H.R. 1 changes the redetermination clock for the expansion population.
Redetermination cycles for the expansion population beginning 2027 under H.R. 1 (P.L. 119-21)
Work requirements; RAND projects roughly 10% of compliant patients still lose coverage to paperwork
Is what every churned patient converts to mid-treatment; teams discover the loss when claims deny
Nightly pipeline plus real-time eligibility checks, feeding exception-only work queues.
Built to run on Epic Agent Factory. Your clinicians and staff decide; the agent assembles and drafts. Epic only for now.
Every coverage span
Every Medicaid patient's coverage span and predicted redetermination date via nightly pipeline plus real-time 270/271 checks.
Churn risk per patient
From coverage history and contact-data quality, validated locally with subgroup bias analysis.
Ex parte evidence packets
Renewal evidence and pre-filled state documentation; the CMS and USDS pattern lifted ex parte renewals 28 points.
Approved outreach
Text, portal, IVR, and mail in the patient's language, with escalation to financial counselors.
Work-requirement gaps
Documentation gaps ahead of effective dates, routed to compliance support.
Ranked work queues
Prioritized, exception-only queues, so eligibility staff work a ranked list instead of a full census.
Humans stay in the loop.
Draft-and-approve on all patient-facing actions; autonomous only for data assembly and prioritization.
Local validation on your data
Human-in-the-loop on every patient-facing action
BAA-covered models with zero-retention inference
Source-linked output with no inferred values
Traceable agent actions
Phase-gated delivery, with a go/no-go at every gate.
Discovery & design
Stakeholder interviews, data profiling, governance intake, and baseline lock.
Data foundation
Pipelines, feeds, and models built on your data; templates signed by your clinical and operational owners.
Build
Agents, workflows, and dashboards; the gate requires QA accuracy on historical cases.
Pilot
Parallel run beside the current process with 100% human review and weekly scorecards.
Scale & handoff
Runbooks, executive ROI readout, 60-day hypercare, optional managed operations.
Start with a coverage exposure briefing.
Your Medicaid census against the 2027 redetermination calendar, in about ten business days.
Sources: H.R. 1, P.L. 119-21 (2025); RAND Corporation analysis of Medicaid work-requirement compliance; CMS and U.S. Digital Service ex parte renewal reporting. Epic, MyChart, Agent Factory, Art, Emmie, and Penny are trademarks of Epic Systems Corporation. MEDITECH and Expanse are trademarks of Medical Information Technology, Inc.