OBBBA is still unclear. The coverage risk to patients isn't.

An estimated 11.8 million people could lose health coverage under the One Big Beautiful Bill Act (OBBBA). For health systems, the fallout reaches past patients to their own bottom line.

As leaders evaluate what OBBBA means, much of the debate has focused on policy and eligibility rules. But the conversations we’re having with health system leaders center on something more practical.

How do we help patients maintain coverage and avoid unnecessary financial hardship as these changes take effect?

Many of the implementation details are still murky, but revenue cycle leaders are preparing for Medicaid work requirements, six-month eligibility redeterminations, and the end of automatic ACA re-enrollment — changes that could affect whether patients keep their coverage. The burden falls on the health system to identify patients at risk of losing coverage, strengthen financial navigation, and build an outreach strategy before disruption hits.

Priorities for revenue cycle leaders

Many of our recent discussions have surfaced a few common themes: • Ongoing and proactive patient communication that spells out what’s known, what isn’t, and what it means for the patient. • Financial navigation that evolves to support patients through redeterminations and coverage transitions. • Collaboration across functions — revenue cycle, patient access, compliance, and community outreach. • Community partnerships and outreach designed to connect patients to resources and reduce barriers to keeping coverage. The goal is simple: spot problems early and help patients navigate the changes before they lose coverage.

Why this matters

The biggest concern is no longer just meeting the requirements.

When patients lose coverage — or are at risk of losing it — health systems need visibility into the potential financial impact. Without early intervention, organizations can see rising self-pay accounts, uncompensated care, and bad debt, while patients face added financial stress and delay the care they need.

OBBBA is pushing the revenue cycle beyond the old mindset of simply collecting revenue. The work now is to preserve coverage, support patients through the financial journey, and mitigate financial risk before it occurs.

How can Inneo help?

Each day, Inneo works with non-profit health systems on their most pressing issues — including how to prepare for OBBBA and navigate the areas where clarity is still lacking. We help revenue cycle leaders evaluate practical approaches that support both patients and financial performance. From patient communications to eligibility checks to financial impact, we can come alongside your team.

Sources: How RCM leaders are preparing for OBBBA’s ripple effects, What revenue cycle leaders are prioritizing in the 2nd half of 2026, Revenue cycle leaders’ top priorities in 2026, Operational resilience is the RCM imperative of the OBBBA era (HFMA)

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