Industry Voices—Why health system CFOs can't budget their way out of coverage disruption

October 9, 2026 - 18:44

When insurance coverage ends, revenue that was fully collectible the day before can drop to cents on the dollar overnight. This harsh reality is forcing health system finance leaders to rethink their planning strategies as they confront a wave of coverage disruptions that no spreadsheet can fully absorb.

Semi-annual redeterminations and new work requirements are set to test payer-mix assumptions across the industry over the next two years. These policy shifts mean millions of patients could lose Medicaid coverage or see their eligibility change unexpectedly. For hospitals and health systems, the financial ripple effects will be significant and difficult to predict.

Matthew Ennen, a senior vice president at Ensemble, argues that now is the time for health systems to prepare. Traditional budgeting methods assume a stable payer mix, but that assumption no longer holds. CFOs must build flexible financial models that account for rapid shifts in coverage status and the resulting changes in reimbursement rates.

The challenge goes beyond simple math. Health systems need to strengthen patient access teams, improve eligibility screening processes, and develop strategies to help patients transition between coverage options. Without these steps, uncompensated care costs could rise sharply, squeezing already tight operating margins.

Ennen suggests that organizations should stress-test their revenue cycles against various coverage scenarios. They should also invest in technology that tracks eligibility changes in real time. The coming years will reward those who plan for uncertainty rather than those who rely on static budgets.