RBMA shares concerns over major Medicaid cut impacts

"It is almost a tidal wave of change from the federal level that is going to begin impacting state legislatures across the country. I think folks should probably be aware of that,” he said.

State budget pressures will lead to loss of Medicaid coverage for many

Crancer said one of the biggest concerns is the scale of potential funding reductions. Because most states are required to maintain balanced budgets, the loss of federal funding may force legislatures to reduce Medicaid coverage, lower reimbursement rates for providers, or both. He said the likely result is increased financial pressure on healthcare providers or loss of coverage or access for Medicaid patients.

States will have to look at restricting the number of Medicaid patients, or cutting reimbursement payments. That policy direction will lead to an uptick in uninsured patients and many patients just foregoing treatment, medications and preventive care and screenings. This will inevitably lead to uncompensated care when patients show up in hospital emergency departments with a preventable, acute need for care, Crancer said.

The Congressional Budget Office estimates 11.8 million people will lose health insurance coverage due to the changes, with rural health systems bearing the brunt of the impact.

Rural healthcare transformation funding

Federal lawmakers attempted to offset some of the Medicaid reductions through the creation of a Rural Health Transformation Program designed to support rural healthcare infrastructure.

“Congress looked at offsetting some of those significant cuts to the states by implementing a rural transformation fund that states could apply for,” Crancer said.

However, he noted that the distribution of funds varied widely depending on state policies that matched interests of the Trump administration. Crancer said CMS awarded more funding to states that had expanded the scope of practice for nurse practitioners and other non-physician providers.

Change in Medicare payments

Crancer noted there also are reimbursement changes within the Centers for Medicare and Medicaid Services (CMS) physician fee schedule that are affecting hospital-based specialists. While there was a 2.5% increase in 2026 for the physician conversion factor, Crancer said CMS is decreasing reimbursement for hospital-based or facility-based physicians to enable increased reimbursements for non-hospital based or non-facility-based physicians.

“So, in other words, almost a phantom site-neutral provision from what we've seen,” he said.

Progress on lung and breast imaging coverage

Despite the broader concerns about Medicaid funding, Crancer highlighted some positive policy developments affecting medical imaging. One example is growing legislative support for eliminating out-of-pocket costs for follow-up breast imaging.

He said the Find It Early Act, which aims to close insurance coverage gaps for diagnostic breast imaging following a screening mammogram, is being introduced in several state legislatures. This bill would require insurance companies to cover the costs of the diagnostic imaging, rather than leaving patients with sometimes hefty medical bills. The bill was originally introduced in Congress in April 2025 and never progressed out of committee, so Crancer said states are now taking the lead.

“So a patient comes in and their screening mammogram is covered 100% under the Affordable Care Act,” Crancer said. “But if there's a finding, then she's called back for a diagnostic mammogram, those can run in excess of $1,200.”

This can serve as a cost barrier that prevents many patients from returning for additional imaging. He said the Komen Foundation's last estimate for a diagnostic breast imaging follow-up was that between 20 and 25% of women do not come back because of the extra cost.

More than 30 states have already passed laws addressing the issue, and similar coverage policies are now emerging for lung cancer screening follow-up imaging.

“So, [if] a patient comes in for a low dose lung screening and they detect a nodule, the patient is called back for a diagnostic,” Crancer said. “Those in states under state governed plans are now covered for those diagnostics as well.”

RBMA leaders say continued engagement by providers with state and federal policymakers will be critical as the healthcare system adapts to the coming policy changes.