The anxiety among healthcare leaders is widespread. Sixty-six percent of healthcare finance leaders now name Medicaid cuts their top concern, according to Strata’s latest survey — ahead of labor costs, payer negotiations and everything else. HR 1 is projected to reduce federal Medicaid spending by nearly $1 trillion over the next decade, and research from the Urban Institute and the Robert Wood Johnson Foundation estimates hospitals alone could face a $31.9 billion revenue decline in 2026 if Medicaid expansion coverage collapses.
For Nick Stavros, CEO of Scottsdale, Ariz.-based Community Medical Services, the stakes are real. His organization’s more than 80 outpatient opioid treatment program clinics across 14 states serve approximately 28,000 patients, the vast majority of them on Medicaid. By any measure, that is a vulnerable position.
But Mr. Stavros says he has seen this before. “It’s not something that keeps me up at night,” he said. “We had the whole redeterminations after COVID, which was supposed to cut Medicaid rolls in a lot of states, but for whatever reason, it didn’t really affect our patient population. So we’ve kind of weathered the storm already.”
Geography has helped. Community Medical Services operates primarily in Medicaid expansion states, where the impact of ACA-related changes has been more limited than in non-expansion states — a factor Mr. Stavros credits explicitly. The organization has also carried less debt than many of its peers, giving it more flexibility to absorb uncertainty without being forced into reactive cuts.
Still, Mr. Stavros is not dismissive of what lies ahead. Community engagement requirements, also known as Medicaid work requirements — a central feature of HR 1 — will add compliance burdens for patients who already face social and logistical barriers that make navigating insurance systems especially difficult. He is building state-by-state response plans accordingly.
“We just need to make sure as a provider we’re geared up to support our patients as those regulations take place,” he said. “It’s state by state, so different states can do different things, and we have to make sure we have a plan in place for our patients in each state to accommodate their needs.”
In Mr. Stavros’s view, what positions Community Medical Services differently is the frequency with which it sees patients. Opioid use disorder treatment programs interact with patients far more often than a typical outpatient setting — creating more opportunities to identify coverage gaps, walk patients through re-enrollment requirements and catch potential lapses before they become crises.
The broader environment remains volatile, he acknowledged. Executive orders appear and disappear overnight. Regulatory guidance shifts state by state. Planning against that backdrop is harder than planning against a clear threat.
“The biggest headwind is just the volatility — not knowing what to expect,” Mr. Stavros said. “We might get some executive order overnight canceling grant funding that gets reinstated two days later.”
But for an organization that has spent more than a decade building in primarily Medicaid expansion states, avoiding heavy debt and having survived post-COVID redeterminations, the coming cuts feel more like a known quantity than a shock.
Mr. Stavros will discuss lessons learned from payer negotiations at Becker’s 14th Annual CEO + CFO Roundtable later this year in Chicago.
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