Medicaid's Tech Tightrope: Can AI Tame a Thorny New Work Mandate?

MIAMI, FL – December 15, 2025 – State governments across the nation are in a high-stakes race against the clock. The passage of H.R. 1, the sweeping legislation signed into law this past July, has handed Medicaid agencies a monumental task: implement and verify community engagement, or work requirements, for millions of able-bodied adult recipients. With a deadline of January 2027 looming, states must overhaul their processes to track, verify, and report at least 80 hours of monthly work, education, or community service for a vast portion of their Medicaid population. The challenge is not merely technical; it’s a logistical and human services labyrinth, fraught with the risk of administrative chaos and the potential for millions to lose essential healthcare coverage.

This is the complex, pressure-filled environment into which Miami-based Healthy Together has just launched its Community Engagement Verification System as a Service (CEV SaaS). The new platform is engineered to be a direct answer to the H.R. 1 mandate, promising to untangle the knot of verification for beleaguered state agencies.

A Digital Answer to a Policy Mandate

Healthy Together, a firm specializing in technology for government programs, is positioning its new system as a ready-made solution for a problem many states are just beginning to grapple with. The CEV SaaS is designed to operate as a nimble, intelligent layer that integrates with states' existing, often decades-old, Eligibility & Enrollment (E&E) systems. This API-driven approach is critical, as it promises to deliver modern functionality without the time, cost, and disruption of a full-scale system replacement.

Built on the company's proprietary Polycore platform, the system automates the verification of employment, education, and volunteer hours. It leverages AI-assisted reviews to flag complex cases for human attention, aiming to reduce backlogs and the potential for manual error. For Medicaid recipients, the system offers a mobile-first portal for reporting hours and submitting documentation, coupled with automated reminders and alerts designed to keep them on track.

"With evolving policy requirements, states need solutions that deploy quickly, scale reliably, and deliver measurable outcomes at speed," said Jared Allgood, Chief Executive Officer of Healthy Together, in the company's announcement. The platform's goal, as he framed it, is to give agencies "the real-time tools they need to monitor compliance, make data-driven decisions, and deliver faster, more reliable outcomes."

The Promise of Modernization

The launch is not happening in a vacuum. It represents a significant move in the broader GovTech trend, where private technology firms are increasingly stepping in to modernize essential public sector functions. Healthy Together's strategy aligns perfectly with the Centers for Medicare & Medicaid Services (CMS) vision for the future of state IT. Through its Advance Planning Document (APD) guidance, CMS has been pushing states to adopt a modular, interoperable Medicaid Enterprise System (MES) framework.

This framework encourages states to move away from monolithic, inflexible legacy systems toward a collection of specialized, interconnected components. By offering a solution that plugs into existing infrastructure, Healthy Together is providing a pathway for states to modernize a critical function while preserving their prior investments. This modularity is a key selling point, as it makes the prospect of achieving H.R. 1 compliance seem far more manageable and financially viable. States that adopt such CMS-compliant solutions can often qualify for enhanced federal funding, with the federal government covering up to 90% of development and implementation costs. The recent approval of over $25 million for Colorado to build out its own work requirement system underscores the significant federal investment available and the urgency states are feeling.

The Human Equation: Efficiency vs. Access

Beyond the technical architecture and administrative efficiencies lies the profound human impact of this new policy landscape. For a Medicaid recipient with stable internet access and a predictable work schedule, a mobile app for reporting hours could be a welcome simplification. Proactive text reminders might prevent a missed deadline and a catastrophic loss of coverage. This is the best-case scenario that technology like the CEV SaaS aims to deliver.

However, the history of Medicaid work requirements is shadowed by a much darker potential outcome. When Arkansas implemented a similar policy, over 18,000 people—nearly a quarter of those subject to the rule—lost their coverage. Subsequent analysis revealed that the vast majority of these losses were not due to a failure to work, but to a failure to navigate the complex reporting system. People were confused, lacked reliable internet, or were simply unaware of the new rules.

Advocacy groups and policy experts warn that even the most user-friendly technology cannot eliminate the “red tape” burden entirely. The Congressional Budget Office has projected that H.R. 1 could cause millions nationwide to become uninsured. The risk is that an automated system, no matter how intelligent, could become a digital gatekeeper that inadvertently locks out the most vulnerable—those with unstable housing, limited digital literacy, complex caregiving responsibilities, or fluctuating gig economy work that defies simple verification. The challenge for states and their technology partners will be to ensure the system accounts for the complex realities of people's lives.

The High-Stakes Verification Game

The core of the H.R. 1 mandate is verification, and this is where the new wave of technology will be most rigorously tested. Automating the validation of payroll data or educational enrollment can dramatically reduce the workload for state employees and increase accuracy. AI can help prioritize cases, theoretically allowing human reviewers to focus on the nuanced situations that require judgment, such as determining valid exemptions for health conditions or caregiving.

But the stakes are immense. An error in an algorithm or a failure in a data exchange is not a mere bug; it could mean a parent losing access to life-saving medication or a child losing coverage due to a parent's administrative misstep. The promise of efficiency must be constantly weighed against the risk of procedural denials that punish eligible individuals for their inability to navigate the bureaucracy.

As states race to comply with the 2027 deadline, they will be evaluating solutions like the one offered by Healthy Together not just on their technical prowess, but on their ability to implement a deeply controversial policy with fairness and precision. The deployment of these sophisticated digital tools represents a pivotal test, one that will ultimately determine whether technology serves as a facilitator of policy or an inadvertent, and unforgiving, gatekeeper to essential human services.