OBBB—What Changes Mean for Clinic Payments in 2026

Andres Jimenez
Oct 5
2 min read

“Documented care is paid care. In 2026, the winners are clinics that convert prevention into proof within days—not months—so patients get timely care and clinics get credit.” Dr. Andres Jimenez, Double-Board-Certified in Public Health and Prevention and Clinical Informatics, Founder of HealthPrevent360

Independent, Medicaid/Medicare-heavy clinics in NYC are heading into a tougher payment environment. The “One Big Beautiful Bill Act of 2025 (OBBBA)” is now law and, per the AMA, it was “signed into law (Public Law 119-21) on July 4, 2025” and includes “significant funding cuts and policy changes” affecting Medicaid, Marketplaces, and Medicare physician payment—“all of which will worsen patient access to care.” American Medical Association

What’s most relevant for care-management leaders?

1) Quality dollars face closer scrutiny. Plans are more likely to require clean, timely, auditable proof before releasing bonuses and withholds. Move documentation upstream (at ingestion), not after the fact.

2) More administrative friction in public coverage. OBBB introduces new Medicaid administrative and eligibility conditions, which can drive mid-year churn. The AMA notes “new administrative requirements and conditions on eligibility (including work requirements).” American Medical Association

3) Prevention + evidence = survival math. In a budget-tight world, prevention documented quickly is more valuable than prevention documented late.

What leaders should do now

Define acceptable evidence per measure (e.g., CRC, BCS, CCS, A1c, BP).
Use national exchange rails to retrieve outside results without phone-tag.
Publish weekly exceptions and a Friday scorecard to surface issues early.
Pair AI parsing with MD validation to ensure payer-safe packets.

Source callouts to share with your team

AMA’s overview summarizes the law and flags key Medicaid/Marketplace/Medicare changes and timelines. American Medical Association

How HP360 can help

HP360 standardizes measure rules, ingests outside results (CommonWell/Carequality/TEFCA), and produces MD-validated evidence packets—reducing rework and protecting value-based dollars.

Schedule a quick consult to see the evidence workflow in action.