H.R.1 (or the One Big Beautiful Bill Act) was signed into law in July 2025. This bill delivers major changes to multiple areas of the healthcare system, including Medicaid provider payments, Section 1115 Medicaid waivers, home- and community-based services, and rural community support.
Health systems and health plans are preparing for these changes and predicted financial impacts by reducing administrative staffing and budgeting for a continued increase in medical utilization. Plans should also provide support to members affected by the bill who will need assistance with accessing care and community programs, redetermination documentation and enrollment.
Here are three ways a health plan can prepare members for the impacts of H.R.1. to reduce confusion and maintain member engagement:
1. Strengthen partnerships with health providers, systems and offices
During the post COVID-19 redeterminations, the main cause of Medicaid coverage loss was administrative issues, not eligibility. Similarly, there are increases in documentation required by H.R.1 for Medicaid expansion members, so there is also a greater risk of coverage loss due to administrative issues.
This is a great time to work collaboratively with health providers, systems, and state-level Medicaid offices to ensure the best member health outcomes and help prevent issues like late redeterminations and member abrasion. Here’s what you can do:
- Stay up to date in discussions about changes related to H.R.1
- Eliminate duplicate efforts across plans, providers and administrative offices
- Present areas of opportunity to stakeholders
- Work closely with state-level Medicaid offices to ensure that members at risk of disenrollment are clearly identified so plans can provide support
Healthmine can help plans and members navigate redetermination. Our library of ready-to-go health actions include a redetermination health action that notifies members documentation is due 75 days before the official due date, giving members a running start to avoid falling behind and losing coverage. We can also guide members to state-specific preparation activities, such as the submission of renewal forms, appealing decisions and finding new coverage.
Redetermination campaigns can be run for Medicaid expansion and non-expansion members, unique to the two timelines these groups operate within.
2. Provide clear and timely communication
There has been plenty of news and information shared about H.R.1, and members may feel fearful and uncertain about its impact on their care. Plans can provide clarity to members through clear communication that helps them understand potential changes and next steps.
It’s especially important to build a process to provide timely notifications and support to members when they’re up for redetermination. Additionally, Medicaid members are often managing complicated conditions, so communicate with them frequently to encourage engagement and prevent delays in treatment.
There’s a high risk of a member missing a mailed notification, which may jeopardize their coverage. When developing a communication strategy, it’s recommended to use email, phone calls and text messages to reach members quickly and effectively.
Healthmine provides plans with a digital-first outreach strategy to help engage, educate and control operational costs during the redetermination process. Within the Quality Relationship Management™ (QRM®) platform, payers can track these outreach campaigns in real time and follow-up with non-engagers. Campaigns can be sent from the platform in 15 minutes or less.
3. Use technology strategically to increase engagement
Even with fewer resources, the goal for the healthcare system remains the same: improve health outcomes for members and reduce overall cost. To help achieve this goal, plans need to engage members and educate them on their available benefits, resources to improve their health, and coordination support to help them navigate the often-confusing healthcare system.
These outreach and member engagement strategies typically require high touch rates, which isn’t possible for plans with limited staff. Leveraging technology can help plans effectively communicate with a larger cohort of members in less time. Streamline communications and eliminate duplicate efforts across healthcare products with the help of technology to reduce administrative costs.
Healthmine is connecting with more members, faster and more efficiently than ever. Our platform is tracking the right data in real time, using AI purposefully to connect members to care and reducing the burden on call centers, marketing teams and quality and risk departments. Across our client portfolio, we see a 52% improvement in clinical gap closure, 73% success rate in appointment scheduling and 64% lower operational costs through AI scheduling.
Stay engaged with your members
Healthmine can help you build an engagement strategy to keep your members informed on the impacts of H.R.1 and to reduce costs. Reach out to me at Ana.Berridge@Healthmine.com to get started.
Summary
- H.R.1, or the One Big Beautiful Bill Act, will cause many changes in the healthcare system, especially for Medicaid.
- Health plans are reducing administrative staffing and cutting costs to prepare for the impacts of H.R.1, but plans still need to help their members effectively navigate redetermination, enrollment, and accessing care.
- Plans should collaborate with health providers, systems and state-level Medicaid offices to help prevent Medicaid coverage loss due to administrative issues, which can be a major cause of coverage loss.
- Plans can help members understand what’s going on and how it may impact their care by sending clear, timely communications, especially when they’re up for redetermination. Focus on digital communications like emails, phone calls, and texts.
- Plans should use technology to engage and educate more members with less resources and staff.
- Healthmine is partnering with payers on tailored, automated redetermination outreach to assist members and reduce operational burden on plans and help engage retained members on an ongoing basis.
Ana brings more than 20 years of healthcare and health plan experience to Healthmine. She most recently came from WellSense Health Plan, formerly Boston Medical Center HealthNet Plan. She had oversight of work related to Stars, HEDIS®, NCQA, Quality Rating System, External Quality Review Organization, population health programs, new product implementation, value-based care programs, policy advocacy and health equity programs.
Ana developed multiple innovative member and provider interventions that were integral in the successful improvement of key HEDIS and Consumer Assessment of Healthcare Providers and Systems (CAHPS) quality measures and meeting corporate and contractual goals. She has experience with successfully identifying and implementing new to industry initiatives, such as texting, with proven quality and financial improvement. Ana is bilingual in English and Spanish and has used this in community initiatives to help engage members and improve the quality of care for the Medicaid, Medicare, Affordable Care Act, and Commercial populations.
Ana holds a master’s degree from Simmons University in Health Administration and a bachelor’s degree from the University of New Hampshire.
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