H.R. 1 and Medicaid redeterminations: How healthcare organizations can prepare for 2027

What is changing in 2027?

H.R. 1, enacted as Public Law 119-21, requires states to move most adults in the Medicaid expansion group from annual eligibility renewals to renewals every six months, beginning with scheduled renewals on or after January 1, 2027. CMS guidance says adults in the expansion group will be subject to the six-month renewal cycle. [1][2]

The scale could be significant. Urban Institute projects that six-month redeterminations alone could reduce average monthly Medicaid expansion enrollment by 2 million to 3.1 million people in 2028, depending on how effectively states limit procedural disenrollment. [3]

For healthcare organizations serving Medicaid populations, the operational impact is easier to picture:

• Patients showing up without active coverage
• More staff time spent fixing insurance issues
• More revenue at risk

The 2023–24 Medicaid unwinding offers an operational preview, though it affected a broader population after continuous enrollment ended. In a 2024 survey of 222 community health centers, respondents reported an average of $595,000 in redetermination-related losses and 1,600 staff hours spent helping patients. NACHC estimated that 23% of health center Medicaid patients lost coverage during the unwinding.[4]

4 ways Phreesia can help organizations prepare

1. Catch coverage changes before they become denials

With more frequent renewals, insurance information from a patient’s last visit may no longer be current. Phreesia helps patients review and update insurance information during digital intake and supports automated eligibility verification across Medicare, Medicaid and commercial payers. Checks before the visit can surface a payer response for staff to investigate. [5]

Earlier visibility can give staff time to update the record, follow up on an unclear or failed response and determine the next step before a claim is submitted. Phreesia does not determine Medicaid eligibility; states do. The value is in making the provider-side workflow more current and less reactive.

2. Reach Medicaid patients without adding hundreds of calls

Redetermination may require patients to keep contact information current and respond when Medicaid requests additional information. The challenge for provider organizations is reaching the right patients without turning every renewal cycle into a manual call campaign.

Phreesia’s digital intake and outreach tools can help organizations identify Medicaid patients and coordinate education by text, email or phone. Teams can tailor clear, accessible messages to patients’ language needs, honor contact preferences, limit sensitive details and offer direct help when digital access is unreliable. [6][7]

“Digital intake and outreach tools make it easy to identify patients who are on Medicaid and educate them about why it’s important to keep their information up to date and respond to any requests from Medicaid to verify it.”

That scale matters. Community health centers spent an average of 1,600 staff hours helping patients through the last unwinding. The exact burden will vary by organization, but the lesson applies broadly: repetitive outreach can quickly consume staff capacity. [4]

3. Protect revenue when coverage changes

Coverage churn doesn’t stop at eligibility. If a patient moves to another plan or becomes temporarily self-pay, registration and payment workflows need to adjust too. As Beth Wrobel, former CEO of HealthLinc, puts it, “If there’s no money, there’s no mission.” Protecting revenue helps organizations preserve the access and services their communities rely on. Accurate insurance information and clear, convenient payment options can help teams respond sooner and reduce downstream rework. [6]

Phreesia connects eligibility, intake and payment workflows so patients can review balances and pay digitally before, during or after the visit. In one client experience, NorthShore Health Centers, an FQHC in northwest Indiana, collected 7x more after visits with Phreesia, including $402,000 in post-visit collections and $2.9 million in total payments collected. [8]

“We’ve been far more likely to collect with Phreesia’s Patient Bill Pay than any other process. It allows our smaller collections team to work more efficiently without needing to add staff.”

That result reflects NorthShore’s experience with Phreesia’s payment tools overall. The same workflow applies wherever a coverage change shifts a patient’s financial responsibility—helping the organization identify what changed and manage the financial next step more efficiently.

4. Reduce the administrative lift around every visit

More frequent redeterminations can create more eligibility questions, demographic updates and financial conversations. The goal is not to automate away complex cases. It’s to keep routine work from consuming the people who need to handle them.

Phreesia helps patients complete registration, insurance updates, forms and other required information before the visit. Across Phreesia’s platform, digital workflows are designed to reduce calls and manual tasks; primary care organizations can also use self-service and automated workflows to reduce billing calls and staff involvement. [10]

“Phreesia delivers tremendous value to our organization by automatically capturing and integrating important clinical, demographic and social data from patients, consistently and at scale.”

That capacity becomes especially useful when eligibility changes generate exceptions. If routine intake and communication are already digital, staff have more room to focus on patients whose coverage transition, financial situation or eligibility response actually requires a person.

Why health-center data still matters to every Medicaid-heavy organization

Community health centers are not the only organizations affected by Medicaid coverage changes, but they offer some of the clearest evidence of what widespread disenrollment can do. About half of health center patients were covered by Medicaid in 2024, and Medicaid accounted for 45% of total health center revenue. The number of uninsured health center patients also rose by more than 250,000 from 2023 to 2024 as the continuous-coverage unwinding played out. [12]

Primary care groups, multispecialty practices, rural organizations and other providers will have different payer mixes and financial exposure. But the operational pattern is similar: when coverage changes, the effects often surface first in registration, eligibility, patient communication and revenue-cycle workflows. For a primary care organization, that might mean discovering inactive coverage during a routine follow-up, asking staff to rework insurance information at the front desk or shifting a balance to the patient after the visit. For a rural practice, the same tasks may fall to a smaller team with less capacity to absorb them. The setting changes; the need for an early, repeatable workflow does not.

What healthcare organizations can do now

The 2027 changes are a reason to pressure-test the front end now. Ask:

• Are we verifying Medicaid eligibility early enough to act before the visit?
• Can patients update insurance and contact information digitally?
• Can we identify Medicaid patients and communicate with them at scale?
• What happens when a patient becomes uninsured, underinsured or moves to another plan?
• Which steps still depend on staff calls, payer portals or manual follow-up?

Prepare for the next wave of Medicaid coverage changes

The last Medicaid unwinding showed what widespread coverage churn can mean: patients losing coverage, staff time consumed by enrollment and insurance issues, and greater financial pressure on provider organizations. Six-month redeterminations beginning in 2027 could put those workflows under new pressure. [1][3][4]

Phreesia can help healthcare organizations identify coverage changes earlier, reach Medicaid patients without adding hundreds of calls, keep registration information current and strengthen financial workflows when coverage changes.