Medicaid Work Requirements
Helping Medicaid members navigate work requirements and prevent coverage loss
Try it: Call our demo and roleplay a Medicaid patient navigating the new rules.
Call (520) 468-0635The Challenge
With the upcoming implementation of the new Medicaid work requirements in the One Big Beautiful Bill Act (OBBBA), more than 5 million people are projected to lose coverage nationally due to administrative hurdles like complex paperwork and reporting periods. This will put serious financial strain on hospitals and MCOs and cause hardship for families. The timeline is tight: state outreach begins in summer 2026.
The Scale Problem
Proactive outreach to every at-risk member requires a level of scale and budget that human staffing can't deliver. If each case manager can maintain a caseload of a few dozen members, an organization with a significant Medicaid population would need hundreds or even thousands of case managers to prevent mass churn. The math doesn't add up.
The Solution
The Virtual Case Manager (VCM) is an AI-powered assistant designed to help Medicaid members navigate the work requirements and prevent them from losing coverage. It acts as a dedicated case manager for every member simultaneously, providing unlimited, proactive support to ensure they stay on track and fully informed. It's the first point of contact for every member, escalating to human case managers only when situations require it, so your staff can focus on the cases that need a human touch.
How It Works
The VCM communicates through natural-sounding phone calls and SMS text messages, so there are no new apps to download or portals to learn. It proactively reminds members of approaching deadlines, helps them determine exemption status, helps connect members with eligible job training or educational programs, and clearly explains the rules. The system integrates with existing health records, so the VCM already knows any relevant information in the system when it reaches out. A simple dashboard lets providers see which members are compliant, need action, or are at risk, complete with a full audit trail for every interaction.
Secure & Compliant
The VCM uses state-of-the-art AI models from Google and Anthropic, all operating within a secure, HIPAA-compliant cloud environment.
In The News
Partner With Us
We're working with MCOs, hospitals, and other health systems to deploy the VCM ahead of the work requirement implementation.
States must begin member outreach as early as July 2026, with full enforcement starting January 1, 2027.
Let's discuss how we can help your organization retain members and reduce churn.