H.R.1 Doubles the Problem. It Also Doubles the Opportunity.

Every health center I talk to survived the unwinding the same way: hope for grant money and throw bodies at the problem.

It made sense. And grant funding arrived; close to $100 million in navigator funding poured into health centers in 2021 and 2022. So centers hired. They staffed sites and waited for the wave of uninsured to arrive. 

It still wasn't enough. Millions of patients fell out of coverage. Many never came back. Health center revenue took the hit.

Now H.R.1 is about to double the volume of renewals. Staffing isn't doubling with it. The model that already buckled under the unwinding is now getting twice the weight put on it.

That playbook won't work a second time. Not because the people running it aren't good at their jobs. Because the model itself was never built to scale.

The real problem isn't paperwork. It's visibility.

Here's what most health centers don't realize until they look closely: coverage data is opaque.

You can usually tell if a patient is eligible today. You often can't tell who else in that household is covered, when a renewal is coming, what plan a family member moved to outside your walls, or whether work requirements are about to knock someone off the rolls.

Without a central, continuous view of that information, you're not managing coverage. You're throwing darts at a dartboard in the dark. You'll reach out to patients who don't need it yet, and miss the ones who need it now. More touchpoints without more clarity just creates noise. Sometimes it does more harm than good.

This is the shift from enrollment to what I call Coverage Intelligence™: watching every patient's eligibility every month, predicting the next coverage event before the deadline hits, and acting on it across Medicaid, Medicare, and the Marketplace, before the patient ever shows up uncovered.

And this isn't just an operator's problem. It's a CFO's problem. Do this manually, and the cost to get and keep someone covered eats up half to three quarters of that patient's entire annual value to your center. Do it with Coverage Intelligence™, scaled right, and that cost drops below $50 a year. That's the number that should be on every health center's budget review.

"Procedural termination" is often the wrong term entirely

We've been told for years that most coverage losses are "procedural," meaning the member didn't complete the paperwork.

Look closer, and that story falls apart. Our data shows patients get terminated even when they never had a redetermination date to begin with. No packet. No notice. No process to fail. I'd call that a third category: not factual, not procedural, but a ghost lapse. Nobody, not the member, not the state, not the health center, saw it coming.

That's not a paperwork problem. That's a visibility problem. And it's exactly what coverage intelligence is built to close.

Three things a health center actually needs

1. A coverage management partner. Health centers should be in the business of healthcare and patient relationships, not health insurance. The state-to-state, county-to-county permutations are too vast for a couple more navigators to keep up with.

2. A shift in how staff and leadership think about the future. You can't scale the last ten years of manual enrollment. Think of a parking garage that switched from ticket booths to a QR code: a short learning curve, then no more lines. Point-of-care enrollment needs the same shift, toward something fluid and perpetual.

3. An organization-wide push to make coverage management visible. Flyers, banners, front-desk conversations. This isn't optional anymore. It's mandatory if you want patients covered and coming back.

    

The states aren't waiting. Neither can you.

I've never seen a state cap how many people get approved. I have seen states raise termination rates, month over month, disconnected from what's happening on the approval side. Call it cat and mouse. If the state is looking to save budget by trimming rolls, you have to be one step ahead of them, every month, not one step behind.

What this looks like in three years

The health centers that get ahead of this will have a stronger payer mix, lower uninsured rates, and a financial position that can absorb what H.R.1 throws at it. The ones that don't won't just lose coverage for their patients. They'll lose the patients themselves, to a health center down the road that already has this figured out.

Nationally, the stakes are bigger than any one center. Federal estimates put more than 15 million Americans at risk of losing Medicaid coverage under the proposed funding changes, and Medicaid already makes up roughly 43 to 50 percent of total CHC revenue. This isn't a margin story. It's a mission story.

Come talk through this with me in person. I'm speaking on this exact topic at NACHC's Community Health Institute & Expo.

Partner of Choice: Protecting Patients and Revenue as Redeterminations Double Under H.R.1 Monday, August 17, 2026 · 1:00–2:00 PM PT · Juniper 2-3 (West Level 3) CE credit available.

We'll walk through the Coverage Intelligence™ framework in full, with a real CHC's results from the unwinding, so you leave with a plan you can apply at your own center, no matter what tools you're running today.

See you in the room.

Everett