HJBR Sep/Oct 2025

HEALTHCARE JOURNAL OF BATON ROUGE I  SEP / OCT 2025 25 The One Big Beautiful Bill passed inWash- ington, and there’s been a lot of interest in what it does. What do you wish people knew about the bill and the changes that it would implement to Medicaid? The changes that we see in the Big Beauti- ful Bill are really in three broad categories. There’s changes to Medicaid eligibility that will start in the spring of 2027. Some of those would be the work requirements. You’ve also got changes to the financing of the program – capping or freezing the provider taxes, and then ultimately reduc- ing them in about 2028. You also have a new rural health trans- formation program where I expect about $150 million to $200 million of newmoney in Louisiana, starting in 2026. Do you have any estimates – or has the state produced any estimates – about what type of change we might see in the Med- icaid program? The eligibility changes are sort of phased in depending on which one it is. They start in the spring of 2027 and some start as late as December of 2029. With those changes, I do expect there to be some reduction in the Medicaid expan- sion rolls of anywhere from 50,000 to maybe 150,000. When you start getting into the address verification and a little closer to 2030, there could be another potential 100,000 people coming off the rolls. Right now, we’ve got about 1.6 million people on the rolls. We could have 200,000 people come off the rolls and bring Medic- aid enrollment down to about 1.4 million. But I really do not expect us to see the full impact of all these changes until we get closer to 2030. And of course, that’s five years out and it’s hard to project that far out. But based on my experience and how eligibility works in Medicaid, that is the potential impact. Are we going to see a change in funding for the Medicaid program that comes from the federal government? The hospital program and the physician program are absolutely affected by the Big Beautiful Bill. But right now those programs are capped at their 2026 levels. So for 2026, the hospitals are fully funded based on the appropriations act that the state legislature passed in the spring legisla- tive session. So for 2026 through 2028, there is really no reduction in funding to those hospitals, but those supplemental payments are capped at the 2026 amounts. Then, we start seeing a 10% reduction based on the language in the Big Beautiful Bill starting in 2029. And that 10% reduction would occur right now, based on the num- bers I’m seeing, through fiscal year 2035. So it is a case where the funding reductions are very much in the out years – not immediate. We are really sort of stabilized for the next four to five years. Then, we’ll start see- ing reductions, and that’s why I’ve been tell- ing people, for the short term, we’re abso- lutely fine. But yes, we’re going to need to work with our federal legislators and our state legislators to help try to address these future reductions. Why is the Medicaid program so important to rural hospitals and healthcare providers in rural areas? In Louisiana, you’ve gotta remember there’s 4.6 million people in the state. Right now, we’ve got 1.6 million people enrolled in the Medicaid program. We’ve got about 300,000 people uninsured, and that represents about 41% of the state’s total population. So it’s just a huge portion of the popula- tion is covered by Medicaid or is in the unin- sured bucket. When you look at some of the rural parishes that my rural hospitals serve, those population amounts are even greater. Medicaid is a big funder of healthcare services in those rural communities. And if you start adjusting or reducing what Med- icaid pays, then it does affect the ability of those rural hospitals to continue to provide services – not only to the Medicaid clients but also to the private insurance clients. I want tomake sure that I understand what you’re saying there, which is that changes to the Medicaid program would not just affect Medicaid patients, but it would affect other people with private insurance. If you’ve got close to 50% of your clients as Medicaid clients, as it pays less, then those healthcare providers in those rural communities have less resources to run This is an abbreviated transcript of a July 16 interview with Jeff Reynolds, executive director of the Rural Hospital Coalition of Louisiana, which represents 49 rural hospitals in 41 parishes. Reynolds also worked for 30 years at the Louisiana Department of Health, including five years as the agency’s undersecretary and chief financial officer for Govs. Bobby Jindal and John Bel Edwards. In that role, he oversaw the state’s Medicaid budget, including after Edwards adopted Medicaid expansion in Louisiana in 2016. He is considered one of the state’s foremost experts on federal and state healthcare financing in Louisiana. This interview has been edited for clarity.