Optimizing Reimbursement in the Wake of the One Big Beautiful Bill
Signed into law on July 4, 2025, the One Big Beautiful Bill (OBBB) Act introduces a complex set of policy changes that touch nearly every corner of the healthcare industry. From restructured reimbursement models to narrowed eligibility criteria, the legislation reshapes how federal healthcare dollars will be distributed and who will be left without coverage.
For providers who rely on timely and accurate reimbursement to sustain care delivery, these shifts could translate to tighter margins, more uncompensated care, and greater administrative strain. Skilled nursing facilities (SNFs), therapy organizations, and any provider with a high Medicaid census will need to take proactive steps now to ensure they’re prepared.
At Health Advisory Partners by Aegis Therapies®, we’re working alongside providers to help them stay ahead of these changes because, in a climate of increased financial scrutiny, reimbursement optimization has never been more critical.
The Medicare “Bump” Isn’t Enough
Let’s start with what looks like a win: the 3.2% increase in Medicare Part A payments for fiscal year 2026, which is up from the proposed 2.8% increase. The increase is based on the final SNF market basket of 3.3%, plus a 0.6% market basket forecast error adjustment, and a negative 0.7% productivity adjustment. However, the increase is still significantly less than in recent years.
That being said, that slight bump is eclipsed by the bill’s broader financial impact, which includes a $1 trillion cut to federal Medicaid funding over the next decade. While Medicare sees a symbolic gain, Medicaid, which supports millions of vulnerable Americans and underpins much of the SNF and post-acute system, takes a major hit.
As seniors stand to lose coverage, hospitals and long-term care providers will face more patients without payers, fewer resources to absorb costs, and higher risk when accepting new admissions. And that 3.2% increase? It’s unlikely to keep pace with inflation or offset the operational pressures providers are about to face.
Medicaid Coverage Limits May Mean More Unpaid Claims
Beginning in 2027, the OBBB limits retroactive Medicaid eligibility, cutting the traditional three-month window down to just two months for standard Medicaid and one month for Medicaid expansion enrollees. This change, although subtle, could significantly increase the volume of uncompensated care, especially in settings like SNFs and long-term care, where delays in enrollment are common.
As Health Affairs explains, providers will no longer be able to rely on Medicaid backdating to recover costs for care delivered before enrollment. The government is allocating $10 million in FY2026 to implement this change, another signal that this policy is here to stay.
This means facilities that don’t have airtight intake and eligibility verification processes could see major shortfalls in reimbursement. In an environment where margins are already thin, even a few missed days of coverage per patient can snowball into substantial financial losses over time. Now is the time to tighten workflows and build strategies that account for these new constraints.
SNFs Face New Risks and New Opportunities
According to a recent analysis from Holland & Knight, the OBBB may be one of the most consequential legislative changes for SNFs in recent history. While some providers breathed a sigh of relief over the 10-year delay of the federal staffing mandate, the long-term financial impact of Medicaid reform is significant.
Holland & Knight advises SNF owners and operators to:
Reassess facility portfolios with an eye on payer mix
Diversify payer sources to reduce Medicaid dependence
Model potential scenarios for declining Medicaid reimbursements
Invest in specialized care programs that command higher rates
Leverage AI and analytics to monitor compliance and optimize operations
Providers who wait to adapt may find themselves underwater as reimbursement tightens. By taking strategic action now, providers can position themselves not only to survive but to thrive in an increasingly challenging financial environment.
HAP: Helping You Stay Ahead of the Curve
At Health Advisory Partners, we understand how regulatory changes can throw a wrench into your operations. That’s why we take a proactive approach to reimbursement optimization, helping you capture every dollar you’ve earned, especially now as new policies take effect.
Here’s what makes us different.
How HAP Helps You Stay Accurate
We go beyond scrubbing software with expert analysis, real-time interventions, and personalized support to help you get paid for the care you’re delivering. Whether you’re working within PDPM, PDGM, Medicare, Medicaid, or managed care, we provide the strategies and insights to improve financial outcomes.
Our support includes:
· PDPM and PDGM coding consultation
· Management reporting and analytics
· Quality and compliance support
· I-SNP consulting
· Medicare, Medicaid, and case mix strategy
We align your clinical documentation with reimbursement requirements to prevent missed revenue and reduce audit risk.
Why Coding Accuracy Matters
Roughly 35% of MDS assessments miss key coding, which means facilities often leave money on the table. Our coding consultation helps correct that. You send us your completed MDS and any off-EMR documentation, and we send back:
· Coding recommendations with rationale
· CMI impact estimates
· Monthly Impact and CMI Trend Reports
In 36% of cases, our recommendations increase reimbursement by over $300 per audit. Most clients see a 150%+ return on investment.
The Sooner, The Better
The ripple effects of the One Big Beautiful Bill will be felt throughout 2026 and well into the future. What may appear to be a small policy tweak can quickly add up to significant financial loss when multiplied across multiple admissions, hundreds of patient days, and a high-Medicaid census.
With shifting eligibility rules, stricter documentation requirements, and heightened financial pressure across the board, reimbursement management has evolved from a billing function into a strategic imperative.
Optimizing reimbursement isn’t just about increasing revenue; it’s about protecting your ability to deliver consistent, high-quality care in a system that’s becoming more constrained by the day. Facilities that take a proactive approach now will be better positioned to weather future cuts, avoid audit risk, and maintain operational stability.
If you’re ready to make sure your care is accurately coded, documented, and reimbursed, let’s connect. At HAP, we bring real-time strategies, tailored consulting, and industry-leading insight to help you stay compliant, stay profitable, and stay focused on what matters most: your patients.
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