Doubled recertification cycles
Six-month recertification cycles double the administrative burden on eligibility teams and double the opportunities for procedural failure.
H.R. 1 Signed into law July 4, 2025
When patients lose coverage, everyone loses
Procedural disenrollment under H.R. 1 means uncompensated care for your system and interrupted care for your patients. MediKey prevents both
What happened last time
During the 2023 Medicaid unwinding, 25 million people lost coverage nationwide. Subsequent analyses showed most remained eligible: they missed a notice, couldn't navigate the paperwork, or were never contacted. H.R. 1 rebuilds that dynamic as a permanent feature of the program, with work requirements and six-month recertification cycles that don't end after the unwinding is over.
Your Exposure
What does H.R. 1 cost your organization?
H.R. 1 is law. Know your exposure now
The policy is settled. What isn’t settled is whether your organization will have the operational infrastructure in place when states begin enforcement on January 1, 2027. This calculator gives you a conservative, citable estimate of what’s at stake in under 60 seconds
Based on published projections from the Urban Institute, Congressional Budget Office, and Commonwealth Fund (2025)
Work requirement documentation
New work requirements create documentation friction for patients who may already qualify for exemptions but lack the paperwork to prove it.
Revenue and care continuity
Every patient lost to procedural disenrollment becomes uncompensated care. Revenue disappears while the care need remains.
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How It Works1 2 3 4
From patient risk to enrollment secured
MediKey works across your existing EHR and eligibility infrastructure. No rip-and-replace, no app installs, done in 6 weeks
Risk Identification
Ingests your Medicaid population and runs prospective eligibility checks, flagging patients by recert timeline, coverage gaps, exemption likelihood, and disenrollment risk factors before encounters go unbilled.
Automated Outreach
Text and voice campaigns reach patients before deadlines at configurable intervals, not paper notices.
Guided Completion
Mobile-first workflows for document uploads, form completion, and exemption documentation. No app download.
Closed-Loop Tracking
Every application tracked from outreach through determination. Population dashboard for eligibility teams.
Revenue Protection
Stop losing revenue to eligibility gaps
Coverage lapses don’t just affect patients. They create unbilled encounters, unrecoverable claims, and compounding revenue loss. MediKey catches what manual processes miss
Prospective eligibility verification
Pre-visit coverage checks flag lapsed or unverified insurance 24–48 hours before scheduled encounters, giving your team time to confirm coverage or re-enroll the patient before the visit becomes uncompensated care.
- Pre-Visit
- Automated
Retroactive billing recovery
Identifies encounters delivered to patients with lapsed coverage who can still be enrolled within the 90-day retroactive billing window, recovering revenue your organization has already earned but couldn’t bill.
- 90-Day Window
- Revenue Recovery
Platform Capabilities
Everything your team needs to prevent procedural loss
Six-month recertification cycles create twice the administrative surface. MediKey automates the steps that cause procedural disenrollment
Recertification Date Tracking
Individual and population-level deadline visibility surfaced before failures occur, not after.
Automated Patient Outreach
Configurable text and voice campaigns. Meets patients where they are, not through paper notices.
Exemption Flagging
ICD-10 F-code matching identifies patients likely exempt from work requirements without manual review.
Mobile-First Application Support
Guided workflows for document uploads and form completion. Device-agnostic.
End-to-End Application Tracking
Every application tracked from outreach through determination. Nothing lost after paperwork leaves the clinic.
Population Risk Stratification
Flags patients at highest procedural disenrollment risk based on housing, language, and digital access.
Deployment Options
Two ways to deploy MediKey
Whether you’re already on HealthBase or need a focused standalone solution, MediKey fits your current stack, not the other way around
HealthBase Module
For existing HealthBase customers. Turn on MediKey to activate Medicaid-specific modules within your existing platform.
Learn moreStandalone MediKey
For new ITO Health customers. A focused interface built for organizations that need Medicaid enrollment and recertification capabilities.
Learn moreImplementation Readiness
Implementation takes time. Coverage loss doesn’t wait
H.R. 1 is signed. January 1, 2027 is the state implementation deadline, and implementation takes time. Here’s what the runway looks like
Q1–Q2 2026 — Window Open
Assess your exposure and begin implementation planning
The law is signed. Organizations that start now have time for a full implementation, staff training, and a controlled pilot with your highest-risk patient cohort before state enforcement begins January 1, 2027.
Comfortable runwayQ3 2026 — Window Narrowing
States operationalize requirements; early recertification waves begin
States will begin rolling out work requirement verification and six-month renewal cycles. Organizations starting implementation in Q3 can still go live before January 1, 2027, but the margin for error is gone.
Limited runwayJanuary 1, 2027 — State Implementation Deadline
Work requirements and six-month recertification mandatory in all states
Organizations without automated recertification tracking and outreach in place will face the same procedural disenrollment cascade seen in the 2023 unwinding — this time, as a permanent, legally mandated feature of the program.
No runway remainingFrequently Asked Questions
The questions your team actually has
How long does MediKey implementation take?
Most standalone MediKey implementations go live in 6–8 weeks. HealthBase module activations for existing customers can be operational in 2–4 weeks. Both timelines assume standard EHR API access and an internal eligibility point of contact. ITO Health provides implementation support and project management throughout.
Which EHR systems does MediKey integrate with?
MediKey integrates with Epic, Cerner, athenahealth, and eClinicalWorks via standard FHIR APIs. For EHRs outside this list, we’ll do a discovery call to assess integration complexity. Many regional EHR systems have compatible APIs. Contact us for a technical assessment specific to your environment.
How does MediKey identify patients exempt from work requirements?
MediKey queries ICD-10 codes in your EMR, specifically F-codes associated with serious mental illness, substance use disorder, and medical frailty diagnoses that qualify as work requirement exemptions under H.R. 1. This surfaces patients who are already clinically documented as exempt but haven’t been flagged for exemption processing, reducing unnecessary documentation burden on patients and staff.
What’s the pricing model?
MediKey offers flexible pricing based on your organization’s size, patient volume, and deployment model, including per-member-per-month tiers for FQHCs, hospital systems, and enterprise networks. The revenue protection math is straightforward: one prevented disenrollment or one recovered unbilled encounter typically pays for months of platform access. We’ll build a specific ROI model for your patient population on your first call.
Who owns the patient relationship during outreach?
You do. All outreach is conducted under your organization’s name, branding, and authorization. Your team controls the messaging and approves campaigns before they go live. For organizations that prefer hands-off execution, ITO Health can conduct outreach on your behalf, always under your authorization, using your approved templates, and reporting back to your team.
Does MediKey replace our eligibility staff?
No, it extends what they can do. MediKey automates recertification tracking, prospective eligibility verification, patient outreach, and documentation workflows so your team stops spending time on tasks that don’t require human judgment. It also identifies unbilled encounters from lapsed coverage and flags retroactive billing opportunities. Your eligibility staff still own complex cases, escalations, and direct patient relationships. MediKey handles the operational infrastructure around them.
Ready to get started?
The law is signed. Now it’s an operations problem
States implement work requirements and six-month recertification on January 1, 2027. Organizations that build the infrastructure now will protect their patients and their revenue. Organizations that wait will face the same cascade as the 2023 unwinding, but this time, it won’t end
- Flexible deployment options
- Live in 6–8 weeks
- Implementation included