Skip to main content

Rebuilding the Medicaid Retention Workflow from the Inside Out

How clinical experience, frontline interviews, and six months of unbilled encounters shaped a tool designed to keep patients covered, from eligibility check to recertification.

When a patient arrives for an appointment and their Medicaid has lapsed, the damage is already done. A gap in coverage that could have been caught weeks earlier now disrupts care, delays billing, and leaves a frontline worker scrambling to figure out what happened. The workflows that are supposed to keep patients enrolled in Medicaid are fragmented by design: siloed across departments, dependent on manual hand-offs, and largely invisible to the people best positioned to intervene.

The new H.R. 1 compliance chain — paperwork, verification, system review, and eligibility decision — that every Medicaid expansion enrollee will navigate starting January 2027.

Starting with the Problem, Not the Solution

Our team came to this work with firsthand clinical context. As practicing physicians and case managers, we live inside these workflows. We know what it feels like to discover a patient’s coverage status as a vague flag in the EHR, or from the patient directly. We know the navigator who is also managing social needs referrals and a voicemail inbox full of messages from patients who don’t know where else to turn.

But for this project, we didn’t assume our experience was universal. We conducted structured interviews with navigators, financial assistors, case managers, billing staff, and IT teams at CCBHCs, FQHCs, and hospital systems. We also drew from look-back analyses with existing customers, examining six months of billable encounters that had never been billed and tracing what had gone wrong, and at what point in the process, for each one.

Research conducted
5roles interviewed: navigators, financial assistors, case managers, billing staff, and IT
3organization types: CCBHCs, FQHCs, hospital systems
6 moof unbilled encounters analyzed to trace where coverage gaps occurred
Key finding

What emerged was a picture of a workflow that no single person owned, at any stage.

How the Workflow Actually Works

Five structural breakdowns in the standard Medicaid retention workflow — from the eligibility check no one shares to the state portal friction that ends coverage.

The eligibility check no one shares

Medicaid eligibility checks (the 270/271 transaction) are typically run by IT, billing, or revenue cycle teams. In many organizations they’re integrated into the EHR, though the quality of that integration varies considerably: some systems surface clean, up-to-date information; others return data that’s quickly stale or hard to interpret.

Because there is a per-transaction cost to eligibility checks, access is deliberately limited. Batch lookups are done sparingly; individual lookups happen on a schedule. Frontline staff typically have no access at all.

Information that goes nowhere standard

Once eligibility is confirmed or flagged, there is rarely a standard protocol for what happens next. The result might surface in the EHR, appear in an Excel report routed to the insurance navigator or access team, or simply remain with billing for internal revenue-cycle purposes. By the time a navigator learns that a patient’s coverage has lapsed, it may have been weeks. Worse, the patient may already be sitting in the waiting room.

A fragmented frontline response

Organizations employ a range of staff to help patients with insurance: state-certified CAC navigators, internal case managers, financial assistors, front desk staff trained informally. Often it is some combination of all of these, with overlapping responsibilities and inconsistent training.

What these staff members actually do when they encounter a patient without coverage varies just as widely across organizations. Some provide education. Some screen for eligibility and walk patients through online applications. Some serve as authorized representatives. Others, stretched thin or uncertain of their scope, refer patients elsewhere or hand them materials and hope for the best.

In our interviews, this variability came through clearly. One navigator at a CCBHC described printing paper applications and sitting beside patients to complete them by hand, because the state portal was too difficult for patients to navigate on their own. Another, at a busy FQHC, had a different problem entirely.

By then, they’ve already missed an appointment. Sometimes two.

Navigator at a busy FQHC, on how she learned of lapsed patient coverage

The patient experience

Patients receive renewal notices by mail or email. These are frequently missed, confusing, or both. State Medicaid portals vary in usability, and nearly all require two-factor authentication, which has been shown to be a barrier for elderly patients and those with limited digital literacy. Supporting documents typically need to be hand-delivered or uploaded to the state portal directly.

Meanwhile, the methods navigators use to communicate with patients are just as heterogeneous as everything else: EHR patient portals, desk phones, personal work cells, and the occasional walk-in visit. Many do not allow patients to email them for HIPAA compliance reasons.

What We Built and Why

MediKey patient workflow: a single interface where any staff member can check coverage, run a guided eligibility screening, and track every navigator action in context.

Understanding this fragmentation shaped every decision we made in designing MediKey. Rather than addressing one piece of the workflow in isolation (just eligibility, communication, or reminders), we built a platform that enables any staff member to complete the entire process, end to end.

01

Proactive eligibility monitoring

Direct integration with Medicaid eligibility data allows unlimited individual and batch lookups without per-transaction barriers. Coverage gaps can be identified a month before a patient's next appointment, triggered in real time when someone presents in the ED, or surfaced through regular monitoring across an organization's entire patient panel.

02

A screening wizard that carries the policy knowledge

Walks workers through the questions required to determine eligibility for every applicable Medicaid program, including MAGI, CHIP, pregnancy pathways, LPR pathways, working-disabled pathways, emergency Medicaid, LTSS, and others, and routes them to the correct track. Workers don't need to hold all of this policy knowledge in their heads.

03

Guided application completion and document guidance

For each eligibility track, MediKey surfaces exactly what documentation a patient needs to collect, pre-fills paper applications where organizations prefer that workflow, and provides next steps alongside relevant regional contacts.

04

HIPAA-secure communication, built in

Two-way secure text and calling, integrated into the platform, gives navigators a compliant channel for reaching patients. Documents can be uploaded directly into the case. The exchange stays in the record: convenient and defensible.

05

Recertification triggers and task management

Automated reminders alert staff ahead of deadlines. To-do lists track what's needed for each patient. The system surfaces what step comes next and who is responsible for it, preventing the stall that typically happens in the weeks before recertification.

06

A shared activity log

Every outreach attempt, document upload, and conversation is logged in a shared activity feed, visible to any authorized team member. In organizations where navigators, supervisors, billing staff, and case managers each have partial views of a patient's coverage situation, this shared record makes hand-offs cleaner.

MediKey's shared activity log: every outreach attempt, automated SMS, voicemail, and coverage state change captured in one place — visible to any authorized team member.

The Bigger Picture

The Medicaid retention problem is not, at its core, a technology problem. It is a coordination problem, one that technology has historically made worse by adding systems without adding coherence. We heard this from nearly everyone we interviewed: the issue isn’t that there are no tools, it’s that the tools don’t talk to each other, and the workflows don’t connect.

What we also heard consistently is that frontline workers want to do this work well. They want to catch coverage gaps before they become crises. They want to know what documents a patient needs before the appointment, not after. They want a way to reach patients that doesn’t require giving out a personal number.

We built MediKey to meet those workers where they are, and to make the path from coverage gap to enrollment as short and clear as possible for the patients who depend on them.

What’s next

Because the underlying architecture applies to any structured public benefit program, MediKey is extensible beyond Medicaid. The same logic that routes a patient to the correct Medicaid pathway can be applied to SNAP, LIHEAP, housing programs, and others. Patients don’t experience their benefits as separate systems. They experience them as one complicated life. We’re building toward tools that match.

Related reading: H.R. 1 and what it means for Medicaid retention →

Stay current on Medicaid policy

Monthly briefs on policy changes, enrollment shifts, and workflow tools for navigators and health systems — direct from the ITO Health team.

No sales cadence. Unsubscribe anytime.

ITO Health

Ready to build a retention workflow that works?

MediKey is available now for health systems, FQHCs, and health plans. Implementation typically takes 6–8 weeks.