The One Big Beautiful Bill Act will bring sweeping changes to Medicaid beginning in 2027, while enhanced ACA premium tax credits are set to expire at the end of this year, creating uncertainty for millions of enrollees.
California stands to be among the hardest hit, with the state having the nation’s largest Medicaid program and operating state-funded coverage programs for immigrants regardless of documentation status.
Blue Shield of California’s Chief Growth Officer, Ellen Sexton, joined the Becker’s Payer Issues Podcast to share how the nonprofit health plan is preparing for these policy shifts. Below is an excerpt from the conversation, which will air later this month.
Question: What immediate and long-term impacts are you considering for Medicaid members following the passage of H.R. 1 this year?
Ellen Sexton: It’s certainly very impactful, the different changes and the policies that are coming from an implementation side. With Medicaid, there’s removal of ex parte, or the expedited renewal process, as well as an additional semi-annual renewal requirement for Medicaid beneficiaries. That creates extra eligibility hurdles for them to get access to care. Many of those members may not go through all those challenging forms and actually lose coverage. There’s also the implementation of work requirements, and so how we work to streamline that and make the eligibility requirements around that are top of mind.
There’s also an impact on members with unsatisfactory immigration status. And then there’s possible non-renewal of what California has with CalAIM. The CalAIM waivers really looked at areas like enhanced care management and other flexible community support services like housing and nutrition and behavioral health that really extended into the community and improved health outcomes. All of these are really a big impact to Medicaid.
As far as Covered California, there’s the fact that the extension of the enhanced tax credits is still being considered, although that is probably not too likely. That will also have a real impact across Medicaid because some of those members flip in and out of exchange coverage or Medicaid. We’ve had to file two rates with the state about whether or not the subsidies will be extended, and it just creates a lot of confusion in the system for members who are thinking about their eligibility.
Q: How is Blue Shield of California responding to these policy changes?
ES: We are preparing for implementation and interpretation of it on all fronts, and one of the first things is to be really close partners with your state agencies, providers, the community and some of the organizations that help members beyond just the doctor’s office. A first focus for us is going to be ensuring the access and care for our members while ensuring overall population health, emergency care and continuity of care.
One of the things we have is our community resource centers, and they serve everyone in the communities, not just our health plan members. They provide really high-impact services that reinforce the benefits of coverage and enrollment. We offer these in partnership with L.A. Care Health Plan in Los Angeles County, and we have 14 different community resource centers. They offer support to people with eligibility and other social determinants of health.
You also have to think about continuity of care, and that is really top of mind for me. How do you ensure that members that might be in the middle of oncology treatment for cancer, or think about an expectant mother who is in her last trimester — making sure that we identify those members and ensure that they’re not losing eligibility during this time period is just really important.
We’re really lifting up programs that can help people meet these new eligibility requirements. With the 28-page Medicaid eligibility form, we’ve thought about how to apply artificial intelligence to try and pre-populate parts of it to help identify these members sooner. We’ve also lifted up a GED program to help people actually go back and get their high school diploma. The Promise Medicaid plan that we have within Blue Shield is so creative, and they come up with all these different areas to really extend beyond insurance and help people continue their coverage.
