H.R. 1 Medicaid Changes: What the Washington Physician Community Needs to Know

H.R. 1, passed by congressional Republicans and signed into law by President Donald Trump last year, will radically change Medicaid eligibility, starting this year. Numerous new requirements are coming online in the Medicaid system that will have a significant impact on patients as well as the physician community.

The federal law is projected to result in millions of Medicaid enrollees losing access to coverage. For an in-depth look at the expected impact on patient access to care from the perspective of the Washington physician community, be sure to read our cover feature, “The Looming Disaster for Medicaid,” in the September/October issue of WSMA Reports, in members inboxes this week and available digitally from the WSMA website.

It’s important that physicians and practices stay up to date on how to keep their patients covered. The Washington State Health Care Authority has released new resources aimed at helping the physician community help their patients navigate eligibility changes.

H.R. 1 provider toolkit

In the coming months there will be continued changes to Medicaid eligibility for some non-U.S. citizens, as well as the imposition of work requirements, more frequent coverage renewals and changes to retroactive Medicaid coverage. The H.R. 1 provider toolkit from the Health Care Authority provides details on these changes and options for keeping patients covered.

Medical frailty guidance

Beginning Jan. 1, 2027, new work requirements will be imposed on Medicaid enrollees. Some exceptions to the requirements are made, including for those who are determined to be medically frail by diagnoses that likely impact their ability to work, in addition to other factors. In alignment with several other states, the Health Care Authority adopted a diagnosis code list and methodology developed by the Harvard School of Public Health to help identify diagnoses that likely impact an individual’s ability to work. For context, review this guidance memo to physicians and health care professionals from Trinity Wilson, the Washington state Medicaid and CHIP director.

Medicaid provider revalidation

The Centers for Medicare & Medicaid Services has directed the Health Care Authority to complete revalidations of all Medicaid providers by June 5, 2028. Typically, revalidation is conducted every five years, but the CMS requirement will result in off-cycle revalidation for some Medicaid providers. The Health Care Authority and state Department of Social and Health Services offer a FAQ on off-cycle provider revalidation.