How exposed is your organization to Medicaid coverage loss?
Model your revenue at risk from administrative disenrollment and H.R. 1 work requirements, with state-specific data, in under two minutes.
Coverage loss is already hitting revenue
People lose Medicaid coverage not because they're ineligible, but because the renewal process fails them. H.R. 1 makes this worse: more frequent recertification, new work reporting rules, and administrative burdens that states aren't resourced to manage. Every member who falls off the rolls is a lost encounter and a direct hit to your bottom line.
Calculate Your Exposure
Revenue at Risk
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Estimated Members at Risk
Estimated Encounter Impact
Revenue Exposure by Channel
Enter your data to see what's at stake
Two drivers. One exposure number
Paperwork failures
Eligible members losing coverage because renewals weren't completed, not because they don't qualify. Rates vary dramatically by state, from under 20% to over 50%.
Work reporting requirements (H.R. 1)
H.R. 1 requires certain Medicaid members to document work hours to keep coverage. Historical data shows 15–30% lose coverage when these rules take effect. We adjust for overlap so nothing is double-counted.
Methodology
This model combines state-reported Medicaid renewal outcomes (2023–2024), estimated expansion enrollment share, and H.R. 1 work requirement coverage-loss data (15–30% range). Duration-adjusted with overlap correction.
Complete the calculator above to see your model assumptions.
Model v2.0Directional estimates only. Some state expansion shares are interpolated. Does not model managed care capitation changes or secondary payer shifts. Not actuarial, regulatory, or CMS-certified guidance. Validate against your organization's financial data.
Ready to reduce your Medicaid coverage risk?
MediKey catches at-risk members before they lose coverage. Automated monitoring. Proactive renewal outreach. Fewer gaps.