Medicaid Webinar Series Part 2 — Prepare for HR1 Coverage Disruptions
Aired: November 6, 2025
About the Webinar
Rethinking Medicaid: Turning Data Into Action Before HR1
This session breaks down what community health centers can do now to prepare for upcoming Medicaid changes in H.R. 1, which will add work requirements for some adults and require twice-yearly redeterminations beginning in 2027.
Guided by Alcar Health’s Joe Rivera (32 years in health center operations and outreach & enrollment), the webinar shows how to: identify Medicaid-eligible patients using your own data, build multi-channel outreach that actually gets a response, and choose a staffing model (in-house, virtual, or hybrid) that meets demand without overextending your team.
Why it matters: During unwinding, many patients lost coverage due to procedural issues—not eligibility. The next 15 months are critical for securing and retaining coverage to create a financial cushion before new rules take effect.
Key Takeaways
Start with data. Analyze self-pay/uninsured patients (adults & children), household size, and income to flag likely Medicaid eligibility.
Make in-reach routine. Use multi-channel communications (text, phone, email, signage, face-to-face) with clear “what/why/how” messages and easy next steps.
Activate the whole clinic. Front desk, call center, intake, providers, billing, CHWs—create simple referral workflows to enrollment staff.
Right-size your workforce. Compare in-house, virtual, and hybrid models; train teams beyond “application completion” to understand eligibility rules and follow-up.
Tighten sliding-fee workflows. Avoid “passive” sliding scale—screen for eligibility and warmly hand off to enrollment assistance.
Track outcomes. Measure applications submitted, approvals, renewals, denials/cancellations, and PMPM/encounter impact to prove ROI.
Who Should Watch
CEOs, COOs, CFOs, and Population Health leaders
Call center & front desk managers, CHW supervisors
Outreach & Enrollment directors, Rev Cycle/Billing leaders
Quality & Data/IT leaders supporting reporting and dashboards
“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.”
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.
What You’ll Learn
How to design an in-reach campaign that reaches eligible patients quickly
Which channels drive response (and how to tailor by population)
How to structure workflows & policies so everyone can make referrals
When a virtual or hybrid enrollment team makes financial sense
How to report activity, outcomes, and ROI to leadership and boards
Resources & Next Steps
Watch Part 1: Identifying Medicaid-Eligible Patients with Your Data
Request a 30-minute consult: See sample in-reach messaging, staffing plan templates, and reporting dashboards.
Transcript
Johanna Cazares:
Welcome, everyone, and thank you for joining Part 2 of our Medicaid Webinar Series on preparing for HR1 coverage disruptions.
Our host today, Joseph Rivera, is back. Joe is Alcar Health’s Senior Medicaid Consultant, and he’ll walk us through practical steps to set up robust internal and external campaigns that ensure patients stay connected, engaged, and educated.
Joe — the floor is yours.
Joe Rivera:
Thank you, Johanna. It’s a privilege to be here and to speak with so many of you.
For those who joined our first session—welcome back. For anyone new, here’s a bit about me: I come from the health center world, spending 27 years with a community health center in southern Colorado. Most of that time, I led outreach and enrollment teams, helping thousands of patients obtain and retain Medicaid coverage.
Since 2021, I’ve had the privilege of partnering with Alcar Health on multiple projects supporting Medicaid enrollment for FQHCs across the country. This work has always been close to my heart—it’s where access, mission, and sustainability meet.
Recap of Part 1
In Part 1, we discussed how to use data to identify uninsured patients who might qualify for Medicaid.
Health centers that conduct this analysis are often surprised—finding hundreds or even thousands of existing patients who are potentially eligible. This includes many children who, with the right support, could be covered today.
Medicaid remains the financial backbone of many health centers. Knowing who your patients are, analyzing income and household data, and acting on that information are essential first steps toward financial stability.
Why Act Now
Acting now is critical.
Upcoming provisions under HR1—such as work requirements and twice-yearly redeterminations—will create unavoidable coverage losses beginning in 2027.
Patients will receive confusing notices and will need guidance to comply. Health centers that prepare now—by enrolling eligible patients and retaining current members—will build the revenue cushion needed to offset those losses later.
Implementing an In-Reach Campaign
So, what happens after you identify eligible patients?
You build a plan to reach them, engage them, and help them apply.
An effective in-reach campaign includes:
Using patient data to identify those who need assistance
Developing clear messaging: why coverage matters, what to do, and how to get help
Reaching patients through multiple channels: phone, text, email, signage, or in-person
Providing direct enrollment support
Tracking outcomes to refine your process
At Alcar Health, we’ve seen that text messaging works particularly well—patients may ignore phone calls but tend to respond to texts.
Every health center is different, but a consistent, multi-channel approach increases engagement dramatically.
Making It a Team Effort
Successful in-reach involves everyone: front desk staff, call center representatives, providers, case managers, billing, and care coordinators.
For example:
Providers can refer self-pay patients to enrollment support when making external referrals.
Billing staff can contact patients with unpaid balances and offer Medicaid assistance instead of payment plans.
CHWs and case managers can identify social barriers and connect patients with both coverage and resources.
In short—make coverage retention everyone’s responsibility.
Leadership & Buy-In
Johanna Cazares:
Joe, can you speak to how leadership buy-in plays into this process?
Joe Rivera:
Absolutely. Before starting any in-reach campaign, you need support from key leaders—your COO, CIO, and other executives—because they control access to the data, reporting tools, and staffing needed to make this work.
When everyone understands the “why” behind the campaign, participation and accountability naturally follow.
Workforce Models
Once you know who needs outreach, the next question is who will do the work?
Health centers typically choose one of three staffing models:
In-House Enrollment Teams
Virtual (Outsourced) Teams
Hybrid Models combining both
Virtual Enrollment Teams
A virtual model serves as an extension of your health center.
These teams work under your guidance, use your patient data, and follow your messaging. Communication between the health center and the virtual team is essential.
They conduct outreach via phone and text, assist patients with applications online, follow up with counties and states, and ensure approvals are completed. They also anchor patients to your health center as their primary provider to strengthen PMPM revenue.
The cost-effectiveness is significant—no office space, training, or benefits to manage—and monthly activity reports make impact clear.
In-House Teams
An in-house team provides direct, on-site support for patients.
A best practice is to have a dedicated Enrollment Manager—someone responsible for supervision, training, and reporting, not just additional duties for a director already stretched thin.
This structure ensures consistency, accountability, and measurable outcomes across departments.
Hybrid Models
The hybrid model combines the best of both:
In-house staff handle in-person enrollment and patient support, while a virtual team extends reach through phone and text.
This approach helps health centers manage larger patient lists, scale quickly, and maintain continuity even during staff shortages or turnover.
Sliding-Fee and Referral Workflows
Sliding-fee patients should never be a dead end.
Every self-pay encounter should trigger a quick Medicaid eligibility screen and a warm hand-off to an enrollment specialist.
Health centers that track and formalize this process in writing see stronger financial stability and fewer missed opportunities.
Tracking and ROI
Tracking is key to long-term success.
Monitor:
Applications submitted
Approvals vs. denials
Renewals completed
Patients anchored to your site
Consider the ROI:
If 1,000 patients become newly enrolled and your PPS rate is $200 with an average of 3 visits per year, that’s $600,000 in new revenue.
Even helping 2,500 existing Medicaid patients renew coverage could retain $1.5 million annually.
These numbers prove that outreach and enrollment are not just compliance—they’re core business strategy.
Closing Discussion
Johanna Cazares:
Joe, for leaders who already have in-house teams, how do they introduce outside help without making staff feel threatened?
Joe Rivera:
It’s about data and capacity.
When there are more patients than your team can reach, bringing in a virtual partner simply ensures no one is left behind. We’re all on the same team—helping health centers stay financially strong while keeping patients connected to care.
Johanna Cazares:
And to clarify—virtual doesn’t mean automated or AI-based. These are real people, trained professionals who become an extension of your team.
If a health center decided to launch a virtual model, how long would that take?
Joe Rivera:
Typically 30–60 days, depending on data access and communication processes. Collaboration and feedback loops determine how quickly it’s up and running.
Final Remarks
Johanna Cazares:
Thank you, Joe. Your experience and insights are invaluable—especially your reminder that this work is about people, not just policy.
For everyone who joined, stay tuned for Part 3 of our Medicaid Webinar Series, where we’ll continue exploring strategies to strengthen coverage and financial sustainability.
Joe Rivera:
Thank you, everyone. It’s been a pleasure.
