Significant changes to Medicaid are expected to take effect in 2027, bringing new requirements and processes that could increase the risk of coverage loss for eligible individuals if systems are not prepared. While many details are still emerging, one thing is already clear: 2026 will be a critical year for hospitals and health systems to prepare patients and their own organizations for what’s ahead.
Hospitals serve as trusted access points for care and information, especially for Medicaid populations. As changes approach, the concept of a ‘No Wrong Door’ approach offers a practical, patient-centered framework for ensuring individuals receive clear guidance and support to maintain coverage, no matter where they first seek help.
“Hospitals and health systems have a vital role to play in helping patients navigate upcoming Medicaid changes,” said MHA CEO Brian Peters, “Taking steps now will help protect access to care, reduce confusion and support healthier communities when new requirements take effect in 2027.”
The Medicaid changes anticipated for 2027 include more frequent eligibility checks, new administrative requirements and adjustments that could make it easier for coverage to lapse due to missed paperwork or misunderstandings, even among people who remain eligible.
The stakes are high. Coverage disruptions can lead to delayed care, worsening health conditions, increased uncompensated care and greater strain on the healthcare ecosystem. Preparation in 2026 can mitigate reactive problem-solving in 2027.
A ‘No Wrong Door’ approach ensures that wherever a patient interacts with the healthcare or community system, whether that be a hospital, clinic, emergency department, school, pantry or community organization, they receive consistent information and help related to Medicaid coverage. The goal is simple: eligible people stay covered. The process of reaching that goal however is much more complex.
This approach relies on alignment across internal teams and external partners, shared messaging and clear pathways for escalation when patients need additional support.
Key Components of a ‘No Wrong Door’ Strategy
Internal Readiness
Consistency across departments helps ensure patients don’t fall through the cracks. Hospitals can begin by strengthening internal workflows, including:
- Identifying patients at risk of loss of coverage.
- Training frontline staff to recognize coverage red flags.
- Developing standard scripts and referral pathways.
- Aligning registration, financial counseling, care management and clinical teams.
Tiered Outreach and Escalation
Not all patients need the same level of support. A tiered model ensures resources are used effectively to reach those most in need, and allows hospitals to:
- Use broad messaging and reminders for most patients.
- Provide targeted follow-up for higher-risk individuals.
- Escalate complex cases to financial counselors, navigators or legal support.
Community Partnerships
A ‘No Wrong Door’ strategy also extends beyond hospital walls. Community partners including health centers, local agencies, faith organizations, schools, libraries and managed care plans can serve as trusted messengers and access points for assistance. Strong partnerships expand reach, particularly for patients who may not regularly engage with healthcare.
Shared Tools and Training
Developing shared materials, role-specific training and clear communication protocols helps ensure everyone, from hospital staff to community partners, is delivering accurate, consistent guidance.
2026 can be structured as a year for hospitals and health systems to build internal systems and partnerships, pilot workflows and outreach strategies, refine approaches based on real-world experience and prepare for broader implementation ahead of 2027. This phased approach allows hospitals to adapt as additional state and federal guidance becomes available.
Even with all this preparation, many aspects of the Medicaid changes remain uncertain. The MHA will continue to keep members informed as additional guidance is released by the Michigan Department of Health and Human Services and the federal government.
In the meantime, investing in ‘No Wrong Door’ strategies during 2026 can help hospitals protect patients, preserve access to care and position their organizations for a smoother transition in 2027, no matter how the details evolve.
