North Gate Group kicked off its first webinar with a fireside chat with Gary Jessee. Gary is a SME on Medicaid policy having been a former Medicaid Director with the State of Texas and currently SVP at Sellers Dorsey. We caught up with him and the investor community to discuss the ‘One Big Beautiful Bill Act’ (OBBBA). While this bill is in the proposal stage of the legislative process, if enacted, it will have sweeping impacts, potentially reducing Medicaid spend by $700M+ and having 8M+ Americans lose Medicaid coverage.

Few insights we all cleaned from the conversation and our take (gut, unverified view) on how the investor community can evaluate the learnings from Gary.

• Timeline: While it’s difficult to predict the timeline, Trump has asked the Senate to pass the proposed bill by July 4, 2025 with enactment of the work eligibility requirements and semi-annual redeterminations by the end of 2026. 
• Significant Beneficiary Churn: With the work requirements and semi-annual redeterminations for eligibility, the CBO expects the bill to drive significant churn  – about 10% of the Medicaid population!
  
  • Beneficiaries that don’t check their email or ground mail frequently, and generally those less tech savvy are at the highest risk of looking for eligibility.
  • Dual eligible Beneficiaries could face care coordinate friction with their providers
  • States that have significant non-citizen healthcare programs, like California and Minnesota, could be affected by the federal funding statutes within the bill
• Health System and Payor Challenges: Providers can expect lower utilization of preventative care services while also expecting increased utilization of urgent care centers and the ED.‍
  
  • Patient Mix & Volume: It’s going to be increasingly important for provider networks and health systems to understand their patient mix and patient volumes and evaluate the impact of the proposed bill on them‍
  • Cost Containment: Providers will need cost containment strategies to support an expected Medicaid volume decline, potentially driving site closures and limited access in certain markets.‍
  • Eligibility: The burden of eligibility is going to be particularly hit payors that support Medicaid, of which 70%+ are private vendors (MCOs) that provide healthcare plans at the state level on behalf of the state.

Our initial gut take on investor opportunities: 

• Eligibility Redetermination & Compliance Infrastructure: States will be required to reverify Medicaid eligibility every 6 months (instead of annually), which strains existing state systems and will overwhelm administrative processes. Consider civic tech platforms, document verification and workflow engines, and state IT integrators that can enable:
  
  • Automate Medicaid redeterminations (identity, income, residency checks)
  • Enable real-time eligibility tracking and alerts for disenrollment risk

• Medicaid Member Engagement & Navigation: Millions of Medicaid members risk losing coverage due to procedural issues—not ineligibility. There's a gap in outreach, literacy, and navigation. Consider digital health engagement platforms, payor communication infrastructure, Medicaid engagement platforms that can enable:
  
  • Offer multilingual, mobile-first tools to help people stay enrolled
  • Use communication technology to remind members of recertification and provide direct assistance or Medicaid "retention-as-a-service" to MCOs‍
• ‍Workforce Tracking & Work Requirements Compliance: The bill mandates 80 hours/month of work, education, or volunteering, requiring proof of compliance to maintain Medicaid benefits. Consider workforce tech platforms, AI document parsing tools that streamline verification upload and compliance that can enable:
  
  • Mobile-first tracking and reporting hours worked, job search activity, or volunteering
  • Integration tools for job boards, gig platforms, or community orgs to report to Medicaid systems‍
• MCO-Facing AI and Ops Enablement: MCOs will bear operational risk from increased churn, compliance burdens, and higher call center volume tied to re-enrollment and documentation. Consider contact center tech, revenue cycle management platforms that can enable:
  
  • Call center AI or human-in-the-loop solutions to handle spikes in member questions
  • Claims audit, overpayment recovery, or eligibility prediction technology that flags churn risk
  • Prior auth and documentation workflow tools to manage compliance documentation

Huge thanks to everyone who showed up for the conversation. Thanks again Gary for bringing clarity, candor, and insight to the conversation!