Medicaid’s Breaking Point: How Health Plans Are Bracing for a Storm of Reform, Redeterminations, and Risk

As Medicaid faces sweeping changes under HR1, much of the national focus has centered on coverage loss and churn. But Enrique Balaguer, Chief Growth Officer at MedZed, says that’s only part of the story—and not the most urgent one.

In the recent Healthcare Business Today article, Balaguer points to deeper systemic threats emerging beneath the surface: collapsing quality metrics, administrative overload, provider exits, and a growing erosion of trust between members, providers, and health plans.

“This isn’t just about losing members,” Balaguer says. “It’s about losing stability, continuity, and the financial backbone of Medicaid managed care.”

According to Balaguer, the so-called “quality-metrics math problem” is putting plans in an impossible position—penalized for outcomes they can’t realistically achieve when nearly 40 percent of members are disengaged from care. Add to that the shift to six-month eligibility redeterminations, which he calls “a churn crisis in motion,” and the entire system faces cascading consequences.

Despite these challenges, Balaguer sees hope in innovation. MedZed’s model—rooted in trust-building and human connection—is showing health plans how to re-engage hard-to-reach members, stabilize care delivery, and strengthen communities. “Without trust,” he says, “even the best system fails.”

As policymakers and plans brace for HR1’s full impact, Balaguer’s message is clear: the time to rethink Medicaid’s foundation is now. The solutions won’t come from policy alone, but from partnerships that understand the realities on the ground—and act accordingly.

Read the full article on Healthcare Business Today to explore Enrique Balaguer’s insights and MedZed’s forward-thinking approach to Medicaid reform:👉 https://www.healthcarebusinesstoday.com/medicaid-reform-challenges-hr1/

To learn more about how MedZed partners with health plans to reach and retain high-risk members, contact us at Contact | MyMedZed