What Leading Healthcare Organizations Are Doing Now to Prepare for 2027 Medicaid Changes
By Michael DiLuca
PATHS, LLC
The Conversation Has Changed
Earlier this year, most discussions centered on what H.R. 1 meant and how upcoming Medicaid reforms might affect providers.
Today, the conversation is very different.
Healthcare organizations are no longer waiting for every question to be answered before they begin planning. Across Pennsylvania, New Jersey, Delaware, and New York, hospitals and health systems are transitioning from policy discussions to operational readiness.
Revenue Cycle leaders, Patient Access teams, Information Technology departments, Clinical Operations, Financial Counseling, and executive leadership are beginning the work now because implementation will require coordination across the enterprise.
The organizations making the greatest progress aren't necessarily those with all the answers. They're the ones building the foundation before implementation deadlines arrive.
Here are the common themes emerging across provider organizations this summer.
Build Your Internal Workgroup Now
One of the clearest trends is the creation of multidisciplinary Medicaid implementation teams.
Organizations recognize these changes extend well beyond Revenue Cycle.
A large academic health system in the Northeast has committees focused on medical frailty and work requirement planning. Another nonprofit, multi-hospital health system in PA is forming an internal stakeholder workgroup, while another 10B+ academic health system has developed an implementation group that can serve as a model for organizations interested in comparing approaches and sharing operational best practices.
Successful implementation requires collaboration among:
Revenue Cycle
Patient Access
Financial Counseling
Clinical Operations
Care Management
Information Technology
Compliance
Executive Leadership
Waiting until final implementation guidance is released leaves very little time to coordinate people, technology, education, and workflow.
Build the System Before You Need It
Technology preparation has already begun.
One enterprise system has added Epic fields for Medicaid redetermination dates and work-requirement exemptions, even though those fields are not yet populated. By creating the infrastructure early, future workflow changes can be activated much faster as guidance becomes available.
Healthcare organizations should also begin discussions with their Epic representatives regarding future Medicaid functionality and implementation support.
Preparing systems today reduces the operational burden later.
Turn Planning Into Workflow
Policy alone doesn't improve operations.
Organizations are already aligning clinical leadership, training departments, Information Technology, Revenue Cycle, and Patient Access so future guidance can be translated into workflows immediately.
One simple recommendation continues to resonate:
Ask every Medicaid patient:
"Are you aware of the Medicaid changes coming this fall?"
Those conversations create opportunities to educate patients, verify contact information, answer questions, and prevent avoidable administrative disruptions before implementation begins.
Patient Access professionals may become one of the most important resources patients encounter during this transition.
Meet With Your Largest Medicaid Managed Care Organizations
Providers are not navigating these changes alone.
Medicaid Managed Care Organizations face many of the same enrollment and communication challenges.
Plans cannot independently determine compliance for their members, making collaboration between providers and health plans increasingly important.
Organizations are scheduling meetings with their largest Medicaid MCOs to discuss:
Renewal communication
Member education
Operational readiness
Enrollment workflows
Coordination strategies
Escalation processes
Strong partnerships established now will reduce confusion later.
Prepare for Another Application Surge
Healthcare leaders who experienced the Public Health Emergency unwinding remember the operational challenges that followed.
Incomplete applications.
County assistance offices stretched beyond capacity.
Processing delays.
Growing appeal volumes.
Coverage interruptions caused by administrative issues rather than eligibility.
Many organizations expect similar operational pressures as new Medicaid requirements are implemented.
One strategy already gaining traction is proactive outreach to Medicaid patients approximately 90 days before scheduled appointments. Early outreach allows providers to verify contact information, encourage renewals, identify potential barriers, and connect patients with available resources before deadlines become emergencies.
Four States, One Common Goal
Although implementation details differ across Pennsylvania, New Jersey, Delaware, and New York, the overall direction is remarkably consistent.
Healthcare organizations are focusing on preparation rather than reaction.
Common priorities include:
Building internal governance teams.
Preparing electronic health record workflows.
Coordinating with Medicaid Managed Care Organizations.
Training front-line staff.
Developing patient communication plans.
Monitoring implementation timelines.
Preparing operational resources well in advance.
The lesson is clear.
Organizations are choosing to prepare now instead of waiting for perfect certainty.
Revenue Cycle Will Lead-But It Won't Stand Alone
These Medicaid changes will influence nearly every operational area of a healthcare organization.
Revenue Cycle will remain central, but successful implementation will require support from Patient Access, Registration, Financial Counseling, Information Technology, Compliance, Clinical Operations, and executive leadership.
Organizations treating Medicaid readiness as an enterprise initiative rather than a departmental project are positioning themselves for a smoother transition.
Summer 2026 Medicaid Readiness Checklist
Healthcare organizations should consider completing the following over the next 90 days:
✓ Establish a multidisciplinary Medicaid implementation workgroup.
✓ Review Epic and EHR workflows for future documentation requirements.
✓ Engage Information Technology and training teams now.
✓ Meet with your largest Medicaid Managed Care Organizations.
✓ Educate Patient Access, Registration, and Financial Counseling staff.
✓ Begin asking Medicaid patients about upcoming changes.
✓ Launch proactive outreach to scheduled Medicaid patients.
✓ Monitor state implementation guidance and operational timelines.
Looking Ahead
January 1, 2027 may be the implementation date, but preparation is happening now.
Across the RCM CommUnity, providers are sharing ideas, comparing workflows, and learning from one another as they prepare for one of the most significant Medicaid operational transitions in recent years.
Organizations that begin planning today will be better positioned to support patients, reduce administrative disruption, and respond quickly as implementation guidance continues to evolve.
Healthcare organizations seeking operational guidance, implementation planning, or Medicaid readiness strategies are encouraged to contact:
Michael DiLuca | PATHS, LLC
michael.diluca@hcpaths.com