LAS VEGAS, Nev.—The One Big Beautiful Bill Act, signed by President Donald Trump in July, brings sweeping Medicaid changes that will pose challenges to patients and providers by reshaping eligibility, funding and access.
The OBBBA trims federal spending on Medicaid by more than $1 trillion over the next decade. The program covers more than 71 million people with low incomes and disabilities. Ten million people will lose coverage over the next decade due to the law, according to the nonpartisan Congressional Budget Office (CBO). It's also estimated that these Medicaid changes could drive hospital uncompensated care costs up by $63 billion over the next decade.
These policy changes come as many patients in the U.S. were already facing a healthcare affordability crisis.
To help address the impending challenges, health tech company Cedar, which offers a patient financial platform, launched a digital safety net to help patients access coverage and financial assistance, marking a deeper move into Medicaid.
The digital solution, called Cedar Cover, assists patients in identifying, securing and maintaining coverage through four key capabilities: Medicaid enrollment, proactive Medicaid renewal workflows, denials resolution and medication assistance. Cedar Cover embeds a financial safety net directly into hospital billing workflows, helping patients access resources in one digital platform.
Cedar Cover also can connect patients to billions in unclaimed medication co-pay assistance directly within the billing experience, executives said.
Nearly a dozen health systems have deployed Cedar Cover as early adopters, including Novant Health, Baystate Health, ApolloMD and The Iowa Clinic.
The solution enables providers to adapt quickly to legislative changes while delivering faster ROI than legacy vendors, Cedar executives claim.
"The OBBBA is only going to further increase self-pay and make it even harder to get people enrolled in insurance, so you need a technology solution to help," Seth Cohen, president of Cedar, said in an interview with Fierce Healthcare, offering a first look at the new solution.
Cedar has served 50 million lifetime patients across 55 health systems and its medical billing data indicates that the healthcare affordability problem continues to grow.
"At the beginning of this year, we noticed a really interesting trend in our data. We have robust data on patient financial interactions, and we saw in this data set that over the course of 2024, the amount of dollars owed to hospitals from patients with no insurance coverage grew 8% to the point where now about 30% to 35% of all dollars owed to hospitals are from patients who have no insurance. That's more than a third of what's owed and its patients who have the least ability to pay and are often looking at the biggest bills," Cohen said.
Uninsured or underinsured patients facing high medical bills don't need better billing functionality, he noted.
"It's like if I said, 'Here's your $13,000 bill from your emergency department. Would you like to pay with Apple Pay or Google Pay?' What you need is a unique connection to resources. You need help," Cohen said. "We evolved our thinking to, 'OK, if we're not solving a billing problem here, how do we solve this affordability problem?' What we learned is that there is actually a lot of resources available to patients in the underinsured and uninsured markets, but they're not accessing those resources."
The OBBBA outlines work requirements for existing Medicaid enrollees as well as verifications for meeting work requirements when newly applying. Republican lawmakers and Trump administration officials said the requirements were “commonsense reforms” necessary to reduce unnecessary taxpayer spending for able-bodied adults “choosing not to work.”
Provider are bracing for significant impacts from the policy changes and funding cuts.
"That loss of coverage and that conversion to self-pay is going to result in a lot of uncollectible balances. These are no longer patients you can expect to get reimbursement from and for some hospitals, depending on where they are, that can result in a 60% increase in operating loss and enormous increases in charity care," Cohen noted.
"Every missed enrollment or overlooked aid program is a patient who may delay or forgo care, and a provider left with dollars they’ll likely never collect,” said Florian Otto, CEO and co-founder of Cedar.
Health systems who are early adopters of Cedar Cover have reported notable results. A large integrated health system in the West reported a 30% increase in insurance reimbursement from overturned denials, driving an $8 million annual value recovery. Another large integrated health system reported a 97% Medicaid application approval rate, with applications surging over 3x month-over-month. During a six-month pilot, Novant Health reported $12,000+ average medication assistance grants per approved application.
Cedar partnered with several digital health companies, including Fortuna Health and TailorMed, to flesh out Cedar Cover's capabilities.
Through these partnerships, Cedar identifies potentially eligible patients and guides them to the right options, assists in securing coverage and reduces bad debt for providers.
"We looked for partners who had some of that last-mile capability that we need to really give a full solution," Cohen said.
Medicaid navigation startup Fortuna Health offers a self-serve, digital platform to make it easier for patients to enroll in Medicaid and renew their coverage.
"At Fortuna, we see ourselves as the 'Turbo Tax' of healthcare. We're a digital platform built to help patients enroll in Medicaid and government programs," said Nikita Singareddy, CEO of Fortuna Health.
Fortuna shares Cedar's mission to create a "consumer-grade financial experience in healthcare," she said. The startup had a tie-up with Cedar to serve as its Medicaid enrollment partner starting last year. Cedar Cover was a natural progression of the relationship, she noted.
Because Cedar is embedded directly into hospitals' billing workflows, the partnership allows Fortuna Health to proactively identify patients who may be eligible for coverage and guide them through enrollment. "And because this outreach happens in the context of a real bill, patients are far more motivated to act, seeking coverage to help pay for the care they've already received," Singareddy said.
TailorMed is a New York-based startup focused on medication affordability. Founded in 2018, the company built a platform that serves health systems, large pharmacies and infusion centers and identifies patients with high-cost medications and connects them to financial assistance programs, according to Srulik Dvorsky, co-founder and CEO of TailorMed.
TailorMed now works with 900 hospitals, 3,000 clinics and 1,500 pharmacies.
The startup and Cedar have been tackling the issue of affordability with different approaches, Dvorsky noted. Cedar has focused on simplifying the financial journey with a consumer-oriented approach. TailorMed has focused on expanding the wallet share of patients by "leveraging third-party dollars that can offset patients' expenses," he said.
"With Cedar, there is true mission alignment of how can we provide patients with all available options. In an ideal state, if a patient has a high out-of-pocket responsibility and a third-party program can assist, then the patient benefits and their healthcare provider benefits," Dvorsky said.
"When you can streamline that journey, exhausting third-party assistance and having a best-in-class patient payment platform that Cedar provides, I think of that as the way to do a cohesive end-to-end financial experience for patients, one that will really address not only the simplicity, but the true affordability for their care," he noted.