ACA Lawsuit, Medicaid Tensions, and the Road Ahead for Rural Hospitals
- mdavis107
- 18 hours ago
- 5 min read
As healthcare regulations shift, one constant remains: wound care programs need clarity, stability, and support — not more uncertainty. That’s why a new legal challenge to recent Affordable Care Act (ACA) rule changes is making headlines, especially for hospitals serving rural or medically complex populations.
What’s Happening?
On July 17, a coalition of 21 states filed a lawsuit in federal court challenging a new final rule from the Centers for Medicare & Medicaid Services (CMS). The rule — scheduled to take effect August 25 — includes several major changes to ACA marketplace enrollment and eligibility¹². Among the most notable:
Stricter verification requirements for insurance eligibility
Shortened open enrollment periods
Removal of gender-affirming care as an essential health benefit
According to CMS estimates, the rule could result in up to 1.8 million people losing health coverage — an outcome the plaintiffs argue would raise costs for states, strain Medicaid programs, and reduce access to essential care³.
Why It Matters — and What You Can Do About It
Whether or not this lawsuit succeeds, it highlights a critical reality: regulatory changes can directly impact access, reimbursement, and continuity of care. For wound care teams — especially those treating chronic or hard-to-heal wounds — insurance status often determines whether patients can receive timely, consistent treatment.
At SHS, we’re already thinking through what these changes might mean:
Increased administrative burden during eligibility verification
Potential drop in visit volumes if coverage lapses for complex patients
More pressure on hospitals to absorb uncompensated or emergency wound care
But here’s the good news: you don’t have to wait for the fallout.
At SHS, we’re not just a compliance or operational partner — we help hospitals become strategic extensions of their own mission to reach, engage, and retain the right patients before they fall through the cracks. The 1.8 million projected to lose coverage? That’s not just a number — it’s a missed opportunity unless someone helps catch them early.
How SHS Helps Wound Care Programs Reach At-Risk Patients
These patients aren’t unreachable. They’re just unsupported. SHS helps wound care programs implement smart systems that connect the dots before people drop out of eligibility or miss their window.
SHS Tools That Make a Difference:
Referral Pipeline Optimization
Many at-risk patients are already in the hospital’s orbit — they’ve been seen in the ED, primary care, or post-acute settings. SHS helps your team identify these missed opportunities and build a referral strategy that keeps eligible patients from slipping through the cracks.
Eligibility Support + RADDs Tools
SHS equips our partners with a site-specific RADD (Remote Access Domain Database) — a secure online portal that gives your wound care team easy access to SHS-built templates, referral guides, eligibility resources, and workflow tools. In other words, the tools to help your staff screen patients for coverage in real-time — before your patient population gets discouraged by paperwork or denied services they could have qualified for.
Community Outreach Strategy
From care managers and case workers to home health agencies and transitional care teams, SHS helps you build local partnerships that uncover at-risk patients before they disengage. It’s about knowing who’s out there — and connecting the dots early.
Education for Physicians and Frontline Teams
Eligibility isn’t always the issue — sometimes, it’s just a lack of awareness. SHS equips referring providers and frontline staff with clinic-ready resources like monographs, patient and physician guides, and case studies — fully branded with your hospital or practice logo. Through our WOUNDWISE Visual Communication Index, your team can access ready-to-use graphics, captions, and education materials that simplify complex topics and strengthen referrals. No design tools or marketing background needed — just clear, shareable insight grounded in wound care realities.
Medicaid Coverage: A Rising Point of Tension — or a Strategic Opportunity?
Some states are weighing cuts to Medicaid coverage for undocumented individuals⁴ — a move that’s sparked concern about rising uncompensated care and emergency visits. And while that could create pressure in some settings, it’s important to step back and look at the big picture.
The truth? You likely have more than enough eligible patients already living in your catchment area — citizens who qualify for coverage but haven’t yet made it into your wound care program⁵.
That’s not a patient volume problem. That’s a systems and processes problem — one that can be addressed with the right tools:
Better referral management
Smarter eligibility screening
Proactive physician engagement
Real-time data tracking
At SHS, we help our partners close these gaps — so they can reach more of the right patients, without relying on unpredictable policy shifts to drive growth.
One Potential Lifeline: $50 Billion in Rural Health Funding
Here’s where there’s some good news.
As part of the recently passed One Big Beautiful Bill (BBB), $50 billion has been earmarked for rural hospitals and rural health initiatives⁶. While details are still being finalized, this funding could provide much-needed relief — helping facilities shore up critical services, invest in infrastructure, and protect access for underserved populations.
For wound care programs, this may offer a path to:
Expand eligibility screening and referral processes
Sustain services for high-risk patients
Prepare for reimbursement changes tied to CMS rule shifts⁷
How SHS Helps Our Partners Stay Steady
We’re not here to take sides in legal disputes or political debates — we’re here to support the hospitals and providers doing the work.
If you’re wondering how these changes might affect your wound care or hyperbaric oxygen therapy (HBOT) program, SHS can help you:
Simplify workflows around enrollment and documentation
Prepare for new compliance requirements
Strengthen financial sustainability through proven billing and coding guidance
From eligibility challenges to funding opportunities, our role is to help you adapt with confidence — and keep delivering high-quality wound care in your community.
Final Thought
The road ahead isn’t without bumps. But with the right support, wound care programs can stay compliant, responsive, and ready for what’s next. If you need help thinking through the impact of these latest regulatory shifts, reach out to the SHS team today.
References
Centers for Medicare & Medicaid Services. HHS notice of benefit and payment parameters for 2025 final rule. https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2025-final-rule. Accessed July 21, 2025.
Centers for Medicare & Medicaid Services. 2025 marketplace integrity and affordability final rule. https://www.cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-final-rule. Accessed July 21, 2025.
Emerson J. 21 states sue CMS over new ACA restrictions. Becker’s Payer Issues. https://www.beckerspayer.com/legal/21-states-sue-cms-over-new-aca-restrictions/. Accessed July 21, 2025.
Medicaid and CHIP Payment and Access Commission. Eligibility. https://www.macpac.gov/topic/eligibility/. Accessed July 21, 2025.
Rural Health Information Hub. Healthcare access in rural communities. https://www.ruralhealthinfo.org/topics/healthcare-access. Accessed July 21, 2025.
Ortaliza J, McGough M, Cox C, Pestaina K, Rudowitz R, Burns A. How will the One Big Beautiful Bill Act affect the ACA, Medicaid, and the uninsured rate? KFF. https://www.kff.org/policy-watch/how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate/. Accessed July 21, 2025.
Centers for Medicare & Medicaid Services. CMS finalizes major rule to lower individual health insurance premiums for Americans. https://www.cms.gov/newsroom/press-releases/cms-finalizes-major-rule-lower-individual-health-insurance-premiums-americans. Accessed July 21, 2025.