationwide.
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Johanna Cazares: In 2021, he partnered with Alcar Health to build a virtual and on-site enrollment team, leading to thousands of new Medi-Cal and Medicaid enrollments.
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Johanna Cazares: Today, he serves as our Senior Medicaid Enrollment Consultant for Elkhar Health, where he continues to help organizations strengthen enrollment, retention, and access strategies.
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Johanna Cazares: Welcome, Joe. Thank you so much for collaborating, and I'll go ahead and turn it over to you so that you can go ahead and share your presentation. Following the presentation, we'll regroup and we'll go through the moderated discussion.
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Joe Rivera: Thank you very much, Joanne. I sure appreciate that, and it is a very real pleasure to me to be, talking to you today about preparedness, really, of the
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Joe Rivera: for H.R. 1 and the policy changes that are coming that will profoundly impact community health centers. So if you'll give me just a moment, I'm going to share my screen and bring up the presentation, and we'll get started.
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Joe Rivera: Okay, here we go.
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Joe Rivera: Again, thank you. I've got to say that your attendance here today shows your commitment to your health center, to the mission at your health center, and to the patients that you serve.
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Joe Rivera: This is why I do what I do. As Joanna mentioned, I was at a community health center for 27 years and loved every minute of it, and certainly very grateful to be with you today for this presentation.
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Joe Rivera: We're going to dive right into this. These are some things that we can expect from this webinar today. A brief look at recent legislation and rules that are impacting health centers, the real impact to patients who have to comply with some of these rules and provisions from H.R. 1.
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Joe Rivera: And then, how to take a close look.
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Joe Rivera: at patient data, how taking a close look at patient data will put you ahead of the game for when H.R.1 and other policy changes are implemented.
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Joe Rivera: And then how data will help you to identify threats and opportunities. We're going to take a look at some data points, pretty simple data points, and just how beneficial they will be for you to analyze these at your health center, if you have not already done so.
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Joe Rivera: And then, what you can do now to mitigate the impact of HR1. We know that it's, you know, a little over a year away, but really right now is the time to start planning and strategizing for that.
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Joe Rivera: Before we get started, though, just to kind of take a temperature of how your… what your comfort level is with knowledge of HR1, the question is, what is your level of comfort in understanding H.R.1 and its impact on Medicaid enrollment at your health center?
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Joe Rivera: So, we're gonna ask Annalisa to, launch this poll, and just, please take a few seconds to
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Joe Rivera: to look at this and gauge your comfort level, then we'll come back and just briefly discuss it. Go ahead, Annalisa, please.
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Annalissa Santoemma: Can you see the poll?
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Joe Rivera: I cannot see the pole.
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Joe Rivera: I think you've got to launch the poll.
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Annalissa Santoemma: I'll relaunch it. Okay.
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Joe Rivera: There we go. Yes, there it is.
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Annalissa Santoemma: Perfect.
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Joe Rivera: And of course, H.R. 1 is the one big, beautiful bill act.
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Joe Rivera: That was signed into law just recently, and, the impact with work requirements and twice-yearly redetermination. So that's really what this is about.
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Joe Rivera: All right, thank you. Alright, so it looks like we've got some poll results here. 8% of those respondents were very comfortable, which is great. The vast majority, though, are moderately comfortable with
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Joe Rivera: understanding the impact on Medicaid enrollment, and that is… that is so good to hear. We have some other levels of comfort, but we're going to really dive into what those impacts are on Medicaid enrollment and… and how they affect patients and health center… health center sustainability. So, thank you for that. You can go ahead and close that.
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Joe Rivera: By now, Alyssa.
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Joe Rivera: So thank you so much for taking the time to, to respond to that poll.
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Joe Rivera: All right.
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Joe Rivera: Well, looks like it is not allowing me to advance the slides for some reason. Oh, it's because I've got to stop my share. Thank you.
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Joe Rivera: Alright, let's go back.
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Joe Rivera: I'm sorry, everyone.
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Joe Rivera: We gotta go back to the,
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Joe Rivera: Gonna have to go back to the… Presentation, here we go.
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Joe Rivera: Alright, let's see…
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Joe Rivera: All right, looks like we're having some technical difficulty here. I am unable to advance these slides, I'm not sure why.
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Johanna Cazares: Joe, go ahead and try to hit your spacebar.
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Joe Rivera: Yeah, that's not working, I don't know why. I'm going to… I'm going to reduce this, screen, and then put it back in presentation mode, and then let's see what happens.
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Joe Rivera: I really want to apologize to our audience that we're having this technical difficulty. We did test it beforehand, and it was working just great.
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Joe Rivera: Please, bear with me one moment.
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Joe Rivera: Okay, let's try this again.
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Joe Rivera: We may have to leave it off of presentation mode, but let's… let's try it one more time.
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Joe Rivera: There we go. Okay, looks like it's working.
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Joe Rivera: Strange.
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Joe Rivera: Okay, let's just take a brief look… a brief overview of H.R. 1 and Marketplace Integrity Rules. These are two policy changes that have come up, major policy changes recently. We're not going to spend a whole lot of time on the Marketplace Integrity and Affordability Rule.
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Joe Rivera: Because there has been some changes on that and challenges in the courts for some of those provisions. But the HR1 basically impacts Medicaid enrollment in two areas. That's work requirements, the institution of work requirements.
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Joe Rivera: to keep Medicaid, and also twice-yearly redeterminations. These provisions mainly impact those who are in expansion populations, so mainly expansion states. If you're not from an expansion state, I encourage you to continue to watch this.
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Joe Rivera: this webinar, because there are some points here that every state, every health center in every state should be keeping in mind, but the biggest impact from HR1 is going to be those two on
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Joe Rivera: Those who are ages 0 through, through 64, work requirements, ages 19 to 64. So…
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Joe Rivera: In those expansion populations. Work requirements are basically saying you've got to show that you are working at least 80 hours a month.
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Joe Rivera: And in order to continue to either apply for Medicaid or to renew your coverage when it's time to renew.
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Joe Rivera: So, that's… keep that in mind. It's that population, and it affects those situations.
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Joe Rivera: Also, there's some exemptions to the work requirements. If you are a caretaker, if you're, children or an adult, you're disabled, you are involved in volunteer or community engagement, or you have children ages 0 to 13.
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Joe Rivera: For those who have children in the home ages 14 through 18, however, even though you're caretakers, you're parents, you will need… they will need to comply with these work requirements.
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Joe Rivera: The states are going to be required to be ready by October 2026, and full implementation will be December, the end of December 2026, or the first part of January.
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Joe Rivera: So, of 2027. So, it may look like this is really down the road, but it isn't. There's so much work to do at the state level. We're going to talk about state readiness.
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Joe Rivera: For, HR1, how's each state… what is their level of readiness to implement this? And we're going to take a closer look at that.
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Joe Rivera: And then for Marketplace, of course, the open enrollment dates have been changed.
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Joe Rivera: From, from prior, specifically, much shorter enrollment period, open enrollment period, which is, they're, they're, they're showing to, cause some, confusion and some, some frustration in trying to, do that, in a shorter period of time.
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Joe Rivera: And by the way, we want to make this as informal as possible, so if you have questions, that burning question, please put it in the Q&A, and we'll try to answer it as we go along. At the end of the presentation. There'll also be a Q&A session, too, that we can answer some questions, so I just wanted to put that out there, too.
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Joe Rivera: Some real-world impacts on your patients. So think about this from the eyes of your patients, looking back at unwinding what they went through, and trying to redetermine, in such a short period of time.
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Joe Rivera: the, the frustrations that they had to go through. Work requirements, and twice-yearly, or the more frequent redeterminations.
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Joe Rivera: Are projected to be, very difficult, for some.
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Joe Rivera: So, work… the documentation compliance, understanding the notices that they'll be receiving from the, from the, Medicaid office. If they are not able to… if the state is not able to.
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Joe Rivera: independently verify their work status or their income, then your patients are going to receive notices that they'll have to interpret and understand in order to comply.
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Joe Rivera: with those requirements. We know from, from Medicaid unwinding, that has been… that was a very difficult proposition, for many patients. So those are some… some real.
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Joe Rivera: world impacts that, that the patients, that they can look forward to, that this is, this is going to happen. Right now, the once-yearly redetermination still is a process for many that is difficult to go through, but think about this, twice yearly, how that's going to affect them.
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Joe Rivera: To, to go through, to go through that process. Marketplace integrity rules, short and open enrollment, also changes to the immigration status, so, those who,
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Joe Rivera: understanding the… what those new rules are for immigration status. Only certain people with certain statuses will now be able to get a tax credit.
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Joe Rivera: And, and, and get that assistance to pay for their health coverage.
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Joe Rivera: And of course, that's going to result in some loss of coverage or disruption in coverage as a result of those changes. Same thing with the HR1 provisions and the loss of coverage as a result.
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Joe Rivera: We'll go to our next slide. These are what we learned from unwinding, talked a little bit about this already. This is a study or report from NAC.
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Joe Rivera: the National Association of Community Health Centers on the impact of unwinding for community health centers on their patients' revenue and resources. Some very interesting data from a survey that was taken. The average loss of $595,000 in revenue for health centers across the board.
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Joe Rivera: That was the average loss. So, your health center might… may have lost less than that, or more. There was one health center that lost up to $20 million as a result of unwinding. Just the… so many loss… such a huge loss.
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Joe Rivera: and their Medicaid members, loss of Medicaid coverage for their members really impacted their revenue and finances.
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Joe Rivera: 23% of those members were disenrolled during the redetermination process. 56% had a coverage disruption. So, what that means is that
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Joe Rivera: They may have lost their coverage temporarily because they had not complied with paperwork requirements, documentation requirements, or they turned onto another program, and that coverage did not begin right away. Perhaps they were no longer eligible for Medicaid, but now we're going to be on a marketplace plan, but that
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Joe Rivera: that process took some time, and they lost coverage temporarily, so it was a disruption in coverage. This last statistic was really…
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Joe Rivera: really telling for me. And really, thinking about your patients at your health center and how they may be affected by these changes, 86% of them identified
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Joe Rivera: Not understanding the renewal process as the biggest
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Joe Rivera: as a biggest burial to renewing… barrier to renewing their Medicaid coverage. That was the biggest barrier, is their understanding. So the notices were confusing.
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Joe Rivera: Some thought that they had already been on, you know, renewed and retained on Medicaid coverage when, in fact, they were getting notices asking for documentation. Others
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Joe Rivera: they… they lost coverage and did not realize it. It was… it was a lot of frustration. But that impacts health center finances when you, when a patient comes in and needs to see a provider, and their Medicaid coverage is no longer in effect.
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Joe Rivera: That's… that's big. So now somebody's got to help them. They've got to work through that process to get back onto Medicaid.
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Joe Rivera: But for health centers, that was the impact of unwinding. And those are just a few of the statistics from that report.
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Joe Rivera: I'm going to stop there, just real quick. Joanna or Annalisa, were there any questions, that, any burning questions that we can answer right now before we move on, or should we move on?
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Johanna Cazares: There was one question in the chat a bit ago, Joe. I went ahead and answered it, and the question was just around whether or not we were going to go ahead and share the slides. The answer to that is yes, as well as the recording.
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Joe Rivera: Okay, thank you, thank you for doing that.
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Johanna Cazares: You're welcome.
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Joe Rivera: Appreciate that. Got another, report here, projected enrollment losses at community health centers. This is a report from the Commonwealth Fund. The… they're projecting between 2 and 5 million losses, enrollment losses, due to HR1.
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Joe Rivera: So…
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Joe Rivera: That is enormous. This is just at health centers, it's not the overall loss. I think we've heard, you know, figures in the 10 million.
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Joe Rivera: 12 million realm of those who will lose Medicaid coverage or lose health insurance due to H.R. 1.
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Joe Rivera: But for health centers alone, it could be between 2 and 5 million. Just think what an impact that is going to make on your health centers, to your… to your revenue and your sustainability, your ability to continue to serve patients. It's, you know, Medicaid, you know, it realistically is the bread and butter
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Joe Rivera: of most community health centers. That's their largest payer mix, largest portion of their payer mix, and they're really… health centers can't afford to lose any or some of those members and still stay financially
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Joe Rivera: viable. So, that's how important it is. That's why we're having this webinar today, because of the impact that they're looking for this to happen.
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Joe Rivera: And by the way, you know, some of you might be thinking, well, you know, this is, you know, what could still change if Congress, you know, if the party shifts in Congress.
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Joe Rivera: In midterms, but truthfully, there's going to be some impact from this.
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Joe Rivera: And we're going to… we're going to feel that. Whether it is exactly the way they're projecting it now, or if it might look different, really, that impact is going to be there one way or another.
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Joe Rivera: We're going to talk about state readiness now. How are states doing right now to show their readiness for the implementation of H.R. 1? This is a really interesting
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Joe Rivera: a study done by George Washington University, their Center for Children and Families. This is one map, this is one just data point that they used. They list all states, and then states who scored poorly on readiness metrics. And so let's talk about those metrics real quick.
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Joe Rivera: Well, there's one, a few of those down. You may or may not know this, but states every month have to report to CMS on 8 specific metrics. Those metrics are call center wait times, call abandonment.
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Joe Rivera: And so this is what we're talking about, is when a member calls their Medicaid office and is requesting assistance of some kind, or they're calling there for whatever reason, and they're needing to renew their coverage, they're applying, they need help. So these metrics are really telling.
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Joe Rivera: Call center wait times, call center abandonment rate, call abandonment rate, let's see, there's, application processing time that is over 30 days.
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Joe Rivera: So, that is a red flag. We're going to talk a little bit more about that, those red flags, call, excuse me, overall renewal rate, the ex parte renewal rate, and if that's kind of a strange word for you, ex parte renewal means
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Joe Rivera: that the Medicaid office is able to, through other data sets, able to independently verify a person's income, you know, will they be able to do that for their work status later on? And in order to seamlessly either approve
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Joe Rivera: Their next, eligibility span, or deny them for cause, say, you know, showing that they're either over income and, you know, in 2027, or they… did they have gainful employment?
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Joe Rivera: And so, if they're able to determine that independently, then they'll move ahead with the processing of that renewal. If they're not, if they're unable to do that, then a notice is generally sent to the member, and they're asked to provide that information.
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Joe Rivera: But, so ex parte renewal rate is one of those metrics. Their share of enrollees disenrolled at renewal.
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Joe Rivera: So, of all those who are renewing, what is the percentage of those renewals that are actually being denied and disenrolled? So that's another metric. They're looking at procedural disenrollment rates and their share of pending reviews. How many of those
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Joe Rivera: renewals are still pending, perhaps after that 30 days, or 45 days, or 60 days, they're still pending, they have not been resolved. So, in this map here, this is, in red, those who were states who scored poorly, they had 4 or more of these metrics that they did not meet.
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Joe Rivera: And they scored poorly on these metrics. And you see the states there. There's California, Colorado, where I'm from, New Mexico, Pennsylvania.
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Joe Rivera: Those who are not lit up in red, however, still have… they just have less than four. They have… most states have at least one or two or more deficiencies in their readiness
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Joe Rivera: In these metrics, so… but these states, they're… they got 4 more. So, why are we sharing this? Well, this shows you what the challenge is right now, and what it very well could be when this is implemented in, in our…
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Joe Rivera: in your health center patients, Medicaid patients, getting the renewals done.
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Joe Rivera: Or getting an application processed, in a timely way. Are the renewals happening seamlessly?
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Joe Rivera: in your, you know, if that's going to impact whether or not they stay on the Medicaid program.
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Joe Rivera: And, of course, you know, a best practice is for health centers to be very communicative and engage with your Medicaid office. No doubt you have some of those relationships. If you don't, it's good to establish those relationships to help people, help move that processing along, but this is,
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Joe Rivera: You know, it's… it just shows, you know, the states that really have a lot of work to do still before H.R. 1 is implemented.
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Joe Rivera: We're gonna take another poll.
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Joe Rivera: This is… really, we're going to move in this part of the presentation, we're going to move into, you know, what health centers can do right now, what you are doing right now. This poll is going to address what type of strategic planning is happening at your health center to prepare for
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Joe Rivera: to prepare for HR1. So you can choose all that apply. You might be doing a number of these. One of these predictive analysis of revenue loss due to HR1 or other policy changes. I know that has been recommended by a lot of consultants who serve community health centers.
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Joe Rivera: To start looking at, you know, a percentage of loss of Medicaid
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Joe Rivera: members, and what that's going to do to your, to your revenue, and then how you can adjust or respond to that. Have you reviewed, or are you reviewing, your sliding fee policies and fee schedule? You might wonder, well, what does sliding fee have to do with this? Well, it has a lot to do with it, because
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Joe Rivera: Somebody who loses Medicaid is going to end up on sliding fee. It's going to be uncompensated care. You'll be giving them discounts for that. Is your fee schedule and your co-payment schedule for your sliding scale, is it up to date? And does it reflect the needs of your health center?
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Joe Rivera: Reviewing… have you reviewed your health center staffing model to adjust to HR1? Will you… will the staffing model look the same? Will you try to provide that same level of services that you are right now?
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Joe Rivera: Are you going to have to cut back? Some health centers are reviewing that also. Have you reviewed current operational efficiencies at front desk? You know, providers, nursing, administrative staff? What efficiencies are there that can be improved?
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Joe Rivera: To help save money, for, for when this, for when this hits. Analysis of your health center's patient payer types. Taking a prospective look. You do this every month when you have your financial
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Joe Rivera: when your health center finances come out, and you're looking at, you know, what is the trend? Are your Medicaid patient visits trending up? Are they trending down?
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Joe Rivera: your self-pay or sliding scale? Are those trending up? Are they trending down? Are you looking at that? Are you looking at what, perhaps, what the losses of what that… those trends might look like?
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Joe Rivera: Or are you still developing a strategy? Or something else? If there's something that's not listed here that, that we have listed here that you're doing, please mark others. So, Annalisa, go ahead and launch this poll, and then we'll see, we'll see what it looks like.
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Joe Rivera: And we'll give that a few more seconds.
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Joe Rivera: Annalisa, if it looks like we've gotten the majority of the responses, we can go ahead and close it.
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Joe Rivera: All right, thank you. All right, so, very nice. So, we see that, a number of you are doing, doing,
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Joe Rivera: most or some of these that we talked about. The majority, however, 60%, are still developing a strategy, and that's good. And the fact that you're thinking about this, and you're developing a strategy.
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Joe Rivera: is so important, to start planning now, strategizing now, to, to respond. We're going to look now. Thank you for that. We'll go ahead and close the poll.
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Joe Rivera: No, with everything that we've considered, you know, what are lessons from Medicaid unwinding, the, you know, what state readiness.
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Joe Rivera: what the potential revenue losses are. We're going to move into, now, just what health centers can do now. Now, the strategizing that you're doing is great. Please keep doing that to be ready. We're going to look at some very specific
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Joe Rivera: data points to… to look at or to review that will help also, that, in our view, is really vital in preparing for this. And, you know, I think I'm having problems with,
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Joe Rivera: with advancing my slides again, I think it was that crazy poll that did it to me, because I think that's when it happened last time, so please bear with me, I'm going to stop my share.
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Joe Rivera: Or actually, what I'll do is…
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Joe Rivera: Yeah, it's not even allowing me to get out of this. I'm going to stop my share. I apologize for this, for that little glitch.
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Joe Rivera: this up.
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Joe Rivera: There we go.
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Joe Rivera: There we go. Okay.
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Joe Rivera: Okay, I'm going to share my screen again.
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Joe Rivera: Alright, let's see if it works now. There we go. Oh, perfect. Okay, so why now is the time… why is now the time to act?
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Joe Rivera: Obtaining and retaining coverage for the next 15 months, is going to keep you
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Joe Rivera: Give you a cushion.
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Joe Rivera: a revenue cushion to offset the losses after 2027. There are going to be some losses, there's no way to get around it if this is implemented in the way that they are planning, but by helping your Medicaid members or your patients to obtain or retain Medicaid, now putting into place a
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Joe Rivera: a process to do that, if you're not doing it, is going to give you that cushion. It's going to help keep those finances steady prior to the implementation. Patient data will highlight where you're vulnerable and what opportunities you have to impact access to care and revenue.
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Joe Rivera: So we're going to talk at length about some data points, as I mentioned, that health centers can start looking at now in planning for.
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Joe Rivera: And then, of course, your patients are going to need reliable information about these changes. The news feeds and the media sources are out there, and there is a ton of information about HR1, about work requirements, about redeterminations, about immigration.
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Joe Rivera: And people are seeing this, and no doubt, or confused, or wondering, well, am I going to be able to keep my Medicaid or not? Is your health center… does your health center have in place some messaging on HR1? Now would be a good time to start doing that.
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Joe Rivera: By acting now on that, you'll be able to provide them information from a trusted source, and you know, again, you know, if they're already on Medicaid, this is not going to affect them until it's time for them to renew their coverage again.
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Joe Rivera: And primarily after January of 2027. But they might, you know, they may be feeling like, well, you know, do I need to do something? Am I going to lose my coverage? Please allay their fears. But now is the time to put together some messaging to benefit your patients, to allay those fears.
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Joe Rivera: Now we're going to take a look at some data points, take a closer look. You may have done this in your health center. If you have, my hat's off to you. To me, this is one of the most important data analyses you can do.
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Joe Rivera: At your health center, where… where that affects your, that affects your Medicaid revenue.
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Joe Rivera: For children, taking a closer look at children, ages 0 through 18, prospectively, over the last 12 months, everyone who has had a med… all your children who have had a Medicaid visit.
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Joe Rivera: or who were self-pay or uninsured.
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Joe Rivera: in the last 12 months that are still uninsured, and… and looking at each site, looking at this data for each site, looking at the number of children who are on Medicaid and CHIP, and the number of children who are on sliding fee… or self-pay or sliding fee only.
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Joe Rivera: Now, you might wonder, well, why would we have somebody, or have a child on sliding fee only? There are very few reasons why you would do that.
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Joe Rivera: And it really should be their only option to get medical care. Now, that could be because of their immigration status, that they're not eligible for Medicaid or any other programs, or they're over income for some of the
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Joe Rivera: Medicaid or CHIP programs in your state, but still below 200% of the federal poverty level. That's why they're on sliding fee.
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Joe Rivera: But if you see that you have children who are on sliding fee with no other payer source, that is a red flag.
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Joe Rivera: There should be no children on sliding fee only, unless that is their only option.
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Joe Rivera: Children generally also visit the doctor a few times out of the year. If they're on sliding fee, you're writing that all off, less a co-payment, and that's if you're even able to collect the copayment.
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Joe Rivera: Same thing with adults, you'll want to take a prospective look at all uninsured adults who are at or below
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Joe Rivera: 138% of the federal poverty level, that's the Magi, Medicaid, MAGI category cutoff.
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Joe Rivera: For, for the expansion population for Medicaid expansion. So if you expanded Medicaid in your.
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Joe Rivera: in your state, you haven't taken a look at this, you really should. There is not one health center that I'm aware of that has done this analysis at Alcar, and myself have, helped with this analysis, that did not show up hundreds
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Joe Rivera: of adults, if not more, who were below 138% of the federal poverty level, and sliding scale was their only option. Now, given there may be those who have no other option because of their immigration status to be on that, but
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Joe Rivera: But, we've, you know, and really sifting through that data and taking a close look at it, then, then we're able to see that there are a lot of adults, parents, single adults, couples, who are on sliding scale only, and that's it.
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Joe Rivera: And they're potentially eligible for Medicaid. So right now, if you did that analysis right now, and you look prospectively for the 12 months, you may be surprised by what you see. There's not a health center that's done this that did not find children who were on sliding scale only, and they could not explain why.
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Joe Rivera: They were not sure why that was the case, why they were not on Medicaid. So that's… that's money that health centers are leaving on the table.
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Joe Rivera: That's… that's revenue that you need
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Joe Rivera: to be generating, prior to, to January of 2027, and then putting these practices, and any improvements in place to, to help with your Medicaid members, even after January 2027.
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Joe Rivera: So this is really important. Hopefully you've done this. If you haven't, take some time to do this. Look at all of your children, uninsured children.
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Joe Rivera: who are… who have seen a provider in the last 12 months. Do you really know who they are? Do you know why they are on there?
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Joe Rivera: I have listed in here, as part of this analysis, looking at all of your Medicaid members, those who are on Medicaid now. And the reason why is because that gives you an idea of how many you have now. You're getting revenue from, that you're receiving revenue from.
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Joe Rivera: But, you could lose that revenue. So, that gives you… that gives you an idea of all of those who still need to retain their Medicaid coverage. Not everybody will.
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Joe Rivera: But if you can, if you can affect
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Joe Rivera: retention for a good portion of those, and help them with that, then you're going to retain that revenue that you need desperately, and right now.
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Joe Rivera: And so, please do this. We're encouraging to make this analysis. I know that, you know, the data that you're pulling from your EMR is,
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Joe Rivera: it, you know, it's probably overwhelming. There's a million things you can look at. Please do take the time to do this, to look at these data points.
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Joe Rivera: I'll give you an example of some findings from health centers. We've kind of talked about this already, some health centers that have done this analysis. They, identified uninsured children who are on sliding scale only, adults, the same thing. Identified patients whose payer type is unknown. I don't know if you have that in your HR, or if you've ever seen that.
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Joe Rivera: But not knowing if there's a child or an adult who's below 138% federal poverty level, if you're tracking their income and household size.
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Joe Rivera: But their… their pair type is unknown. Why is that?
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Joe Rivera: That's a red flag. Everybody should have a payer type. If it's… if it's uninsured or self-pay, okay. If it's sliding scale, great, that should be in there. Have you, health centers have, found that they've had, health insurance?
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Joe Rivera: The patients have had health insurance, but sliding scale was the primary payer.
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Joe Rivera: So, the health insurance, Medicaid, private coverage, marketplace coverage, is not being billed. Why is that?
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Joe Rivera: And sliding scale was being categorized as the primary. And if that's not changed, there might be a good reason why, but if it's not changed back, then all those visits afterward, that's going to happen.
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Joe Rivera: They're gonna just get a sliding scale discount.
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Joe Rivera: They're also able to see the total number of Medicaid and CHIP patients that they have, again, helping them to see what their revenue sources are right now, and how to retain that revenue source. They've also identified that, you know, after looking, making this analysis and seeing the amount of work that needs to be done.
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Joe Rivera: to reach and retain or to enroll these Medicaid members
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Joe Rivera: That their staffing is inadequate for that, and it allows them to take a look at their staffing model and make those changes, too.
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Joe Rivera: So FQHCs can ask these questions after doing a data analysis. Why are there children who are self-paid or sliding scale, but not on Medicaid or CHIP?
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Joe Rivera: do… have these children or parents been reached out to by an enrollment specialist? Are there plans in place to reach
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Joe Rivera: that reach out to current Medicaid members to help them retain their coverage. Are there gaps in the sliding scale application intake process, or intake process, that result in missed opportunities for Medicaid enrollment?
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Joe Rivera: We'll talk a little bit more about that as a threat.
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Joe Rivera: To, to a health center sustainability, but, front desk, sliding scale, intake, those are positions that are vital to a health center, and for it to be functioning at the very highest level.
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Joe Rivera: So identifying those threats. So some threats could be, unchanged sliding fee intake or front desk processes. If you see that these are causing a problem, that after taking a look at the data and you're seeing that
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Joe Rivera: that you've got these issues, but not changing, that is a threat. Or there has not been a review of those processes or workflows in a long time, that is a threat. There could be some efficiencies there that are affecting
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Joe Rivera: whether or not your payer mix, how many people are on Medicaid, are they being connected with an enrollment specialist to apply for Medicaid?
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Joe Rivera: The lack of uniformity in data entry and workflows, and that's across the board, with turnover and training, that could be an issue where
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Joe Rivera: things are being, you know, opportunities are being missed to help people retain or obtain Medicaid. Just keeping the status quo prior to HR1 impact or a passive response, basically doing nothing, or having a wait-and-see attitude, that is a threat.
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Joe Rivera: Let's just see how this is all going to play out. Maybe we don't have to change much.
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Joe Rivera: We don't have to spend any additional money as a result.
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Joe Rivera: That is a threat to your health center. Missed opportunities to generate revenue in the next 15 months. Some of the things we've talked about so far, about doing that data analysis and then acting on it, that's only going to help increase your Medicaid revenue, keep your self-pay or uninsured population as low as possible.
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Joe Rivera: And, and keep that revenue stream coming in.
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Joe Rivera: And then, also a higher uncompensated care and fewer resources for your patients. If a patient is lacking health insurance, whether it's Medicaid or Marketplace or any other kind of insurance than insurance coverage.
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Joe Rivera: that really closes a lot of doors for them. If they need services outside your health center, they need a referral to a specialist.
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Joe Rivera: They need to get services at a hospital. Without those resources, that really limits their access to care. And of course, it's going to affect your bottom line, too. The more uncompensated care means less revenue.
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Joe Rivera: So these are some threats, some really… some things to really think about, and we encourage you to do that. We've helped health centers to do this, to make this assessment, and really take a… take a close look at what those threats and opportunities are, but we encourage health centers to do this as soon as possible.
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Joe Rivera: Taking advantage of opportunities, so acting on your data findings as soon as possible, doing the data analysis, and then acting on it. Plan and implement a robust in-reach campaign.
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Joe Rivera: So, in-reach means your current patients, those who are utilizing your services right now, who are uninsured, reaching out to them, verifying if they have any other kind of coverage.
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Joe Rivera: At that point, and if they don't, screen them for Medicaid eligibility. That's something every health center should be doing.
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Joe Rivera: in one way or another. Depending on your model, your staffing model, it may be an outstation social service worker at your health center. You could be using an outside organization to do those enrollments for you, but
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Joe Rivera: But, you know, do something. Implement, implement that, a robust in-reach
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Joe Rivera: campaign as soon as possible. Create a staffing model that fits. Enroll all eligible children and adults in the next 15 months. In my view, in my experience, health centers should be scratching and clawing
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Joe Rivera: for every Medicaid-eligible member right now.
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Joe Rivera: And to not only improve access to care for those patients, but to also help you with your financial sustainability. We understand that you have…
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Joe Rivera: you know, unlimited priorities, so many priorities on your plate that you have to address. We're just asking, you know, make this one of them.
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Joe Rivera: And, in doing this analysis, and doing your very best to act on it, and have a strategy in place by January of 2027.
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Joe Rivera: have, you know, a staffing model, your chest pieces in place. When people start receiving those notices for work requirements or those
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Joe Rivera: frequent notices for redetermination, you have a strategy in place to help them. They're going to be reaching out to you as a trusted partner, as their healthcare provider, and wanting answers, wanting help. Please try to be ready to do that.
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Joe Rivera: Well, that brings an end to this presentation. We're going to move into Q&A right now, and hopefully this has been enlightening to you, giving you something to think about in preparing for HR1, and what you can do even right now. So, Joanna, any questions that we can pose, or I know you had
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Joe Rivera: Questions to moderate to.
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Johanna Cazares: Yeah, absolutely. Let's go ahead and check the chat.
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Johanna Cazares: Nothing there yet. We are open for questions, so please utilize the Q&A, or chat.
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Johanna Cazares: And,
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Johanna Cazares: While we wait, I'll go ahead and just dig in. So, first off, Joe, thank you so much for going through all of that information. I know there's tons, and it's all very layered. So, if we can go back to, I think, just the initial, slide, or one of the very first slides that displayed the,
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Johanna Cazares: the… 50 states, and the bulk of the states were in red.
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Johanna Cazares: That…
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Johanna Cazares: speaks volumes. I think, you know, the majority of, expansion states are included… are in red, so that…
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Johanna Cazares: Definitely surprising.
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Johanna Cazares: If you had to narrow it down, could you please, identify 3 action steps that states can take today to start, preparing for these changes?
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Joe Rivera: Yes, you know, I just… again, looking at this from the… through the eyes of a Medicaid member, that first… the first… many times, the first step in a redetermination or an application comes from a phone call.
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Joe Rivera: the member makes a phone call to the, to the Medicaid office, and how long are they waiting?
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Joe Rivera: Are there calls… are they not… are they abandoning those calls because the hold time is so high? In my experience, that's usually what happens… what happens when they call the health center. They say, look, I tried to call the county, or I tried to call the Medicaid office, and there was no answer. I couldn't wait on hold for 50 minutes, or 30 minutes.
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Joe Rivera: And so, can you help me with this? So those call wait times and abandonment times, I think, are going to be huge. To the extent that states are able to reduce that and provide that assistance as quickly as possible, I think it's going to be a game changer for many states.
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Joe Rivera: And then, the other one… I think the other one is just the processing time, past 30 days. States are, are,
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Joe Rivera: are overwhelmed, they're short-staffed, there's going to have to be some hiring of additional staff. I know that under HR1, there is millions of dollars, being allocated for, work requirements, implementing work requirements, and, twice-yearly redeterminations. Hopefully, they use that money
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Joe Rivera: to increase staff and training at the Medicaid offices. But those are, just three of, I think, that rise to the top for me on, for, for state readiness.
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Johanna Cazares: All right, and so from… thank you, from the provider perspective, what are the top three actions that health centers can take today?
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Joe Rivera: Yeah, three… so, really, some takeaways, from today's, from today's
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Joe Rivera: Webinar, is do the analysis.
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Joe Rivera: Analyze, take the time to analyze your uninsured population.
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Joe Rivera: And see, you know, and look at those specifically. Those age groups who are uninsured, 0 to 18 on the children, and then… and then adults 19 to 64 who are below 138% of the federal poverty level, looking at those who have previously had visits at your health center.
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Joe Rivera: I think what's going to happen is that you'll… by doing that, you're going to see there is… there is some room for improvement on just how data is entered in your… into your EHR, to get accurate… to get… to receive accurate data, as well as showing, you know, look, we've got some work to do.
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Joe Rivera: We've got a lot of patients… a lot of our own patients, that we need to reach out to. And so, this… so doing the data analysis. Second thing is just putting into place a strategy to do that. The in-reach… in-reach program.
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Joe Rivera: in-reach campaign, I should say. I mean, we've been talking a lot about, you know, what health centers can do, so they have all these findings from the data, and they see, okay, we've got a lot of work to do, but who's going to do that?
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Joe Rivera: who's going to do that work? We don't have the staff right now. We don't think we do have the staff right now to do that work, or the staff we do have are not adequate.
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Joe Rivera: So, that's something we're going to have. I'll just plug it right now, and a future webinar is creating a sustainable workforce to do this work, Medicaid enrollment.
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Joe Rivera: for your health center, and also in implementing an in-reach strategy, or in-reach campaign to reach those who are potentially eligible. How are we going to do that?
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Joe Rivera: And we're going to cover more of that on our next webinar. By the way, if that's a burning question for you, and you'd like to talk about that offline, we'd certainly be happy to talk to you, too.
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Joe Rivera: And give you some ideas, but we are going to have a webinar in November, for… that will address the… will address that also. Today's really was just focused on looking at the data and seeing what you find.
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Johanna Cazares: Yeah, and it looked like, just based on the poll, about 60% of the attendees today, have a strategy in development. Something that's underway, not quite, solidified yet, so I think that November 6th, webinar will be helpful, just to kind of outline and,
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Johanna Cazares: Let them know what that workforce or that, strategy implementation, requires.
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Joe Rivera: Great. So…
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Johanna Cazares: Any questions in the Q&A? No? All right, well, I have a couple more questions for you, Joe.
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Johanna Cazares: When it comes to the cost of doing nothing, if we have, you mentioned a, you know, a leader that wants to kind of just wait and see, what would you say to that, to that leader about their position on wait and see? What would the cost of doing… in this, that holding pattern look like?
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Joe Rivera: Thank you for that. Yeah, number one, it's dollars and cents.
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Joe Rivera: For the health center. If you've identified
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Joe Rivera: 500 children and adults who are potentially eligible, for instance, for Medicaid. And you're having, even right now, having a wait-and-see attitude, or viewpoint on that.
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Joe Rivera: then you are leaving money on the table. Not only that, but as I mentioned, it impacts the… it impacts your patients. It gives them less resources, less ability to seek the care that they need.
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Joe Rivera: And again, those doors are shut for them. It is… I can't stress enough just how vital it is to not do that, to not take a wait-and-see attitude. And I don't think there's many health centers who are going to do that.
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Joe Rivera: To be honest, they're going to have some strategy, work on a strategy. I guess our message today is don't wait too long to do that. You know, start working on that now or as soon as possible in identifying those ones and helping them to get onto Medicaid.
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Johanna Cazares: And you brought up a good point earlier about, health centers really leveraging the trust that they have with their patients, and ensuring that the communication is,
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Johanna Cazares: Coming from a trusted source, rather than, you know, out in media land where a lot of things can get convoluted and
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Johanna Cazares: there's so much nuance to, each patient's experience and, where they're at in their process of, redetermination or immigration, and so, I, I think that
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Johanna Cazares: That call to action is really vital as well, and kind of built into the strategy of
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Johanna Cazares: the HR1 prep.
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Johanna Cazares: Any, any final thoughts on that, specific messaging around,
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Johanna Cazares: That health centers, can share with their patients today.
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Joe Rivera: No, not really. Just, again, you know, having some messaging
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Joe Rivera: put together, you know. For instance, you know, H.R.1 is not… is going to be implemented until 2027, so these changes that they're going to… that are being talked about will not be… especially for those who are on Medicaid now.
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Joe Rivera: And they won't be impacted in that way. However, in the meantime, they may need to have a redetermination, and are they getting the help they need with that between now and then?
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Joe Rivera: And I think that's gonna be important, too.
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Johanna Cazares: And how about for patients that are in a marketplace plan right now? Any… any thoughts on that, or anything that we can share with the audience?
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Joe Rivera: Yeah, we didn't touch on this very much, but I think as our audiences may be… our audience may be well aware of, the enhanced subsidies that have been in place for the last few years, they're due to expire.
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Joe Rivera: And so, there's no doubt a lot of worry among those who are on a marketplace plan on what those premiums are going to look like next year. Are they going to be able to have the same level of health coverage that they do now? And so, that was not part of HR1, the reauthorization.
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Joe Rivera: for those enhanced subsidies that bring down those premiums. It was not in H.R. 1. Congress is still debating this. There, in fact, could be a reauthorization, but more than likely not until, later on this year, before the end of the year.
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Joe Rivera: You know, if that happens, great. If it doesn't, then there's going to be a lot of decisions that patients have to make.
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Joe Rivera: About their health coverage, and what they're willing to pay for, or the type of coverage that they're willing to pay for.
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Johanna Cazares: Alright, so more to come on that, it sounds like.
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Joe Rivera: Yeah.
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Johanna Cazares: Alright, we have about, 6 minutes left.
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Johanna Cazares: Chat is open, Q&A is open,
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Johanna Cazares: But let me go ahead and just, give you an opportunity, Joe. Can you share, without naming any names, or,
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Johanna Cazares: Anything to identify, but can you share a success story you've had with, this type of, you know, the strong in-reach process, the, you know, prioritization and, prospective data analysis, anything you can share?
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Johanna Cazares: As far as,
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Joe Rivera: Sure, I'd be happy to do that. Yeah, there was a health center I had the privilege of working with in California. They had over 100,000 patients. Their uninsured rate before putting some of these practices in place was 25%.
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Joe Rivera: That uninsured rate now is down to 4.3%.
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Joe Rivera: huge, huge difference, obviously, and… and impact on their revenue, impact on their patients. I mean, we're talking about human beings here, that are being impacted by, by things that are… many of the things that are beyond their control. And to be able to have,
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Joe Rivera: a hand in helping them with getting that access to care, I think, is one of the best things we can do.
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Johanna Cazares: Agreed. Agreed, Joe. Thank you. That's the mic drop moment right there. Let me go ahead and check our chat and Q&A.
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Johanna Cazares: Doesn't look like anybody has any questions, so, I… I want to go ahead and be respectful of everyone's time. Number one, Joe, thank you so much for your time, for sharing your… your expertise, and just your…
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Johanna Cazares: Immense knowledge on, you know.
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Johanna Cazares: this… this topic. I think it's… it's a lot of information. We're choosing to break it down in two sessions, and so I think just the… the setup of what to be looking out for today is really going to go ahead and help our audience prepare for part two, which is coming up November 6th.
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Johanna Cazares: So, again, to everyone who joined, thank you so much for your time, for your trust, and your commitment to patient care.
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Johanna Cazares: We hope you left with a, sense of urgency and the opportunity that's in front of you, so please join us for our Part 2 in this series, which will be November 6th at the same time, 10 a.m. Pacific Standard Time.
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Johanna Cazares: If you have any questions beforehand, again, like Joe mentioned,
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Johanna Cazares: We will be sending the slides out. Joe's information will be there as well, so if you'd like to offline, we're more than happy to… to connect with you as well.
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Johanna Cazares: Alright, take care, everyone. Have a great day.
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Joe Rivera: Thank you. Thank you all for attending.
