How CHCs Can Protect Patients (and Revenue!) from the HR1 OBBBA Federal Mandate
The passage of the HR1 OBBBA federal mandate fundamentally alters the Medicaid landscape. With enforcement beginning January 1, 2027, Community Health Centers (CHCs) and hospitals are bracing for a massive increase in administrative burdens and the very real threat of patient churn.

Administrators are asking: How do we comply with the new rules without overwhelming our staff or losing our revenue?

The answer lies in proactive, automated coverage management. Here is a breakdown of the three biggest threats posed by the OBBBA mandate and exactly how Pointcare’s technology suite is built to solve them.

1. Navigating the 80-Hour Work Requirements

The Mandate: Starting January 1, 2027, non-exempt adult Medicaid beneficiaries (ages 19–64) are required to report 80 hours of qualifying activities (like work, education, or community service) every single month.

The Risk: Millions of eligible patients will lose coverage simply because they cannot navigate the monthly reporting paperwork.

The Pointcare Solution: To prevent paperwork-driven coverage losses, Pointcare is launching a dedicated Work Requirements module within our Patient App (available on mobile and web). This module empowers patients to easily and proactively capture, upload, and submit the required documentation to demonstrate compliance with their qualifying activities, removing the friction from the monthly reporting process.

2. Managing the Shift to Bi-Annual Renewals

The Mandate: Under the new rules, the Medicaid expansion population must renew their eligibility twice a year instead of annually.

The Risk: A 6-month redetermination cycle effectively doubles the outreach and administrative workload for your CHC staff, greatly increasing the risk of mass patient drop-offs.

The Pointcare Solution: Pointcare handles this accelerated timeline at scale with our Coverage Triple Play. This interconnected suite ensures that the tighter 6-month window doesn’t decimate your payer mix:

• Redetermination Support: Proactive outreach to prevent lapses before they happen.

• Lapse Detection: Immediate identification if a patient falls off the roster.

• RetroEncounters: Seamless recovery of claims if a lapse occurs.

Pointcare has a proven ability to handle high patient churn, ensuring your administrative team isn't buried under a mountain of bi-annual renewals.

3. Surviving the Reduced Retroactive Coverage Window

The Mandate: The federal retroactive coverage window for expansion adults is shrinking dramatically—dropping from 90 days down to just 30 days.

The Risk: A shorter window means less time to catch uninsured visits, directly leading to a spike in uncompensated care and lost revenue for your facility.

The Pointcare Solution: Pointcare’s entire product suite is engineered to improve the Time to Submit Application, keeping your patients' visits safely within the new 30-day window.

To mitigate the financial risk of this tightened deadline, Pointcare deploys a multi-layered defense:

• Preventative Defense: We proactively support patients with redeterminations to avoid the lapse altogether.

• Omni-Channel Recovery: If a lapse does occur, Pointcare automatically detects it and triggers multi-channel outreach (text, email, phone) to support rapid re-enrollment within the 30-day window.
• Self-Pay Workflows: If a new or lapsed member arrives as a self-pay patient, Pointcare triggers an immediate workflow to proactively assist with their Medicaid enrollment.
• Automated Claim Sweeps: Finally, our RetroEncounters product actively identifies retro-eligible encounter claims that occurred within that crucial 30-day timeframe, ensuring you get paid for the care you provide.

Stop Reacting. Start Protecting Your CHC with Pointcare.

The January 2027 deadline is approaching fast, and traditional, manual outreach will not survive the OBBBA requirements. Your CHC needs a scalable, automated partner that catches coverage risks before they become revenue losses.

Don't wait for the uncompensated care cliff. Equip your team with Pointcare's continuous coverage management platform today.