The U.S. healthcare system is approaching a major inflection point. Nearly $1 trillion in Medicaid cuts are set to take effect in January 2027, driven by new work requirements, more frequent eligibility checks, and tighter limits on state financing.

While the policy changes are months away, their consequences are already clear: millions of Americans are at risk of losing coverage, and provider organizations — many operating on margins near zero — will absorb the downstream impact through rising uncompensated care.

In this episode, hosts Rae Woods and Abby Burns are joined by former Optum Executive Director of Product and Strategy Sunay Shah to help healthcare leaders move from “scramble” to strategy. Drawing on lessons from past Medicaid shifts, including redeterminations and state level work requirement experiments, they explain why administrative disenrollment —not ineligibility — is the biggest threat facing patients and providers alike.

Together, they break down what health systems can do now to keep eligible patients covered: redesigning workflows earlier in the patient journey, using technology more thoughtfully, partnering with community organizations, state agencies, and operational support partners, and rebuilding trust with patients during moments of vulnerability.

We’re here to help:

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2026 State of Healthcare Procurement: Cost, Quality, Resilience

A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.