As federal budget negotiations continue, proposed policy changes under H.R.1 are prompting important questions for states and the healthcare providers that rely on Medicaid funding. While the exact timing and scope of implementation remain uncertain, the structural changes being debated—especially those tied to eligibility, enrollment, and reimbursement—could significantly reshape the Medicaid landscape in Ohio and beyond.
At HMA, we’re helping provider associations, health systems, and Medicaid plans begin modeling how these potential changes could affect state budgets and provider revenue streams over time. By leveraging Congressional Budget Office (CBO) estimates of projected federal Medicaid expenditures, we can develop targeted forecasts that account for major eligibility provisions—such as community engagement requirements, redetermination policies, and limits on retroactive eligibility.
This type of modeling is already underway in several states. For example, HMA is currently working with a multi-state hospital system to estimate how community engagement rules could affect their Medicaid volumes and supplemental payment streams. We’re also partnering with state-level trade associations that represent providers heavily exposed to Medicaid—such as community mental health agencies and FQHCs—to evaluate how future state budgets could impact base reimbursement or access to directed payments.
These forecasts are not one-size-fits-all. More in-depth analysis often requires access to rate letters and state-specific Medicaid financing mechanisms, including provider taxes and pass-through payment arrangements. But even without full data sets, we can begin to sketch reasonable budget and enrollment scenarios that help providers prepare for different possibilities.
For organizations operating in Medicaid-heavy markets like Ohio—whether you’re a health center, behavioral health agency, or managed care plan—this kind of planning can be a valuable input to strategy. Understanding the magnitude and timing of potential funding shifts helps organizations identify risk, advocate effectively, and prepare to adjust operations if needed.
While there are still many unknowns, one thing is clear: Medicaid policy is shifting, and proactive scenario planning is essential. HMA’s team stands ready to support organizations across Ohio and the country as they navigate what’s next.
To learn more about how we can help your organization model the impacts of H.R.1 and other federal changes, reach out to the HMA Ohio team today.
