What changed and why it matters now
The One Big Beautiful Bill Act (H.R. 1), which was ratified on July 4th, 2025, has changed how states verify and maintain Medicaid eligibility. HealthAxis is committed to helping payers, managed care organizations (MCOs), and states understand these changes and prepare their operations to remain compliant, efficient, and member-centric.
Among the most consequential shifts are the shortening of retroactive coverage windows for new applicants beginning in 2027 and that states must redetermine eligibility for the ACA expansion population every six months starting with the first quarter after December 31, 2026. States must also adopt a centralized CMS process for cross-state duplicate enrollment checks and they must run regular checks against the Social Security Administration’s Death Master File to prevent improper payments.
Additionally, states will also be required to begin reporting enrollees’ Social Security numbers and address data to CMS on a recurring cadence to support multi-state matching. These data-sharing and verification requirements compound system complexity (eligibility logic, data pipelines, privacy and security controls) and place a premium on audit-ready processes. Further, they collectively elevate operational volume and compliance exposure for Medicaid managed care organizations (MCOs) well beyond typical year-over-year cycles.¹
Implications for Medicaid plans
For plans administering Medicaid, this means more frequent verifications, more back-and-forth with state systems, and significantly more notices, documentation intake, and member outreach.
Front-end workflows (applications, renewals, changes in circumstance) will need to capture evidence at new checkpoints.
Back-end processes must prove that every eligibility decision aligns to federal and state rules, including new data-matching obligations. Even small gaps, like a missing quarterly data feed, can escalate into payment disallowances or corrective action plans.²
How HealthAxis helps
- AxisCore™ (CAPS): Our core administrative processing platform is designed to handle complex eligibility and enrollment logic, including configurable rules that reflect federal and state program specifics. AxisCore integrates with required data exchanges and supports robust documentation and audit trails, making redeterminations and evidence tracking systematic rather than manual.
- AxisConnect™ (BPaaS/BPO & Consulting): We stand up rapid-response intake, verification, and member-contact teams to absorb redetermination surges, resolve evidence gaps, and standardize compliance documentation. Our teams help health plans optimize letters, scripts, and renewal campaigns that reduce avoidable churn, while aligning to new statutory cadence and verification steps.
Why act now
Eligibility operations often appear to be in order until new rules are introduced all at once. The six-month redetermination cycle and data-matching mandates will strain legacy queues and brittle integrations. We help MCOs conduct readiness assessments, map new verification touchpoints, and deploy AxisCore configuration updates and AxisConnect operational capacity ahead of deadlines. That means fewer backlogs, fewer compliance findings, and fewer members slipping through the cracks during renewal.
Navigating these changes requires more than just compliance; it calls for agile systems and experienced partners. HealthAxis stands ready with AxisCore and AxisConnect to keep your eligibility operations ahead of federal deadlines.
Author
Sources:
1 and 2, Congress.gov
