The “One Big Beautiful Bill” (OBBB) is here, and while policy analysts are unpacking the fine print, rural health leaders are left with a bigger question: What do we do now? Patients, staff, and community members are all wondering how this will affect them and what steps you are taking to prepare.

The impact of OBBB will vary depending on your organization’s structure and payer mix. While in-depth analysis is still unfolding, you should stay informed by attending webinars, talking with your CFO, and engaging your accounting firm.  Advocacy and education are important, but don’t count on OBBB being reversed or on a future administration walking back the provisions.  It could happen, certainly, but there is no guarantee.  In fact, politicians sometimes leave unpopular legislation in place simply because of the cost savings.

It is challenging to find a silver lining here, but in times of uncertainty it is important to have a plan and take action where you can.  The effects of OBBB will unfold over time, which means you can still prepare.  Here are some practical steps you can take now to give your organization a sense of control and direction.

Invest in Medicaid Navigation

If you don’t already have staff trained as Medicaid navigators, now is the time to start.  Navigators help individuals enroll in Medicaid and understand their benefits.  Some modeling shows that people will lose coverage not because they are ineligible, but because they struggle with the signup and maintenance process.

Having trained navigators on your team can keep patients connected to care while stabilizing your organization’s payer mix.

Review Financial Practices and Prepare for More Self-Pay Patients

As payer mixes shift, more patients will be concerned about the cost of care, which makes it essential to review your financial assistance policies, chargemaster, and price transparency practices.

If your chargemaster has not been reviewed in a while, you could be unintentionally overcharging for some services or undercharging for others.  Overcharges create unaffordable bills that damage patient trust and increase the likelihood of bad debt.  Undercharges may mean you are not covering your costs, especially with inflation and rising expenses.  An annual chargemaster review ensures your pricing is consistent, defensible, and aligned with regional benchmarks.

At the same time, we are likely to see an increase in self-pay patients.  Without insurance, patients often delay care until they are in crisis, which is more expensive for them and for your organization. Instead of waiting for that to happen, consider offering a menu of reasonably priced preventive services.  Clear and accessible pricing for things like annual exams, vaccines, or lab work gives patients options they can afford and keeps them connected to primary care.

Make sure your financial assistance policies and price estimate processes are up to date and that staff are trained to speak about them with confidence.  Patients need to know what help is available and what their likely costs will be before they receive services.  When staff can explain policies clearly and consistently, it builds trust and reduces frustration.

Strengthen Primary Care with Specialist Support via Telehealth

Not all services are equal under the OBBB.  Early indications suggest that primary care, along with mental health and substance use disorder services, will remain more favorable for both patients and organizations in terms of access and reimbursement.  For example, primary care services provided through FQHCs and rural health clinics are exempt from certain new cost-sharing rules that apply to other types of care.

This is a good time to double down on primary care.  Make your services as accessible and comprehensive as possible.  Telehealth plays a key role here both in terms of making primary care more accessible and allowing rural providers to collaborate with specialists via video conference or Project ECHO-style case discussions.  Telehealth can help you keep more care in the community, reduce costs, and expand what primary care can offer.  (More on implementing telehealth here.)

Prioritize Value-Based Care

Value-based care will matter more than ever.  In rural health, many organizations have received something of a pass because only a small portion of their annual revenue has been tied to performance.  (There are a variety of reasons for this.)  Under OBBB, that may change.  States are now encouraged to shift from fee-for-service toward value-based models through the Rural Health Transformation Program, which allocates $50 billion over five years to support prevention, chronic disease management, and value-based initiatives in rural settings.  This means your state is financially incentivized to get more serious about VBP, and your organization will likely feel that shift.  If you do not already have someone dedicated to managing quality metrics and value-based contracts, this is the time to consider it.

Strengthen Your Networks

Don’t go it alone.  This is the time to stay closely connected with your Office of Rural Health, Primary Care Association, and Hospital Association.  Networking keeps you informed about emerging updates and practical strategies that peers are testing across the state or region.  It also helps position your organization for consideration when grants, pilot projects, or other new opportunities are announced.  

Revisit Your Revenue Cycle

Revenue cycle health will be a make-or-break issue.  Strong front-end processes, clean claims, and timely follow-up matter even more when margins shrink.  (For a deeper dive, see my earlier post on Revenue Cycle Basics.)

Think Outside the Box: Supported Employment

With OBBB introducing Medicaid work requirements, health organizations should be asking how they can help patients meet those expectations without mission drift.  One idea is Supported Employment.  The Supported Employment model is well established in behavioral health, but is virtually unheard of in primary care.  

Starting in 2027, many adults will need to show regular hours of work, school, or volunteer activity to maintain Medicaid coverage.  For patients facing barriers to employment, this could mean losing access to care.  Supported Employment can bridge that gap.  Consider partnering with your local behavioral health program and identifying payers who may reimburse for these services when integrated into Primary Care Behavioral Health.

Helping patients connect to meaningful work isn’t just about income or insurance access, it also improves health and strengthens community resilience.

Final Thoughts

We can’t directly control what happens in Congress, but we can take responsibility for how we prepare.  And the good news is, if parts of the OBBB are repealed, you won’t be out anything because this is all best practice anyway.

Interested in what we can do for your organization? Contact us to learn more or book a free consultation using Calendly.