Inside the One Big Beautiful Bill Act: What Rural and Post-acute Care Organizations Need to Know

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A lot of commentary has been written about the One Big Beautiful Bill Act (OBBBA), which was signed into law in 2025. As I’ve written about before, the bill’s most dramatic change in healthcare includes deep cuts to Medicaid eligibility, which will account for millions of people losing coverage, and eliminate an estimated $1 trillion in Medicaid spending over the next 10 years. This will be particularly impactful for rural and post acute care organizations that treat many of our Medicaid patients. This month, rural health will start implementing its grants from the Rural Health Transformation Program (RHTP), which aims to provide some relief to rural health. 

Let’s review key areas in the OBBBA that will impact rural health. Preparing for this reduction in Medicaid enrollment and, by extension, reimbursement, is only the tip of the iceberg. For rural and post-acute care organizations, there are four key areas where the OBBBA’s ripple effect will be felt for years to come. 

1. Medicaid enrollment restrictions: As discussed, this new policy change will likely have the largest impact across healthcare. The restrictions state that adults aged 19-64 must work 80 hours per month to remain eligible for coverage and allow for more frequent eligibility checks that may remove members on an ongoing basis.

These cuts will spike the volumes of uninsured patients, leading to a correlated rise in uncompensated care. For rural hospitals, which already operate on some of the slimmest margins in the country, these cuts could be crippling for the bottom line. What’s more, closure or reduction of these facilities could send a wave of uncertainty throughout healthcare, specifically for nonacute care facilities. Skilled nursing facilities (SNFs) could see a drop in referrals as rural care settings and existing provider networks become overburdened. 

2. Medicaid cost-sharing: Patients above the federal poverty level will now be expected to pay up to $35 per visit for various healthcare services. Some healthcare visits are exempt from this cost-sharing, including primary care, mental health and substance abuse treatment, family planning, and emergency and long-term care. 

For many Medicaid patients, this cost may be out of reach. As a result, we can expect patients to delay care or refuse necessary treatment for specialty or complex conditions. Over time, this can have negative impacts on preventative and specialist patient volume, which can lower patient outcomes, as well as hinder overall population health. 

3. SNF staffing requirement rollbacks: Since it was introduced, skilled nursing facilities have pushed to repeal the 2024 nursing home staffing rule, which mandated how many nurses had to be on call at a facility, and how many hours they had to work daily. Though the elimination of this rule is a boon for facilities grappling with the costs of employing these robust care teams, it also means that many facilities will reduce nursing staff. 

The burden of patient work, as well as associated administrative tasks, will fall to the remaining nurses. SNFs that don’t have automated documentation and administrative tools run the risk of burning out existing staff and forcing their focus away from the patient, where it is needed most. 

4. Expanded access to home care and community-based services (HCBS): New waivers will allow more Medicaid enrollees to receive care at home. While it reduces costly inpatient care and allows for more flexible treatment options, states will be required to show that this new waiver path won’t elongate wait times for care. 

As more patients sign up for HCBS following these waivers, the onus will be on healthcare organizations to streamline referrals and drastically speed patient care. Further, collaborating with a wider array of home-based organizations will necessitate a strong foundation of format-agnostic data-sharing to ensure the right information is delivered in a timely manner across the care team, no matter what programs or devices they’re using. 

These changes are concerning and will have long-term treatment impacts on healthcare, specifically for non-acute and rural healthcare providers. For acute facilities, the uncompensated care and financial burden will be a huge headwind starting this year. There is hope. Accessible technology solutions like digital cloud fax, combined with AI solutions, can help prepare for these shifts, create better continuity of care, and create efficient referral management workflows. These technologies are lower cost and require less technical expertise than implementing entire new systems. 

Our recent whitepaper, Understanding the Ripple Effect of OBBBA and National Interoperability Initiatives, goes in-depth into how these four updates will affect your organization and provides actionable steps you can take now to get ahead of the curve. 

Download the whitepaper today!

Bevey Miner

EVP Healthcare Strategy & Policy