Free Tool: Health Care Provider Medicaid Toolkit
- Hollis Brennan
- Jul 8
- 4 min read
Navigating Medicaid Changes for Clients with a Brain Injury
Purpose of This Health Care Provider Medicaid Toolkit
This toolkit equips providers to:
Support clients impacted by Medicaid policy changes (e.g. “Big Beautiful Bill”)
Prevent insurance lapses
Advocate for medical necessity
Connect clients to appropriate legal, clinical, and system-level supports
Medicaid changes are coming. Are you ready to support your clients?
STEP 1: Notify Clients of Major Medicaid Changes
Who Should Be Notified?
Clients with Medicaid or CHIP
Clients who rely on case management, waiver services, or long-term rehab
Anyone at risk for missed paperwork due to cognitive, linguistic, or access barriers
How to Notify:
Add alerts in appointment reminders and check-in scripts
Short example for reminder texts: “Reminder: Medicaid has new requirements. If you’ve gotten a letter or lost coverage, tell your provider at check-in. We can help.”
Longer example for reminder emails: "Hi [Client Name], You are scheduled for an appointment on [Date/Time] at [Clinic Name].
IMPORTANT: Medicaid coverage is changing. You may receive letters asking you to prove income, work hours, or health needs.
If you’ve lost coverage or aren’t sure what to do, talk to your provider or ask at check-in, we can help you stay connected to care. Questions? Call us at [Phone Number]."
At check in: “We’re checking in to see if you’ve had any problems with your Medicaid coverage. Have you gotten any letters, or have you been asked to fill anything out lately?”
If yes:
“Let’s let your provider know so we can help. You may also want to speak with our social worker or resource staff today.”
Add to your intake paperwork: Have you received any letters from Medicaid asking for documentation (like work hours, income, or disability status)? ☐ Yes ☐ No ☐ I’m not sure
If yes, please ask our front desk or your provider for support. We want to make sure your coverage continues.
Include a brief insert in discharge paperwork and client newsletters
Example language:
“NOTICE: Important Changes to Medicaid Coverage
Medicaid rules are changing for many people. If you are on Medicaid and had a recent hospital stay, illness, or injury, you may be asked to:
Prove your income or work hours
Reapply more often
Provide updated medical paperwork
These changes may affect your ability to keep seeing doctors or therapists. If you get a letter from Medicaid or are confused by anything you receive, don’t wait, bring it to your next appointment or call us.
You may qualify for help under the Americans with Disabilities Act (ADA).
Need help? Ask for our case manager, social worker, or resource staff.
[Clinic Phone Number] [Clinic Website]”
Offer a handout summarizing the new requirements (e.g., work hours, documentation deadlines, etc.). Feel free to use ours and edit it for your clinic: Simplified Word Version
STEP 2: Create a Clinic-Wide Plan for Insurance Lapses
Key Elements to Include:
A “coverage status” question during every check-in
A system for flagging at-risk clients in your EHR
Pre-prepared resource sheets for:
Local FQHCs and sliding scale clinics
Suggested Language for Staff:
“There have been recent changes to Medicaid rules. If you’ve had any problems with your coverage or notices from Medicaid, please let us know. We may be able to help or refer you to someone who can.”
STEP 3: Assist Clients in Preventing Lapses
Ways Providers Can Help:
Verify contact info for Medicaid at every visit
Offer help reading Medicaid mail or portal messages
Refer to a case manager or Medicaid navigator if available
Assist in ADA accommodation requests for clients with cognitive barriers
Sample ADA Statement for Client Use:
“I have a brain injury that affects memory and comprehension. I am requesting reasonable accommodation under the ADA to receive help completing required Medicaid forms and to receive extended time.”
STEP 4: Support Appeals and Reinstatement
When Coverage Is Cut:
Help client request an appeal within 10–30 days
Provide a letter of support with diagnosis and functional limitations
Reinforce the client’s need for “aid-paid-pending” during the appeal
Sample Medical Necessity Letter:
RE: Medical Necessity of Continued Medicaid Coverage for [Client Name]
To Whom It May Concern:
I am writing on behalf of [Client Name], a patient in my care who sustained a [type] brain injury on [date]. They currently require ongoing rehabilitation, medical management, therapeutic intervention, and functional/adaptive support. Their condition affects memory, mobility, executive functioning, and communication.
Discontinuing coverage would place them at risk of medical decline, loss of function, and potential re-hospitalization. I strongly recommend continued coverage and support under Medicaid, as well as consideration for the Brain Injury Waiver program.
Please contact my office for additional documentation.
Sincerely, [Provider Name, Credentials, NPI, Clinic Name]
STEP 5: Refer Clients to the Brain Injury Waiver
Who May Qualify:
Individuals with a documented acquired or traumatic brain injury
Clients requiring long-term support for ADLs, supervision, or care coordination
Individuals at risk of institutionalization without waiver services
Application Help:
Partner with local Centers for Independent Living or brain injury resource navigators
Use hospital social work, case management, or outpatient care coordinators
Resources:
STEP 6: Where Providers Can Get Help
Medicaid Policy & Case Questions:
Your clinic’s billing or eligibility team
Local Medicaid office (ask for a provider liaison)
For Uninsured/Lapsed Coverage Clients:
Final Reminders for Providers
Review Medicaid status at every visit
Provide consistent documentation of medical need
Keep letter templates ready
Be proactive with referrals and coverage follow-up
Empower clients and caregivers with written tools and contacts
Download this Health Care Provider Medicaid Toolkit
Download the Brain Injury Survivor’s Medicaid Toolkit
Download the editable, simplified notification of Medicaid changes for your clients
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