Medicaid covers more than 70 million people, and last year it went through the largest change to its financing in its history. The 2025 reconciliation law cut an estimated $911 billion in federal Medicaid spending over ten years, added work requirements, shortened eligibility checks to every six months, and limited how states can raise money through provider taxes. For most of last year those were words on a page. Now the deadlines are real, and many of the biggest changes begin January 1, 2027.

Lisa Bari’s guest is Verlon Johnson, EVP and Chief Government and Corporate Affairs Officer at Acentra Health. Verlon also chairs MACPAC, the commission that advises Congress on Medicaid, and spent decades at CMS. She has seen the program from the federal side, the state side, and the technology side. Together they get past the politics to the harder question of implementation: what it actually takes for states to redefine business rules, retrain eligibility workers, stand up appeals processes, and modernize eligibility systems before the clock runs out. Verlon’s throughline is one every operator will recognize: good policy deserves good implementation, and data alone doesn’t improve health, better decisions do. It’s a clear-eyed look at whether the program can hold, and what it will take to make sure the people who depend on it don’t fall through the cracks.