When Coverage Lapses, Health Centers Carry the Cost

A patient's coverage can lapse but their need for care does not. They still want an appointment. They still call with questions. And health center staff still check eligibility and do everything they can to keep that patient from falling through the cracks. The work does not go away, even though the reimbursement might.

For community health centers, that gap can quickly become a financial strain. Medicaid accounts for roughly 45% of total community health center revenue and more than 60% of patient-care revenue nationally. New eligibility requirements could make reimbursement less predictable at the same time they create more work for the people helping patients stay covered and connected to care.

No one knows exactly how this will play out. Each state will handle the changes differently. But health centers already face a clear question: how can they keep patients connected to care without placing even more work on staff who are already stretched thin?

What Will Change in 2027

Two federal changes will affect many adults in the Medicaid expansion group. First, states will check eligibility every six months for most of these adults. Second, some adults will have to meet new work or community-engagement rules when they apply or renew. States may check more often, and the amount of paperwork will depend on how well each state can use information it already has.

Most affected adults will need to complete at least 80 hours a month of work, job training, education, or community service. Some people will be exempt, including those who are pregnant, medically frail, or caring for a child age 13 or younger.

If a state cannot confirm that someone met the requirement or qualifies for an exemption, it must notify the patient and give them time to send more information. A missed letter, confusing form, or incomplete record could then put coverage at risk.

For planning, two things matter:

• States will handle the rules differently. Some will use existing data to confirm eligibility automatically. Others will ask patients for more paperwork. Some are moving early, while others are still deciding how their process will work. 
• Patients will face eligibility checks more often, which means more chances for coverage to become uncertain. In some states, they may also receive more requests for documents.

No one can say yet how many patients will lose coverage or how much revenue health centers could lose. Those numbers will vary widely by state and will keep changing. Health centers can, however, plan for more coverage questions, more paperwork, and more patients who need help understanding what to do next.

Health centers will have to protect two things at once: reimbursement and staff time. If either one falls short, patients will feel it.

Why Community Health Centers Will Feel This Differently

A coverage lapse creates a payment problem. At a community health center, the patient still receives care even if they cannot pay. If Medicaid reimbursement disappears, the health center carries the cost.

That obligation rests on a financial structure that is tighter than most people outside community health realize. Medicaid accounts for roughly 45% of total CHC revenue nationally and over 60% of patient care revenue, according to 2024 data from HRSA's Uniform Data System, the federal government's own accounting of health center finances. A change to how that eligibility gets processed is not a peripheral administrative update. It touches the largest single line on the health center's income statement, at the same time as it adds work for the staff responsible for keeping patients enrolled.

The added work will fall to staff health centers already struggle to keep. Every hour a scheduler or registration staff member spends explaining a renewal notice is an hour they cannot spend scheduling care, completing referrals, or helping another patient.

At one health center, 20 people are working referral packets, eight more are calling to make sure patients get scheduled, and care gap lists are still printed and worked by hand. The opportunity is not to cut the team. It is to remove the repetitive work so they can close more loops for more patients.

Lauren Knight

AI Solutions Director, Assort Health

Add coverage questions to an already lean staffing model, and something else has to give. Health centers should decide now what work can be simplified or removed, before the new rules begin to test their teams.

Where Patients and Staff Will Feel the Pressure

The added work can show up at four points in a patient’s path to care. Each one calls for a different response.

Before an appointment, patients may call about a renewal notice they do not understand, ask what documents they need, or need a reminder that their deadline is coming. Helping them early can keep a coverage problem from disrupting their next visit.

During scheduling, a simple appointment call can turn into a long coverage conversation. A call that once began with “What time works for you?” may now begin with “I got a letter, and I don’t understand it.” When more calls take longer, more patients may not get through.

At check-in, staff may discover that coverage has lapsed since the last visit. A routine appointment can suddenly become a billing conversation, another eligibility check, or a difficult decision about what happens next.

After coverage lapses, staff may need to reschedule missed visits, explain financial assistance and sliding-scale options, and help patients return to care. This is the point where a paperwork problem can become a care problem.

These are four different problems, and community health centers need a clear way to address each one.

Five Ways Health Centers Can Prepare Now

Health centers cannot solve this by adding renewal reminders to an already full workload. They need to protect revenue, make coverage questions easier to resolve, and save staff time for patients who need judgment and help.

1. Make Renewal Messages Clear and Easy to Act On

Write for the patient who is confused, not the patient who already understands Medicaid. Use everyday language, communicate in the languages your patients speak, and give the same answer by phone, text, email, and on the website. If patients hear three different explanations, they will not know which one to trust.

2. Set Up a Clear Handoff for Coverage Questions

Decide now who handles each kind of coverage question. Put in writing what front-office staff can answer, what goes to enrollment or eligibility teams, and what requires financial assistance or case management. Include the information each team needs so the patient does not have to tell the same story again.

Make sure staff can tell the difference between a routine question and a patient who may soon lose coverage or delay care. Then track transfers, repeat calls, unresolved cases, and how long it takes to help someone. A clear handoff saves staff time and makes it less likely that a patient gives up before getting help.

3. Reach Out Before Coverage Is at Risk

Use the appointment, coverage, and communication information you already have to find patients who may need help renewing. Automated phone and text outreach can help health centers reach more patients without creating another manual call list, while directing patients who need personal help back to staff. Reach out before a missed deadline becomes a missed appointment.

4. Plan for More Work and Staff Turnover

Look at how much coverage-related work your teams can handle today. Decide who will take on the added work and what can come off their plates. Hiring may help, but adding new work without removing anything is not a staffing plan.

Keep scripts, workflows, and handoff instructions easy to find and easy for a new employee to use. If the process only works because one experienced person knows every step, the process is too fragile.

5. Start Tracking the Warning Signs

Start tracking coverage-related calls, abandoned calls, repeat contacts, resolution time, transfers, and appointment cancellations now. A baseline will help you see whether a difficult month is temporary or the start of a lasting change.

Protect Coverage, but Plan Beyond It

Health centers already know how to coordinate care, build community trust, and see the whole person. The challenge is keeping paperwork and phone calls from taking time away from that work.

Helping eligible patients keep Medicaid coverage comes first. Health centers should also look at whether their scheduling, outreach, and referral processes help them close care gaps, keep chronic care on track, complete referrals, and document quality results.

Value-based payment will not replace Medicaid, and many value-based contracts are tied to Medicaid managed care. But strong outreach, scheduling, and care coordination can support both patient care and the quality payments connected to it.

Use Technology to Make Care Easier to Reach

A simple test for technology is whether it makes care easier to reach. Patients should not face a slower or more confusing path simply because their health center has fewer resources than a large health system.

For health centers, that means using automation where it helps. Routine questions, reminders, and call routing can be handled consistently. Patients who are frightened, confused, or at risk of losing care should still be able to reach a person.

The goal is not to replace the front desk. It is to keep repetitive work from taking up the time staff need for harder, more personal conversations.

The measure of AI in a health center is not how much work it automates. It is whether patients reach care sooner and staff have more time for the cases that require judgment.‍

Sunny Eappen, MD

Chief Medical Officer, Assort Health

Technology partners do not carry the same responsibilities as the health centers delivering care. Their job is to support that mission and make the work easier.

What Makes a Technology Partner Effective

Assort brings experience with the scheduling, referral, and access workflows that health centers manage across specialties, along with results from current health center customers.

Chesapeake Health Care, a federally qualified health center on Maryland's Eastern Shore serving more than 150 providers across six specialties, cut hold times from more than seven minutes down to roughly 45 seconds after deploying Concierge for inbound scheduling. The health center generated more than $1 million in new annual revenue from after-hours bookings the front desk used to lose entirely, and increased labor capacity by 50% without adding headcount. Patient satisfaction moved from 2.6 out of 5 to 4.4 out of 5, reflecting fewer patients giving up on hold and more of them reaching someone who can help.

Assort Health has completely transformed how we manage patient access. The AI handles scheduling over 100 providers across 6 specialties with precision, and integration with our EHR keeps everything up to date to reduce additional work from our team. Our patients get through faster, our staff can focus on care, and we're seeing meaningful gains in both satisfaction and revenue.

Josh Boston

Chief Operating Officer, Chesapeake Health Care

The standard should be simple: patients spend less time on hold, fewer people have to call back, and staff have more time for patients who need human help.

If a technology does not improve access, staff capacity, or financial performance, it has added work instead of taking work away.

Start Before the Notices Arrive

Community health centers have spent decades building a model of coordinated, whole-person care, often with fewer resources than larger systems. The new Medicaid rules do not require health centers to reinvent that model. They require protecting the staff time that makes it work.

The goal is not to ask already-stretched teams to absorb more. It is to make routine work easier so staff can be present when a patient calls frightened by a coverage notice or unsure whether they can still receive care. That preparation needs to begin before the first notices arrive.

Frequently Asked Questions

Do the 2027 Medicaid changes affect every state?

The rules are federal, but the number and types of patients affected will vary by state. They mainly apply to certain adults covered through the Medicaid expansion group or similar Section 1115 programs. States will make important choices about how they put the rules into practice.

What counts as meeting the new work requirement?

Most affected adults will need to show at least 80 hours a month of work, job training, education, or community service. People who meet an exemption, including some pregnant people, medically frail adults, and caregivers of young children, will not have to meet the requirement.

How often will patients need to renew their eligibility starting in 2027?

Most affected adults in the expansion group will have their eligibility checked every six months instead of every 12 months. States will also check the work or community-engagement requirement when someone applies or renews, and may choose to check more often.

Why is the impact different for community health centers?

Medicaid funds a larger share of CHC revenue than it does for most other provider types, roughly 45% of total revenue and over 60% of patient care revenue nationally, and CHCs are required by federal law to continue serving patients regardless of coverage status. That combination creates a distinct financial and operational exposure for community health centers.

What should a health center do first to prepare?

Start with two basics: tell patients clearly what is changing, and decide who on staff handles each kind of cov