[00:00:00] Monique Lappas: Good morning, or good afternoon, everyone. Thank you for joining us today for our webinar on surviving the 2026 coverage cliff: Automating financial assistance in a high self-pay environment. Before we jump in, here’s the reality: government payers are stepping back for the first time in decades, which means your self-pay volume is about to go up. For patients who manage to maintain commercial insurance, premiums and deductibles are skyrocketing. If your strategy is to ask existing advocates to just work harder, you’re in trouble; it is impossible for them to manually screen an increase of 5% to 20% against tens of thousands of fragmented options. To survive this cliff, you must maximize philanthropic benefits without burning out staff.

[00:01:35] Monique Lappas: Somewhere between 12 and 15 million people are expected to lose Medicaid or marketplace coverage due to the end of subsidies and BBB cuts. Those staying on the Marketplace will likely see out-of-pocket expenses jump by over $6,000. We are here to introduce thousands of charitable assistance programs available to your patients right now with zero extra time needed from your patient access teams. My name is Monique Lappas, founder and CEO of Qualify Health, and I’m going to show you an exact system that recovers millions per month for hospitals without adding burden to existing teams. We will cover the math that broke, the Qualify Health alternative, a live demo, and a 48-hour action plan to build your war chest.

[00:03:22] Monique Lappas: The coverage cliff is here, and hospitals are under siege. We forecast 4.8 million people becoming uninsured due to the loss of ACA subsidies and premium increases. At a safety net hospital in Georgia yesterday, they were anticipating a 20% reduction in marketplace coverage and seeing remits pended due to premium grace periods. These are patients coming in for $20,000 ED visits thinking they are covered, but if they can’t pay their premiums, you won’t get paid. This leads to a $7.7 billion forecast in uncompensated care and shrinking operating margins. Furthermore, the loss of Medicaid auto-enrollment has caused some hospitals to lose their DISH and 340B status exactly when they need it most.

[00:06:05] Monique Lappas: Each state faces different pressures. Many are investing heavily in technology to manage the administrative burden of Medicaid. Florida, with the largest ACA enrollment, expects a massive self-pay burden from patients rolling off plans they can no longer afford. While a “50% drop” headline is specific to those no longer eligible for expanded subsidies, this will still hit hospital bottom lines dramatically. Non-expansion states will likely be hardest hit due to the larger gap between Marketplace and Medicaid eligibility. Meanwhile, expansion states like Louisiana will see a lower-income population struggle with new enrollment requirements.

[00:08:30] Monique Lappas: Let’s jump into the demo to show why speed matters. Manual checking is slow and requires time, budget, and FTEs you don’t have; our solution doesn’t require any of that. On the dashboard, we screen every patient automatically against thousands of funding sources. Our system ranks opportunities by probability and payout, pre-fills applications, and provides a dedicated team to manage the cycle from application to payment posting. You only pay when money hits the hospital’s bank account. In one live case, we recovered $1.2 million in the first 90 days, largely using Foundation grants to cover deductibles for Medicare Advantage patients.

[00:10:22] Monique Lappas: We have access to over 1,300 diagnosis-specific foundations and 1,500 copay and rebate programs. These are critical for high-cost drugs in areas like GI, cancer, and neurology so hospitals don’t have to eat those costs. Speed is the differentiator; some foundations are open for only minutes. By the time a manual team checks a website, the opportunity is closed. Our system monitors everything in real-time, alerts us the second a fund reopens, and enrolls waitlisted patients in priority order. Your staff is already overloaded and can’t be glued to the screen; our system never misses it.

[00:12:43] Monique Lappas: In the work queue, patients are automatically identified for help, such as Sarah Miller, a breast cancer patient eligible for copay assistance. After capturing electronic consent to avoid chasing paper forms, our team works directly within your EMR environment. Everything is documented in Epic, Meditech, or Cerner so your billing and clinical staff have information at their fingertips without checking outside software. We handle the heavy-duty admin lift, follow up on pending determinations, and chase payments weekly until they arrive.

[00:21:12] Monique Lappas: Our IT lift is minimal and there are no upfront fees. Using our opportunity calculator, a 350-bed hospital in a non-expansion state like Mississippi could see $365,000 in additional revenue by targeting their self-pay population. In an expansion state like Maryland, the revenue might hit $407,000 by focusing on insured patients with high out-of-pockets. Your next steps are to use our calculator, determine the “war chest” you need based on lost Medicaid reimbursement, and talk to your CFO about a zero-risk solution that replaces revenue through automated philanthropic matching.

[00:25:10] Monique Lappas: To recap: 14 million people are losing insurance, and your team likely can’t handle the spike. Qualify Health provides automated screening, manages the full cycle to payment, and requires no upfront fees. During Q&A, we noted that the fastest we’ve been up and running is about 7 weeks. We work closely with patient services and are EMR agnostic, working with Epic, Meditech, Cerner, and others. Whether in an expansion or non-expansion state, we help cover the 60-70% of bad debt that often comes from patients who can’t pay co-pays. Thank you for joining us; we will send the slides and you can reach us at info@qualify.health.