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Health Plan Tactics for Medicaid Retention after the One Big Beautiful Bill Act (OBBBA)

Published Date
Author HealthEdge

Extensive legislative reform is shifting the healthcare landscape. The One Big Beautiful Bill Act (OBBBA) introduces significant changes to eligibility requirements across Medicaid, Medicare, and Affordable Care Act (ACA) plans. For health plans, this means navigating a new era of regulatory complexity, operational disruption, and member retention risk.

But with the right partner, health plans can not only adapt but stay ahead of the curve while better serving their members.

Medicaid Retention in the Spotlight

Among the most urgent challenges posed by OBBBA is the tightening of Medicaid eligibility. The legislation mandates:

  • Six-month redetermination cycles replacing annual reviews
  • Stricter definitions of citizenship and immigration status
  • Mandatory community engagement or work requirements for certain populations

These changes are projected to result in 11.8 million people losing coverage by 2034, with Medicaid members being disproportionately affected. For health plans, this translates into increased membership churn, administrative burden, and the potential erosion of trust among vulnerable populations.

Health plans must now plan to retain members at risk of losing coverage. That means proactive outreach, real-time eligibility management, enhanced care coordination, and seamless integration with state systems.

HealthEdge®: A Partner Built for the Future of Healthcare

HealthEdge offers a connected ecosystem of solutions purpose-built to help health plans navigate OBBBA’s regulatory shifts and retain Medicaid members with:

Real-Time Eligibility Management

With HealthEdge HealthRules® Payer, plans can:

  • Anticipate and adapt to eligibility changes before they impact operations
  • Validate member data in real time
  • Seamlessly integrate with state Medicaid systems to reduce delays and errors

Advanced Payment Integrity

HealthEdge Source™ allows:

  • Nimble contract configuration to manage business rules
  • Enterprise-wide custom claim edits to help address complex policy rules
  • Integrated data across systems and applied AI across claims, enrollment, and care workflows

Scalable, Unified Source of Truth for Provider Data

HealthEdge Provider Data Management supports:

  • Accurate, real-time provider information to streamline workflows
  • Improved outcomes and reduced costs

Whole-Person Care Coordination

HealthEdge GuidingCare® enables:

  • Streamlined workflows across institutional, community, and home-based services
  • Advanced automation and real-time data to manage high-risk populations
  • Support for whole-person care that helps improve outcomes and reduce costs

Digital Outreach and Engagement

HealthEdge Wellframe™  empowers plans to:

  • Reach hard-to-engage Medicaid populations with mobile-first tools
  • Deliver personalized, timely communication during redetermination cycles
  • Build trust and help improve member satisfaction

Future Proofing Starts Now

OBBBA is not just a compliance challenge, it’s a call to transform how health plans operate. The pace and unpredictability of regulatory change demands agility, foresight, and the right technology partner.

HealthEdge’s suite of integrated solutions empowers health plans to stay compliant while retaining members, improving outcomes, and protecting revenue.

Learn more about what matters most to Medicaid and Dual-Eligible members, and how your health plan can meet them where they are. Watch the webinar on-demand: Understanding Your Medicaid and Dual-Eligible Members as Consumers – What Matters Most Today.

Ready to navigate regulatory change with confidence? Partner with HealthEdge and stay ahead of whatever comes next.