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The 80 Million Podcast

The 80 Million Podcast

By: Manatt Phelps & Phillips LLP
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Welcome to The 80 Million Podcast, powered by Manatt Health and hosted by Patti Boozang. Think of us as the proverbial water cooler where you can listen to health care policy discussions particularly focusing on federal and state Medicaid policy, and the potential impact on your organization — whether you’re part of government, a provider system, health plan, life sciences company or another organization within the health care ecosystem that Medicaid touches. Our Substack blog and podcast will feel like talking to your smartest friend (who happens to be deeply entrenched in Medicaid). Subscribe for notifications about new episodes, review our The 80 Million blog and find more information on our services at manatt.com. The views expressed on the podcast reflect the personal views and opinions of the participants and are not intended to constitute legal advice or counsel, nor the views of Manatt Health.

Credits:

Host and Executive Producer: Patti Boozang, Senior Managing Director, Manatt Health

Editorial Director: Amanda Eisenberg, Consultant, Manatt Health

Editor:

Anthony Vito

Copyright 2026 All rights reserved. Hygiene & Healthy Living Political Science Politics & Government
Episodes
  • Episode 2 of The 80 Million Podcast: It’s Complicated — Getting Ready for Medicaid Work Requirements

    Episode 2 of The 80 Million Podcast: It’s Complicated — Getting Ready for Medicaid Work Requirements
    Oct 28 2026
    This episode is hosted by Patti Boozang, Manatt Health Senior Managing Director and 80 Million editor. She is joined by MassHealth Chief Operating Officer Elizabeth LaMontagne, Massachusetts’ Health Care For All Deputy Executive Director Ashley Blackburn and Manatt Health Partner Kinda Serafi to discuss what implementation looks like on the ground — and what states are doing to mitigate harm.Authors: Ashley Blackburn, Elizabeth LaMontagne and Kinda SerafiEditors: Patti Boozang and Amanda Eisenbergtl;dr* Medicaid work reporting requirements take effect Jan. 1, 2027, creating a complex new set of eligibility and verification rules for states to implement.* About 5.7 million people nationally are projected to lose coverage by 2034 due to new work reporting requirements and six-month eligibility checks. MassHealth, the Commonwealth of Massachusetts’ Medicaid program, estimates up to 175,000 residents could lose coverage because of work requirements and six-month eligibility checks.* Massachusetts is partnering with community organizations, like Health Care for All Massachusetts, using data to identify people who qualify for exemptions and preparing to address problems as they arise — work that will need to continue well beyond the initial launch.The 80 Million ImpactStarting Jan. 1, 2027, states must implement new federal work and community engagement requirements for certain adult Medicaid enrollees. What some would describe as a straightforward new eligibility requirement — demonstrating 80 hours a month of work or other qualifying activities or establishing an exemption — is anything but.States must build new eligibility processes, update technology systems, train staff on and help members navigate complicated rules. It’s logistically challenging and the consequences of getting it wrong are significant: People who remain eligible for coverage could lose their access to health care because they misunderstood a notice, missed a deadline or struggled to document an exemption.One of the biggest challenges is distinguishing Medicaid enrollees who must meet work reporting requirements from those who qualify for an exemption. Medical frailty is particularly difficult to assess. Having a serious medical condition like cancer doesn’t automatically qualify someone for an exemption; states must determine whether that condition affects a person’s ability to meet the requirements, often with incomplete information.Massachusetts is trying to reduce the burden on enrollees and applicants by using existing data to identify people who are exempt or already compliant. However, not everyone can be identified automatically — making clear consumer communication and accessible assistance essential.MassHealth is working closely with community organizations and providers to help members understand what the new rules mean for them. Health Care for All Massachusetts has expanded its community-based partner network from about 30 organizations to nearly 50, building on lessons from the state’s post-pandemic Medicaid renewal effort.Massachusetts found that people often turn to trusted local organizations, health centers and help lines before they turn to a state agency. Still, those partners need the training and resources on these new and complicated requirements to help members navigate the process — which is where states can step in.Massachusetts estimates that up to 175,000 residents could lose coverage due to work reporting requirements and six-monthly eligibility checks. Nationally, Manatt Health estimates nearly one in 10 Medicaid enrollees nationwide may lose coverage from such changes.A large swath of those losses will stem from administrative hurdles, not because people fail to meet the requirements, and those challenges will grow in 2028 when more frequent renewals and tighter limits on self-attestation add further demands. States will need to track enrollment patterns, listen to community partners and respond quickly when problems arise, rather than wait months for the data to tell the full story.The Bottom LineListen to the full episode of The 80 Million Podcast to hear how Massachusetts is preparing, where the biggest risks lie and what other states can learn from its approach. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit 80million.substack.com
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    44 mins
  • The H.R. 1 Implementation Squeeze Is Here

    The H.R. 1 Implementation Squeeze Is Here
    Oct 23 2026
    In this episode of The 80 Million Podcast, Manatt Health Senior Managing Director and 80 Million Editor Patti Boozang speaks with Professor of the Practice at Princeton University’s School of Public and International Affairs and State Health and Value Strategies Director Heather Howard and Manatt Health Partner Allison Orris about what H.R. 1 implementation looks like on the ground as states build against a moving target and work to minimize avoidable coverage losses.Authors: Heather Howard and Allison OrrisEditors: Patti Boozang and Amanda Eisenbergtl;dr* Last year’s reconciliation law made unprecedented cuts to Medicaid that will shape the program and our health care ecosystem for years to come. States are building against a moving target even as their implementation efforts are well underway — such as stripping Medicaid coverage from certain lawfully present immigrants as required by H.R. 1 and operationalizing work reporting requirements, more frequent eligibility redeterminations and limits on retroactive eligibility that take effect in January 2027.* States are adapting their systems and policies to major, late-breaking policy changes in the administration’s work reporting requirements rule. At the same time, they are making critical policy and budget decisions as federal rules governing Section 1115 demonstrations, provider taxes, and state-directed payments continue to evolve ahead of key implementation deadlines.* Coverage losses are a major part of the story. Rising uncompensated care and financing changes made by H.R. 1 will also put pressure on Medicaid agencies, providers and state budgets in ways that will be broadly felt beyond people enrolled in Medicaid.* This next year will generate critical evidence. Hard data could take longer but providers will soon see evidence of rising coverage losses and uncompensated care. Other early indicators — most especially enrollees’ experiences navigating new systems — can help policymakers understand how implementation is working in practice.The 80 Million ImpactH.R. 1’s Medicaid changes are arriving in waves, but states are already feeling the cumulative pressure as they prepare to implement various provisions of the law and consider how they will respond to the fallout from rising uninsurance, uncompensated care and budgetary constraints.The law cut nearly $1 trillion in federal Medicaid funding over the next decade, making major structural changes to significant parts of how the program operates. Although some of its biggest provisions do not take effect until 2027 or later — and federal guidance on some provisions is still pending — states have been working to implement these changes at record speed because of tight timelines and high stakes for their enrollees. Getting ready to implement the new Medicaid work reporting requirement in states that expanded Medicaid has garnered significant attention over the last year.There are other near-term changes that states have also been preparing for by updating eligibility systems, communicating with enrollees and providers, and by forecasting how changes will impact their budgets.Beginning Oct. 1, federal Medicaid funding was eliminated for certain categories of lawfully present immigrants. The effects could extend beyond the individuals who lose eligibility. Confusion about the new rules, coupled with new public charge rules, may discourage eligible family members, including children, from enrolling or staying covered. At the same time, the federal matching rate to help Medicaid expansion states cover the cost of emergency Medicaid services for some immigrants who are not eligible for Medicaid was reduced.More changes will arrive in January. In addition to work reporting requirements, Medicaid expansion adults will move from annual to twice-yearly eligibility redeterminations, creating two opportunities each year for eligible people to lose coverage because of paperwork problems or other administrative issues. Retroactive eligibility will also shrink from up to 90 days before application to 30 days for the expansion population and 60 days for other eligibility groups. Together, these policies could mean more medical debt for consumers and more uncompensated care for providers, who will bear the brunt of Medicaid cuts that will take effect later in 2027 and in 2028.States Are Implementing. The Rules Are Changing.States have taken steps to prepare for provisions in H.R. 1, which became law in July 2025, yet they didn’t receive firm implementation direction on work reporting requirements, for example, until June 2026. The Centers for Medicare & Medicaid Services’ interim final rule, which included a narrower reading of the medical frailty exemption, changed key policy elements states had already been building their systems, workflows and policies around.States pivoted quickly but are still awaiting guidance in other areas that will influence their programmatic plans and budget ...
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    32 mins
  • Beyond Coverage — What It Will Take to Fix American Health Care

    Beyond Coverage — What It Will Take to Fix American Health Care
    Jul 1 2026

    The Affordable Care Act (ACA) fundamentally changed American health care — expanding coverage, establishing consumer protections that are now broadly expected, and helping cement the idea that access to health care is a basic human need rather than a privilege tied to health status, gender or income.

    The next challenge is no longer just whether people have coverage, but whether they can afford to get it, keep it and use it. Rising premiums, deductibles, cost-sharing and administrative barriers are straining people across Medicaid, the ACA Marketplaces, Medicare and employer-sponsored insurance.

    Fixing American health care will require looking across the whole system: reducing friction for patients and providers, rebuilding a durable federal floor for coverage and access, resisting efforts to retreat to a pre-ACA coverage framework, supporting state innovation, and accepting that meaningful reform will require mutual sacrifice across the health care ecosystem.

    The challenge before us is creating a health care system that is affordable, usable and sustainable for patients, providers, employers and taxpayers alike — wherever they live and whatever their income, gender, race or age. We have a great deal of work to do.
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    37 mins
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