The 2025 Reconciliation Bill proposes reducing Medicaid retroactive coverage from 90 days to just 30. That change would erode a long-standing safety net—one that keeps patients out of catastrophic medical debt and gives providers a second shot at reimbursement.
If enacted, this and other proposed reforms are projected to drive $42.4 billion in additional hospital uncompensated care by 2034.1 With just one month to secure coverage for the most vulnerable populations, revenue cycle teams would face a tough reality: helping more patients, in both high-touch Emergency Department (ED) settings and overlooked ambulatory sites—with less time and even fewer chances to get it right.
Why prioritize overlooked low-acuity, low-dollar cases? The longer window once gave these patients time to act—allowing providers to recover some reimbursement, even when enrollment came late. But under the proposed change, missing that 30-day window means the full financial burden shifts to the patient, and providers are often left absorbing near-total losses on patient balances without insurance coverage.2
The bottom line: providers must move quickly to identify and assist patients across all care settings, before the window to secure coverage closes. In that world, digital tools won’t be nice to have—they’ll be essential to protecting the organization’s financial health. And revenue cycle teams will need new ways to engage patients before, during, and after their care.
Get up to speed on key Medicaid changes in the 2025 Reconciliation Bill with expert Nikita Singareddy from Fortuna Health
Pre-visit: Catching patients before they need a safety net
Traditionally, providers have focused financial counseling on emergency and inpatient settings—and for good reason. Uninsured patients often delay care until it becomes urgent and skip routine or preventive services they can’t afford. These higher-acuity encounters generate larger balances, making manual intervention cost effective.
However, a 30-day retroactive window shifts this dynamic. To secure reimbursement, providers must move eligibility and enrollment earlier in the process—ideally integrating automated tools into pre-registration when insurance can’t be verified or cost estimates point to high self-pay balances.
This proactive approach becomes even more important under proposed reforms. Work requirements and more frequent eligibility checks are expected to increase Medicaid churn. According to the Congressional Budget Office, 8.6 million Americans could lose coverage due to administrative barriers—not actual ineligibility.3
As a result, more patients will arrive believing they have active Medicaid coverage, only to discover their benefits have lapsed. These patients may be unprepared to navigate financial assistance, unsure why their coverage ended, and have little time to resolve it before the window closes.
Digital tools are essential to catch these patients early and streamline re-enrollment—before they rack up uncovered charges or skip care entirely.
During the encounter: Ensuring continuity across settings
A 30-day retroactive coverage window would put more pressure on in-person financial counseling teams. While boots-on-the-ground efforts are valuable, continuity can break down once a patient is discharged mid-enrollment process. These handoffs often rely on outbound phone calls, which are slow, manual, and easy to miss.
Digital solutions can help close that gap. Low-acuity ED patients can scan a QR code or get a text to start enrollment privately, at their own pace. High-acuity patients can begin once they’re stabilized or moved to an inpatient unit. And crucially, they can finish the process from home, picking up exactly where they left off rather than starting over or waiting for a callback.
Without that continuity, each day lost to phone tag or outdated contact information would shrink the limited window to secure coverage and reimbursement. Digital engagement can create an unbroken thread from bedside to home, keeping patients on track to complete enrollment.
Post-visit: Reaching patients before time runs out
Once patients leave the facility, the 30-day countdown begins in earnest. This is where timely digital outreach becomes critical—whether it’s nudging patients who already started applications, or prompting enrollment opportunities in financial communications.
Billing reminders are proven motivators: our data shows 7 in 10 patients who engage with targeted digital communications go on to begin the Medicaid enrollment process.4 But timing matters. Providers need the ability to send this outreach immediately—not wait for billing cycles or statements to be generated.
When patients do engage, the application process must be streamlined for the compressed timeline. Pre-filled forms using data on file, simple document uploads, and real-time error checking become essential when every day counts.
Finally, speed of processing matters a lot. Cedar’s Medicaid enrollment partner, Fortuna Health, is committed to reviewing and submitting Medicaid applications to state- or county-administered agencies within 24 hours after completion.5 That kind of turnaround can mean the difference between securing retroactive coverage and losing it entirely.
Building the digital safety net
The responsibility for addressing the proposed Medicaid changes shouldn’t rest solely on providers, especially when many are already facing significant financial strain. Yet, when patients need support and access to care is at risk, providers rise to the challenge—just as they always have.
Stepping up doesn’t require relying solely on traditional, labor-intensive approaches. A digital safety net equips teams with tools to reach more patients, across more settings, and with greater speed. It doesn’t replace human effort—it amplifies it, ensuring fewer patients slip through the cracks due to paperwork delays or limited staffing.
Want to dig deeper?
- Read our executive brief to learn how providers can leverage technology to adapt operations for the proposed Medicaid and ACA reforms
- Watch my conversation with Nikita Singareddy of Fortuna Health for proactive steps providers can take today to get ahead of the proposed changes
Joanna Jamar is Sr. Director, Commercial Strategy at Cedar
- Nelb, R. (2025, June). Estimated effects of H.R. 1 on hospital uncompensated care costs (Policy Brief). America’s Essential Hospitals. https://essentialhospitals.org/wp-content/uploads/2025/06/CBO-Analysis-Reconciliation-June-2025.pdf ↩︎
- Cedar. (2023). Median post-visit patient collection rate for self-pay patients across Cedar health system clients. ↩︎
- Congressional Budget Office. (2025, May 7). Estimates for Medicaid policy options and state responses [Letter to Honorable Ron Wyden and Honorable Frank Pallone, Jr.]. https://www.cbo.gov/system/files/2025-05/Wyden-Pallone_Letter.pdf ↩︎
- Cedar. (2024, December). Percentage of patients who view the financial assistance page in the Cedar portal who click get started and begin the Medicaid screening process at a Cedar health system client. ↩︎
- Cedar (2025, June). Based on service-level agreement between Cedar and a Medicaid enrollment vendor. ↩︎
