The Medicaid Readiness Scorecard: When to Add Medicaid Without Breaking Payroll

Many founders treat Medicaid enrollment like an inevitable checkbox — then discover 60–120 day payment delays, provider enrollment backlogs, and state-specific rules that create weeks of unpaid payroll. This episode delivers a practical, repeatable 'Medicaid Readiness Scorecard' built from Scott McKenzie’s work across HCAB’s 531+ licensed agency launches. Daniel, Claire, and Sophia walk through the exact inputs you must score (cash runway in dollars, expected Medicaid lag in days, intake staffing capacity, and audit-readiness), show how a 90-day versus 180-day enrollment timeline changes your hiring and pricing, and use a real HCAB client in Texas to illustrate the math. You’ll leave with a one-page decision rule, a clear dollar threshold (example: $7,500–$25,000 runway bands depending on state lag), and the operational checklist to add Medicaid without risking your first payroll.