Medicaid Work Requirements
Helping Medicaid members navigate work requirements and prevent coverage loss
Try it: Call our demo and role-play a fictional persona navigating the new rules.
Call (520) 809-9518The 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 in English and Spanish, 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 VCM remembers each member's situation across every interaction, just like a human case manager would. The system is available 24/7; inbound callers won't wait on hold. It 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. See feature list below.
Partner With Us
We're working with MCOs, hospitals, and other health systems to deploy the VCM ahead of the work requirement implementation.
State outreach is underway, and the requirements take effect by January 1, 2027.
Let's discuss how we can help your organization retain members and reduce churn.
In The News
Read the Briefing
The Medicaid Cliff and the Virtual Case Manager
PDF · Sky Island AI
Conference Speaking Engagements
The Medicaid Cliff: Preparing for the 2027 Work Requirements
Featured at the Medicaid Managed Care Conference in San Diego (May 2026) and the Arizona Rural Health Conference in Flagstaff (June 2026).
View slides and sourcesThe Medicaid Cliff
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. Critically, the OBBBA bars people disenrolled under work requirements from receiving Marketplace premium tax credits, so there is no fallback: patients who lose Medicaid will become uninsured, and history shows most will not come back. The timeline is tight: state outreach is underway, and the requirements take effect by January 1, 2027. View our briefing or conference presentations for the full picture.
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 VCM solves this: it reaches every at-risk member at once, and your case managers handle only the cases that need a person.
Features
Natural Communication
- Human-sounding two-way phone calls
- Two-way SMS texting conversations
- Fluent in English and Spanish
- 24/7 availability with no hold times for inbound callers
- Persistent memory across every interaction
Proactive Outreach
- Proactive reminders as reporting deadlines approach
- Scheduled callbacks and follow-ups
- Texts members the links and resources they need
Case Management
- Helps members determine exemption eligibility
- Connects members with eligible job training and education programs
- Automatic escalation of complex cases to human staff
Operations
- Real-time provider dashboard with member compliance status
- Complete audit trail of every interaction
- Works with your existing health records
- Built for HIPAA compliance within a secure cloud environment