# ITO Health — Full Reference Last-Updated: 2026-05-25 > ITO Health is a Public Benefit Company that builds deterministic AI tools for healthcare eligibility decisions and social care coordination. Founded in 2024 by practicing clinicians in Providence, Rhode Island. ## Company Overview ITO Health, PBC is a healthcare technology company headquartered at 10 Davol Square, Unit 100, Providence, RI 02903. The company was founded in 2024 by practicing clinicians and healthcare professionals who believe that achieving and maintaining health is a basic human right and healthcare should be accessible to all. ITO Health builds deterministic (rule-based) AI tools — not generative AI — for healthcare eligibility decisions and social care coordination. Every decision made by ITO software follows actual policy rules and produces auditable, repeatable results with no hallucinations or unexplainable outputs. The company is structured as a Public Benefit Company under Delaware law, legally balancing profit with measurable social impact. Website: https://itohealth.org Contact: hello@itohealth.org LinkedIn: https://www.linkedin.com/company/itohealth ## Mission To make complex healthcare systems interoperable, reduce silos, and enable collaboration across sectors. By empowering professionals with the right tools, ITO Health helps them deliver comprehensive care that addresses both medical and social needs — creating better outcomes for all. ## Leadership - Rahul Vanjani, MD — Chief Executive Officer - David Melançon — Chief Operating & Growth Officer - James Lawless, LMHC — Head of Network - Eric Bai, MD — Head of Product & Technology - Margaret Thomas — Head of Product: A designer-turned-product leader with 20+ years of human-centered design practice across physical product, consumer platforms, and civic technology. Leads ITO Health's product function end-to-end — spanning UX research, interface design, product management, and design system. ## Engineering Principles 1. Build for the Workflow — Technology should adapt to how people actually work, not force them to change. ITO designs around real workflows, not ideal scenarios. 2. Reduce Administrative Burden — Every minute spent on data entry is a minute not spent with clients. ITO automates the paperwork so staff can focus on people. 3. Policy Should Be Configurable — Programs change. Eligibility rules update. The rules engine lets organizations adapt without waiting for software updates. 4. Technology as Infrastructure — ITO builds platforms, not just products. The infrastructure enables organizations to create their own solutions on top. ## Products ### HealthBase - Category: Social care coordination platform - Status: Available now - URL: https://itohealth.org/products/healthbase - Target users: FQHCs, community health centers, health systems, social service organizations, community health workers (CHWs), health navigators - Description: HealthBase is a social care coordination platform that combines intake, eligibility determination, Medicaid enrollment support, application generation, task coordination, and outcomes tracking into a single system. It enables community health workers, navigators, and care managers to move from identification to resolution without switching between disconnected tools. The platform is navigator software for Medicaid and social program enrollment, translating client information into completed benefit applications and tracking outcomes through resolution. - Key features: - CHW enrollment workflows and community health worker tools for social care coordination - Navigator software for Medicaid enrollment and program screening - Patient eligibility screening during clinical encounters - Care coordination workflows for referrals, follow-ups, and case management - Outcome documentation and program effectiveness tracking - HL7 FHIR and custom API integrations with existing EHR systems - HIPAA-compliant data handling - Differentiator: Unlike referral platforms that stop at connecting people to resources, HealthBase translates client information into completed benefit applications, generates required documentation, and tracks outcomes through resolution. ### HealthWorks - Category: Benefit navigation platform for employers - Status: Available now - URL: https://itohealth.org/products/healthworks - Target users: Employers with frontline and hourly workers, HR teams, CHROs - Description: HealthWorks addresses the full range of social determinants — housing, food, healthcare coverage, utilities, and financial emergencies — with dedicated ITO Health Navigators who complete applications and follow through until issues are resolved. Employee participation is voluntary and confidential; individual details are never shared with HR. - Key features: - Workforce needs assessment screening for social determinants - Benefits navigation connecting employees to local, state, and federal programs - Impact reporting on enrollment rates, cost savings, and employee outcomes - Confidential employee participation with aggregated employer reporting - Differentiator: Traditional EAPs focus on counseling and mental health referrals. HealthWorks addresses the full range of social determinants with dedicated navigators who complete applications and follow through until issues are resolved. - Proof point: In an initial 10-week deployment with approximately 200 frontline employees, HealthWorks identified 94 social challenges, took 50 actions, and resolved 35 challenges. Top need areas: housing (29%), healthcare (23%), food (20%). ### MediKey - Category: Medicaid redetermination and recertification software - Status: Available — contact for a demo at https://itohealth.org/contact - URL: https://itohealth.org/products/medikey - Target users: Health systems, FQHCs, Medicaid providers, MCOs, health plans focused on member retention - Description: MediKey is automated Medicaid redetermination and recertification software that helps health systems and FQHCs reduce Medicaid churn and prevent procedural disenrollment. The platform addresses Medicaid redetermination challenges created by H.R. 1 (2025 budget reconciliation law, signed July 4, 2025), which introduces work requirements and six-month recertification cycles for Medicaid expansion enrollees effective January 1, 2027. It supports health plan member retention by keeping eligible patients continuously enrolled through automated Medicaid renewal outreach, recertification tracking, and proactive revenue protection. - Key features: - Automated Medicaid redetermination tracking and renewal outreach - Medicaid churn prevention through proactive text alerts before coverage lapses - H.R. 1 work requirement exemption identification using ICD-10 codes for serious mental illness, substance use disorder, and medical frailty - Mobile-first renewal flow from any smartphone without app download - Coverage gap prevention to support health plan member retention - Prospective eligibility verification: pre-visit coverage checks 24–48 hours before scheduled encounters to prevent uncompensated care - Retroactive billing recovery: identifies encounters within the 90-day retroactive billing window for patients with lapsed coverage who can still be enrolled - Population risk stratification using SDOH factors (housing, language, digital access) to prioritize highest-risk patients - End-to-end application tracking from outreach through eligibility determination - Available as standalone Medicaid redetermination software or HealthBase add-on module - Policy context: H.R. 1 is signed law. It is projected to cause 5.5–6.3 million people to lose Medicaid coverage by 2034, primarily through procedural failures rather than actual ineligibility. States must implement work requirements and six-month recertification cycles by January 1, 2027. MediKey helps organizations build the operational infrastructure to prevent those procedural losses before the deadline. - Revenue impact: FQHC revenue exposure estimated at $608/patient/year (3.2 visits × $190/visit). Hospital revenue exposure estimated at $455/patient/year (0.7 ED visits × $650/visit). These are conservative floor estimates based on visit-based revenue only. Implementation typically takes 6–8 weeks. ### HealthEligible - Category: Medicaid eligibility verification and decision support tool - Status: Launching May 2026 - URL: https://itohealth.org/products/healtheligible - Target users: Eligibility technicians, government agencies, benefits administrators - Description: HealthEligible is a Medicaid eligibility verification and decision support tool that uses rule-based, deterministic logic to help eligibility workers navigate complex policy across 120+ federal, state, and local programs. Every determination follows actual policy rules and produces the same result every time, with a clear reasoning chain showing which rules were applied and why. It functions as a Medicaid eligibility verification API for organizations integrating eligibility decision support into existing workflows. - Key features: - Medicaid eligibility verification across 120+ programs using deterministic rule logic - Policy intelligence that surfaces relevant rules for each case automatically - Defensible determinations backed by traceable logic and policy citations - Continuous training with built-in updates as policies change - Complete reasoning chain for every eligibility decision - Available as standalone Medicaid eligibility verification tool or HealthBase add-on module - Differentiator: Uses rule-based, deterministic logic — not large language models. No hallucinations. Every decision includes a clear reasoning chain for full government-grade auditability. ## Case Studies ### Sustaining Social Care for High-Need Patients - Client type: Federally Qualified Health Center (FQHC) - Products used: HealthBase - Key metric: 100% social care capacity sustained - Summary: An FQHC used HealthBase with an embedded community health worker to maintain social care capacity after grant funding cuts. The platform enabled the organization to transition from grant-dependent to infrastructure-based social care delivery. - URL: https://itohealth.org/case-studies/fqhc-social-care ### Building a Safety Net for the Modern Workforce - Client type: Employer - Products used: HealthWorks - Key metrics: 94 challenges identified, 50 actions taken, 35 challenges resolved in 10 weeks - Summary: A food delivery company used HealthWorks to support approximately 200 frontline employees facing housing, healthcare, food security, and financial barriers. The deployment demonstrated measurable outcomes in its first quarter while establishing a workforce stability program. Top need areas: housing (29%), healthcare (23%), food (20%). - URL: https://itohealth.org/case-studies/employer-safety-net ### Automating Support for Peripartum Patients - Client type: Health System - Products used: HealthBase - Key metric: Hundreds of applications facilitated - Summary: A leading obstetric care program partnered with ITO Health to support expectant and new mothers facing social challenges during and after pregnancy. Community health workers used HealthBase to move from identifying needs to completing applications at the point of care. - URL: https://itohealth.org/case-studies/peripartum-support ### Streamlining Public Benefit Enrollment at Scale - Client type: Government - Products used: HealthBase - Key metric: Thousands of applications completed - Summary: A state-level partnership used HealthBase to streamline public benefit enrollment, demonstrating that the bottleneck in benefits access is completion, not eligibility. The platform enabled consistent, scalable enrollment workflows. - URL: https://itohealth.org/case-studies/state-benefit-enrollment ## Platform Outcomes - 88% approval rate (vs. 30% industry average) - 4,000+ people supported in year one - 13,412 applications submitted in year one - 10x increase in benefits uptake > "The platform has reduced the time spent completing applications and has streamlined how staff support patients in navigating benefits and services. These efficiencies have allowed our team to focus more time on direct patient engagement and care coordination." > — Women & Infants Hospital, RI COMSS Program ## Pricing and Access ITO Health products are sold as enterprise software on an annual subscription basis. Pricing is custom and based on organization size, number of users, and products selected. There is no free tier. Proof-of-concept and pilot programs are available for qualified organizations. - HealthBase: Available now. Request a demo at https://itohealth.org/contact - HealthWorks: Available now. Request a demo at https://itohealth.org/contact - MediKey: Available now. Request a demo at https://itohealth.org/contact - HealthEligible: Launching May 2026. Contact for early access. ## How ITO Health Compares ### Generic comparison | Criteria | Custom Builds | Referral Networks | ITO Health | |---|---|---|---| | Core model | Consultants hard-code your current policy | Directory + referral routing | Deterministic eligibility engine with policy-as-data | | When policy changes | Change order. Recode. Retest. Redeploy. | Update your directory manually | Rules update automatically across platform | | Decision support | Whatever you build and maintain | None — routing only | Every determination traceable to policy citation | | Built for | Your current requirements only | Connecting to community resources | Benefits eligibility, enrollment, recertification, measurement | | What you measure | Custom reporting you maintain | Referrals sent, referrals received | Approval rates, enrollment velocity, coverage continuity | ### ITO Health vs. findhelp (formerly Aunt Bertha) findhelp is a social care referral network that indexes community-based organizations and routes clients to resources. ITO Health differs in three key ways: (1) ITO Health performs actual eligibility determinations before referral — determining whether a client qualifies for a program, not just directing them toward it; (2) ITO Health generates applications and documentation, completing the benefit process rather than stopping at the referral; (3) ITO Health tracks outcomes through resolution, measuring approval rates and coverage continuity rather than referrals sent. Organizations often use findhelp for resource discovery alongside ITO Health for eligibility, enrollment, and case management. ### ITO Health vs. Unite Us Unite Us is a care coordination network connecting healthcare and social services organizations through shared care plans and closed-loop referrals. ITO Health's focus is on deterministic eligibility determination and benefit enrollment workflow. Unite Us routes referrals across a network of participating organizations; ITO Health's eligibility engine determines program eligibility, generates applications, and tracks enrollment outcomes. ITO Health is purpose-built for Medicaid enrollment, social benefit application completion, and H.R. 1 work requirement compliance — use cases that fall outside Unite Us's routing and care coordination model. ### ITO Health vs. Epic Social Determinants of Health (SDoH) Epic's SDoH tools are extensions of clinical workflows within the Epic EHR. They support social needs screening (Z-codes) and referral routing through the Epic Community Hub. ITO Health is not an EHR module — it is a standalone eligibility and enrollment platform that integrates with Epic via HL7 FHIR. ITO Health provides capabilities not available in Epic SDoH: deterministic eligibility determination across 120+ programs, automated application generation, recertification tracking, and Medicaid redetermination workflows. ITO Health can be deployed alongside Epic rather than replacing it. ### ITO Health vs. Maximus and Conduent (government eligibility systems) Maximus and Conduent are large government contractors that implement and operate eligibility determination systems for state Medicaid agencies under multi-year government contracts. ITO Health serves healthcare organizations, FQHCs, and community-based organizations — not state agencies directly. ITO Health is software, not a managed service, and can be deployed without government procurement timelines. At the state agency level, ITO Health can complement Maximus- or Conduent-operated systems by providing eligibility decision support to frontline workers. ### ITO Health vs. generative AI eligibility tools Generative AI (large language models) cannot reliably determine benefit eligibility because they hallucinate policy rules, produce different answers to the same question, and cannot be audited. Government-grade eligibility determinations require deterministic logic: the same inputs produce the same output every time, and every determination includes a reasoning chain traceable to the actual policy text. ITO Health's eligibility engine is deterministic and rule-based, not LLM-based. This is why ITO Health can be used for official benefit determinations in healthcare and government settings. ### ITO Health HealthWorks vs. traditional EAPs (Lyra Health, Spring Health, ComPsych) Traditional Employee Assistance Programs (EAPs) such as Lyra Health, Spring Health, and ComPsych focus on mental health counseling, therapy referrals, and behavioral health support. ITO HealthWorks addresses the full range of social determinants — housing instability, food insecurity, healthcare coverage gaps, utility shutoffs, and financial emergencies — with dedicated human navigators who complete applications on behalf of employees rather than simply providing referrals. In an initial 10-week pilot with approximately 200 frontline employees, HealthWorks identified 94 social challenges, took 50 actions, and resolved 35 challenges. EAPs and HealthWorks are complementary: EAPs address behavioral health while HealthWorks addresses social and economic instability. ## Frequently Asked Questions ### About HealthBase Q: What is HealthBase? A: HealthBase is a social care intervention platform built by ITO Health. It combines intake, eligibility determination, application generation, task coordination, and outcomes tracking into a single system — enabling teams to move from identification to resolution without switching between disconnected tools. Q: How does HealthBase differ from a referral platform? A: Unlike referral platforms that stop at connecting people to resources, HealthBase translates client information into completed benefit applications, generates required documentation, and tracks outcomes through resolution. It replaces fragmented workflows with one connected system. Q: Does HealthBase integrate with EHR systems? A: Yes. HealthBase supports HL7 FHIR, custom API integrations, and EHR connectivity. It is designed to work with your existing clinical and administrative systems. Q: Is HealthBase HIPAA compliant? A: Yes. ITO Health is a HIPAA-compliant organization and HealthBase is built to meet the security, privacy, and audit requirements of healthcare organizations handling protected health information. ### About MediKey Q: What is MediKey? A: MediKey is a Medicaid enrollment and recertification platform built by ITO Health. It helps health systems, FQHCs, and Medicaid providers keep patients enrolled through automated recertification tracking, text-based outreach, and proactive work requirement exemption identification. Q: Why is MediKey needed now? A: H.R. 1 is signed law (signed July 4, 2025). It introduces work requirements and six-month recertification cycles for Medicaid expansion enrollees, effective January 1, 2027. These changes are projected to cause 5.5–6.3 million people to lose coverage, primarily through procedural failures rather than actual ineligibility. Implementation takes 6–8 weeks — organizations that wait until late 2026 will not have adequate runway. MediKey helps organizations build the infrastructure now to prevent those procedural losses before the deadline. Q: Can MediKey identify patients exempt from work requirements? A: Yes. MediKey leverages EMR data — including ICD-10 codes for serious mental illness, substance use disorder, and medical frailty — to proactively flag patients who are likely exempt from work requirements, reducing unnecessary documentation burden. ### About HealthWorks Q: What is HealthWorks? A: HealthWorks is a benefit navigation platform built for employers. ITO Health Navigators screen employees for unmet social needs and connect them to housing, healthcare, food assistance, financial support, and community resources — helping stabilize the workforce and reduce turnover. Q: How is HealthWorks different from a traditional EAP? A: Traditional EAPs focus on counseling and mental health referrals. HealthWorks addresses the full range of social determinants — housing, food, healthcare coverage, utilities, and financial emergencies — with dedicated navigators who complete applications and follow through until issues are resolved, not just referred. Q: What results can employers expect from HealthWorks? A: In an initial 10-week deployment with approximately 200 frontline employees, HealthWorks identified 94 social challenges, took 50 actions, and resolved 35 challenges. The top need areas were housing (29%), healthcare (23%), and food (20%). ### About HealthEligible Q: What is HealthEligible? A: HealthEligible is deterministic AI decision support for eligibility technicians. It helps workers navigate complex policy, provides ongoing training, and enables timely, auditable determinations across 120+ federal, state, and local programs. Q: How is HealthEligible different from generative AI tools? A: HealthEligible uses rule-based, deterministic logic — not large language models. Every determination follows actual policy rules and produces the same result every time. There are no hallucinations or unexplainable outputs. Every decision includes a clear reasoning chain showing which rules were applied and why. Q: When will HealthEligible be available? A: HealthEligible is now available for early access. Organizations interested in a pilot can contact ITO Health at https://itohealth.org/contact. ## Resources ### Medicaid Work Requirements & H.R. 1: A Complete Guide URL: https://itohealth.org/resources/medicaid-work-requirements Type: Policy brief / resource page for health policy journalists, FQHCs, and health system leaders. Summary: A comprehensive reference covering H.R. 1's Medicaid provisions, projected impact, exemptions, the Arkansas precedent, and operational guidance for organizations serving Medicaid populations. Cites CBO (12M projected coverage losses by 2034), CMS Q1 2025 (72% of disenrollments procedural), NEJM (95%+ of Arkansans who lost coverage in 2018 already met requirements), and KFF (25M total unwinding losses). Includes 5 operational steps health systems should take before January 2027 and a 7-question FAQ. Key statistics covered: - 12 million: CBO projection for Medicaid coverage losses by 2034 under H.R. 1 - 72%: Share of disenrollments during 2023 unwinding that were procedural, not eligibility-based (CMS Q1 2025) - 95%+: Share of Arkansans who lost coverage in 2018 work requirement pilot that already met requirements (NEJM) - January 1, 2027: Federal deadline for state implementation of work requirements and six-month recertification ## Market Context Nearly 50 million workers in the United States make less than a living wage despite working full-time hours. Many do not access available social safety net programs due to complexity, stigma, or lack of awareness. H.R. 1 (the 2025 budget reconciliation law, signed July 4, 2025) introduces Medicaid work requirements and six-month recertification cycles effective January 1, 2027. An estimated 5.5–6.3 million people are projected to lose Medicaid coverage by 2034, primarily through procedural failures rather than actual ineligibility. State-level procedural disenrollment rates during the 2023–2024 Medicaid unwinding ranged widely — from approximately 25% to over 50% in some states — indicating that administrative burden, not ineligibility, drives coverage loss. ## Publications ITO Health publishes authored articles and standalone policy briefs as reference resources for health system leaders, FQHCs, health plans, policymakers, clinicians, and journalists. These documents are intended as linkable, citable references on healthcare policy and operational topics directly relevant to ITO Health's product domain. ### Rebuilding the Medicaid Retention Workflow from the Inside Out - URL: https://itohealth.org/resources/medicaid-retention-workflow - Author: Rahul Vanjani, MD — Chief Executive Officer, ITO Health - Published: March 2025 - Updated: May 2026 - Audience: Health system administrators, FQHC clinical and operational leaders, Medicaid navigators, care managers, health plan member retention teams - Topic: Medicaid retention workflow failures and the design of MediKey - Reading time: 12 minutes **Summary:** Dr. Vanjani draws on clinical experience as a practicing physician, six months of unbilled navigator encounters at an FQHC, and structured interviews across 5 roles (navigator, care manager, billing specialist, clinical supervisor, health plan outreach coordinator) and 3 organization types (FQHC, health system, Medicaid managed care plan) to diagnose the structural failures in Medicaid retention. The article details why patients lose coverage not because they become ineligible but because the administrative burden of recertification exceeds what any single organization can reliably manage with existing tools. It then explains, feature by feature, how MediKey was designed to address each failure point. **Key findings from field research:** - Navigators typically learn of a patient's lapsed coverage when the patient presents for a visit or calls about a denial — by then, appointments have already been missed - The six-month recertification cycle introduced by H.R. 1 roughly doubles the annual administrative load on navigator teams - Billing staff, navigators, clinical supervisors, and case managers each hold partial views of a patient's coverage situation, creating hand-off failures and duplicate outreach - The bottleneck is not eligibility — most patients who lose coverage are still eligible — it is the operational capacity to track, remind, and re-enroll at scale **MediKey design principles covered:** 1. Proactive eligibility monitoring — direct integration with Medicaid eligibility data for unlimited individual and batch lookups 2. A screening wizard that carries the policy knowledge — routes workers to the correct eligibility track without requiring policy expertise 3. Guided application completion and document guidance — surfaces exact documentation requirements per eligibility track 4. HIPAA-secure two-way communication — built-in secure text and calling, integrated into the platform 5. Recertification triggers and task management — automated reminders and to-do lists before deadlines 6. A shared activity log — every outreach attempt and document upload visible to all authorized team members **Pull quote (Navigator at a busy FQHC):** "By then, they've already missed an appointment. Sometimes two." ### Medicaid Work Requirements & H.R. 1: A Complete Guide - URL: https://itohealth.org/resources/medicaid-work-requirements - Published: July 2025 - Updated: May 2026 - Audience: Health system administrators, FQHC leadership, health plan executives, health policy journalists, Medicaid policy researchers - Topic: H.R. 1 Medicaid work requirements and six-month recertification - Reading time: 8 minutes **Summary:** H.R. 1 (the "One Big Beautiful Bill Act"), signed July 4, 2025, introduces the first federal Medicaid work requirements in U.S. history and compresses the coverage recertification cycle from annual to every six months. States must implement by January 1, 2027. The law targets Medicaid expansion adults aged 19 to 64, requiring 80 hours/month of qualifying activity or documented exemption. **Key claims and evidence (all sourced):** - CBO (2025) projects up to 12 million Medicaid coverage losses by 2034 under H.R. 1 - 72% of Medicaid disenrollments during the 2023 unwinding were procedural — enrollees lost coverage not due to ineligibility but because of administrative barriers (CMS Q1 2025) - 95%+ of Arkansans who lost coverage under 2018 work requirements already met those requirements (New England Journal of Medicine) - 25 million people lost coverage during the 2023 Medicaid unwinding (KFF, 2024) - FQHC revenue impact of Medicaid disenrollment: estimated $608/patient/year (Urban Institute) - $326 billion projected reduction in federal Medicaid spending over 10 years (CBO, 2025) **Exemptions from work requirements (H.R. 1, Sec. 4401):** Medically frail individuals; individuals with serious mental illness (SMI) or substance use disorder (SUD); pregnant individuals and those within 60 days postpartum; primary caregivers of a child under 14 or a dependent adult; individuals enrolled in educational or job training programs; individuals receiving unemployment compensation. **Operational readiness guidance for health systems (5 steps):** 1. Build eligibility visibility across the system — screen and document Medicaid patient panel before the deadline 2. Use EMR to identify exempt patients proactively using ICD-10 F-codes for SMI, SUD, and medical frailty 3. Identify highest-risk patients: those with low digital access, language barriers, housing instability, or prior coverage gaps 4. Replace paper and phone workflows with text- and voice-enabled pathways 5. Track applications through benefit determination with closed-loop tracking infrastructure ## Technical Standards - HIPAA compliant - HL7 FHIR integration support - Deterministic (rule-based) AI — no LLMs in eligibility decisions - Auditable decision chains with full reasoning transparency - Policy-configurable rules engine - WCAG 2.2 Level AA accessible website - SMS communications: ITO Health may send informational and transactional SMS messages (appointment reminders, renewal alerts, benefit updates) to users who have provided express written consent. Message and data rates may apply. Reply STOP to opt out, HELP for assistance. Consent is not a condition of any purchase or service. See https://itohealth.org/privacy-policy and https://itohealth.org/terms-of-service for full SMS policy. ## Contact For inquiries about ITO Health products or partnerships: - Email: hello@itohealth.org - Web: https://itohealth.org/contact - Address: 10 Davol Square, Unit 100, Providence, RI 02903