On March 31, the Primary Care Collaborative (PCC) hosted a conversation exploring how primary care and states can work together to minimize challenges arising from major Medicaid policy changes put in place H.R. 1.
Moderated by Dr. Brandon Wilson (Community Catalyst), the discussion featured Perrie Briskin (Maryland Department of Health), Dr. Sandy Chung (Trusted Doctors and past president of American Academy of Pediatrics) and Ann Jensen (Nevada Medicaid).
Panelists described how changes under H.R. 1—including new eligibility requirements, more frequent redeterminations and community engagement provisions—have already added strain across America’s health care system.
Speaking from the clinician perspective, Dr. Chung shared the confusion and concern patients express about losing coverage even before the full implementation. In many cases, these patients even choose to delay or avoid care. Practices are already seeing declines in visit volume, particularly in communities with a high share of Medicaid patients.
From the state perspective, Nevada Medicaid chief Ann Jensen and Maryland Medicaid Director Perrie Briskin spoke on the scale of implementation. Jensen pointed to the operational challenges a lot of states face in updating eligibility systems while federal guidance continues to evolve.
There is a massive effort required to build and manage so many new processes across multiple platforms. Briskin added that Maryland expects coverage losses among certain populations, which will likely translate into higher levels of uncompensated care and increased pressure on primary care practices.
Both state leaders emphasized the importance of clear, consistent communication as this process accelerates. Jensen described Nevada’s efforts to reach patients early and ensure that their contact information is up to date, while also working with primary care clinicians who are often the most trusted source of information for patients. Briskin added that Maryland is building on lessons from Medicaid unwinding, focusing on keeping eligible individuals covered through better data use and more streamlined processes.
Clinicians are already experiencing the operational impact of these changes. Chung described how primary care practices often do not know a patient has lost coverage until after care has been delivered, often leaving these practices to absorb the cost. She also pointed out that many practices do not have the needed staff or infrastructure to manage eligibility issues, particularly smaller or independent practices. This makes it difficult to support patients navigating a more complex system.
The conversation also highlighted how changes to adult coverage can affect entire families. Chung explained that when adults lose coverage, families may avoid seeking care altogether, even when children remain eligible. Many just simply aren’t aware of this. This dynamic raises concerns about missed preventive services and the long-term impact on outcomes, particularly for children who rely on Medicaid for access to comprehensive primary care.
Panelists also pointed to ongoing efforts to support primary care. Jensen highlighted Nevada’s work to simplify how individuals access coverage and connect with assistance in their communities, while Briskin emphasized the need for continued coordination between states and clinicians to understand what is working and where adjustments are needed. Both outlined how sustaining primary care will require practical solutions that reduce administrative burden and support clinicians in delivering whole-person care.
As the implementation process continues, panelists agreed that primary care will remain central to helping patients navigate changes and maintain access to care. Ensuring that clinicians have the information and support they need will be critical to protecting outcomes and maintaining access in communities across the country.
This summary utilized AI tools for drafting support and editing.