5 Questions Every Medicaid Provider Should Ask Before 2026 Begins

A year-end checklist for staying compliant, solvent, and prepared.

As 2025 winds down, Medicaid-based agencies face more pressure than ever to operate efficiently, retain staff, and stay compliant—despite shrinking margins and mounting complexity.

Whether you serve children, adults with IDD, or a mix of Medicaid-funded populations, the challenges heading into 2026 are real. But so are the opportunities.

Before the ball drops on New Year’s Eve, take a moment to ask yourself—and your leadership team—these five critical questions. Your answers could shape everything from revenue to retention in the year ahead.

1. Are We Leaving Money on the Table?

Unsubmitted claims. Stalled authorizations. Denials we didn’t appeal.

Every Medicaid agency experiences billing leaks—but few track them well. Year-end is the perfect time to audit your revenue cycle and ask:

• Do we have rejected claims that haven’t been followed up?

• Are we billing in real time—or falling behind?

• Are all authorized visits fully documented and verified for billing?

• Is our billing platform integrated with our care delivery tools?

Fix it for 2026: Automate claim generation and track denials by payer. Your software should alert you before visits become unbillable.

2. Where Are Our Compliance Risks Hiding?

Audits are becoming more targeted, and compliance requirements aren’t slowing down. Documentation gaps, expired credentials, or missing EVV data can put your agency at risk.

Ask your team:

• Are all care plans current and properly signed?

• Can we retrieve the 6-point EVV data for every visit in seconds?

• Do we have a process for tracking expiring authorizations and licenses?

Fix it for 2026: Ensure your platform stores and links all service, schedule, and compliance data in one place—with alerts and logs to prove it.

3. Is Our Staff Burned Out or Set Up to Stay?

Retention isn’t just about wages—it’s about support, scheduling, and tools that make the job manageable.

Ask yourself:

• Do our field staff have mobile-friendly tools they actually like using?

• Are schedules predictable and aligned with availability?

• Are we listening to caregiver feedback on what’s working—and what’s not?

Fix it for 2026: Balance your schedules, simplify your tech, and treat your staff like the asset they are. Happy teams lead to better care—and stronger margins.

4. Are We Still Working Around Our Software?

You may have adopted a platform years ago that’s no longer evolving with you—or worse, slowing you down.

Consider:

• Are we juggling multiple systems just to get basic tasks done?

• Can we manage multiple payers and programs without manual workarounds?

• Does our software help us stay ahead of state-specific Medicaid rules?

Fix it for 2026: If your tech isn’t solving problems, it’s creating them. Look for a partner—not just a product—that’s built for Medicaid’s future.

5. Do We Have the Visibility to Lead—Not Just React?

Running a Medicaid agency in 2026 requires real-time insight into operations, finances, and care delivery. If you’re relying on guesswork or fragmented reports, you’re flying blind.

Ask:

• Can we easily see trends in authorizations, billing, staffing, and care delivery?

• Do we know what’s working—and where we’re losing time or money?

• Are our dashboards built for Medicaid, not just general healthcare?

Fix it for 2026: Invest in reporting tools that give you visibility across clients, programs, payers, and teams—in one platform.

Make 2026 the Year You Lead with Clarity

You don’t have to predict every Medicaid change to be prepared for it. But you do need the tools, systems, and strategy to respond with speed and confidence.

At Statewise, we help agencies simplify operations, reduce risk, and scale care—so you can focus on delivering what matters most.