Orgs Will Have To Hire New Staff For Medicaid Work Mandates, Says One Health System

(Source: MIRS.news, Published 07/10/2025) (FLINT) – Healthcare organizations will have to hire new staff specifically to handle new work requirements and six-month eligibility check-ins for Medicaid, says Dan Russel, the head of Genesee Health System. 

"I would just say, in the name of government efficiency, this is not that," Russel said, referencing the "One Big Beautiful Bill Act" (OBBBA) that President Donald Trump signed this month. "We can't go to a case manager or to a nurse and say, 'Hey, in addition to all the rest of your stuff, don't forget to make sure that your patients are working, or they're getting their volunteer activities in.' So it's just going to add…that much more bureaucracy and work to an already over-stressed system." 

Overwhelmed worker

The Genesee Health System (GHS) provides substance-use treatment and behavioral health care. It was the site of Thursday's press conference by U.S. Rep. Kristen McDonald Rivet (D-Bay City), who won her election last fall by 28,173 votes in what was tagged as one of Michigan's most competitive races. 

Her press conference featured Russel, who on Friday will have worked at GHS for 26 years, as well as American Medical Association (AMA) President Dr. Bobby Mukkamala and Allison Harris, a Flint resident overseeing sterile services at a local trauma center. 

While her own career deals with Medicaid, Harris explained that Medicaid is also used to "fill in the gaps" her employer-provided insurance can't absorb for her 18-year-old daughter, Kendall Williams. Her daughter, who was present Thursday, is undergoing chemotherapy for stage 4 cancer. 

Williams has Hodgkin lymphoma, a cancer that starts in the immune system's white blood cells.  

"Kendall has had complications due to her chemo. She has been needing additional therapy for speech and physical health as well, and with the help of Medicaid, we've been able to afford all of those things," Harris said. "I just don't know what we would do if we would lose that help. It could affect my employment. It could affect Kendall's care." 

The new Medicaid reforms within the OBBBA include requiring, starting after 2026, childless adults not considered "medically frail" or disabled to work at least 80 hours monthly. Community service or career education programs would count as work.

For example, outside of Thursday's press conference, MIRS spoke with Sen. Joseph BELLINO JR. (R-Monroe), who worked for the St. Vincent de Paul Society in Detroit providing utility, housing and food assistance. He thinks after people read the federal bill, Democrats won't be able to keep the rhetoric up about people dying. 

"If you can get $14.75 an hour (40-hour work-week) in benefits, why work?" Bellino said via text. "Taking classes, insured. Giving time to a nonprofit, insured. Have young ones, insured. Taking care of older folks, insured…but with Bridge cards, subsidies for rent, electricity, phones, free, free (and) free you can see why we are in the pickle we are in."  

States would be responsible for re-determining eligibility at least every six months. For long-term care providers accepting patients before they're officially enrolled, Medicaid will reimburse them for up to one month prior to their enrollment, instead of today's three-month retroactive standard. 

As the OBBBA looks to downsize federal spending on Medicaid by $1 trillion over the next decade, opponents to the act worry its administrative updates will result in loss of enrollees and services far beyond its intentions to block people from misusing the system.

"I have a liberal arts degree, so math isn't my strong suit. But let me tell you, the math doesn't add up. There is no data that shows you can get to a trillion dollars of cuts with waste, fraud and abuse," McDonald Rivet said. "The idea that…these cuts are only going to affect people who are committing fraud or who are in the country illegally, is just a heads out lie." 

Supporters of the OBBBA make the case that it offers numerous opt-out windows to the new work mandates, and that the act could promote workforce development. However, McDonald Rivet projects people missing deadlines and misunderstanding forms that will determine their access to care. 

When asked if today's technology can make determining someone's Medicaid eligibility simpler and a faster process, McDonald Rivet explained the federal government is "not investing a penny" in technologies that make Medicaid easier to navigate. 

"Innovations in technology require investment. They require the smartest minds coming together to actually implement system-wide technology upgrades," she said. "The possibility of that happening in an environment where the federal government is being stripped of all expertise and tenure…is next to nothing." 

Mukkamala is an ear, nose and throat doctor in Flint Township, and one-third of his practice is seeing local Medicaid recipients. He said he sees people with stage 1 cancer in their mouth all the time. 

Upon the initial visit, Mukkamala explained it's "a small thing" he can remove with a 90 percent cure rate. 

"But what's going to happen when that patient loses insurance? Inevitably, people are going to be waiting at home…(saying) 'I don't have insurance. I don't really want to go in. I'm not sure what that's going to cost,'" he said. "Then it's going to end up being a stage 4 cancer, where that survival drops to 50 percent and it's not just taking something out in my office. It might bleed like crazy and take them to the emergency department."