By BRIAN STANLEY

Patients waiting on Medicaid enrollment face more bills, while Congress touts that as cost savings. Hospitals need to choose their stance.

Medicaid covers the lion’s share of short- and long-term health care expenses for low-income, older, and/or disabled Americans. Until now, the program paid for care received up to three months before someone filed for Medicaid, as long as the person was eligible at the time. That grace period has long been a safety net for people who fall ill before navigating the maze of Medicaid enrollment.

In a quiet change tucked into the “Big Beautiful Bill,” lawmakers shrunk that window by one to two months, depending on the state.

Now, for adults in Medicaid expansion programs, retroactive coverage stops at one month before enrollment. For traditional Medicaid enrollees, it’s two months.

The Congressional Budget Office estimates this change will “save” the government billions over the next decade. But those “savings” don’t reflect fewer illnesses or better care. Instead, they are unpaid bills and costs that move downstream to patients, nursing homes, and other parts of the health care system.

These changes can impact any of us.

Any health event can set off a chain of care –  hospitalization, rehab, then long-term nursing home placement – that easily stretches past 30 or 60 days. Under the new rules, that early care will fall outside Medicaid’s reach: the first month or two of costs now sit squarely with the patient or facility.

Still, this change is especially harmful for dual eligible beneficiaries. Americans on Medicare who become eligible for Medicaid enrollment – think older adults or people with disabilities – are at particular risk.

This scenario plays out often: a person has Medicare and then experiences an illness or injury that drives their assets down. They then become eligible for Medicaid, in addition to holding their Medicare enrollment. For these Americans, the shift in the “Big Beautiful Bill” means that they face significant bills while they wait for their Medicaid enrollment to be completed.

We know that this population, and realistically, all Americans, suffer when retroactive coverage is taken away from them.