25M+ people already disenrolled in the 2023–2025 unwinding and $900B–$1T in federal Medicaid cuts phasing in through 2034 — with work requirements landing by 12/31/26 and renewals moving to every six months. What breaks first when both clocks hit at once, and the margin math behind acting inside the window instead of after the P&L shows it.

Medicaid-heavy programs are squeezed from both sides — fewer covered patients and thinner reimbursement per episode. Where the margin actually lives across labs, pharmacy, staffing, and vendor spend, and why short stays with weak step-down pathways erode it fastest.

Readmission risk for SUD patients runs 18–26% across the literature, with one analysis showing 24% higher 30-day unplanned readmission risk. Every repeat episode re-absorbs intake, utilization review, authorizations, and bed turnover — high-turnover models look busy on paper while quietly taxing staff and margin.

A one-page market snapshot on Ohio's Medicaid exposure: ~3M covered lives, $39B in SFY2024 spend at 69% federal share, and why 40% of expansion enrollees carrying a behavioral health diagnosis puts SUD operators first in line for a payer-mix shock.

A snapshot of how we partner with behavioral health and healthcare operators: services, engagement models, and where we plug in to move the needle fastest.

How Mad Sherpa applies AI to outreach, intake, and growth — practical use cases, guardrails, and the wins we've seen putting these tools in front of real teams.

A field-tested playbook covering outreach, admissions flow, staffing economics, and the data discipline that keeps outpatient programs viable through consolidation.