Medicaid 2027: Connecting the Ecosystem to Meet Community Engagement Requirements
In this four-part series, Carla Nelson, Findhelp’s Senior Director of Healthcare and Public Policy explores key strategies and best practices for meeting Medicaid Community Engagement requirements. We’ll cover beneficiary engagement through a simplified workflow, deployment models that prevent silos, and the data infrastructure required to effectively communicate and verify outcomes across a multi-stakeholder network.
Part 1 begins with the landscape: the requirements, the timeline, and the need for a connected ecosystem.
Under new federal requirements, beginning January 1, 2027, millions of Medicaid Expansion adults will need to document their participation in the workforce or community to maintain their healthcare coverage. Successfully implementing this policy requires a participatory and connected ecosystem.
To keep eligible people enrolled and promote economic mobility, stakeholders from state government, health plans, providers, and community organizations must be able to share data and coordinate support.
In this post, you’ll learn:
Who’s impacted, what counts, key exemptions, and the rollout timeline.
How states, plans, providers, CBOs, & beneficiaries must coordinate to avoid coverage loss.
How you can use shared infrastructure and data to verify participation and reduce burden.
The policy baseline: Community engagement requirements
To understand the impact, we must clarify the rules. Under the new requirements, adults aged 19–64 in the Medicaid Expansion group must document at least 80 hours per month of qualifying activities (work, volunteering, or education). Eligibility reviews will occur every 6 months, requiring a steady flow of data to maintain coverage.
- Exemptions: A significant portion of members will be exempt (e.g., caregivers, medically frail, SUD treatment).
- Ex parte verification: States are required to attempt to verify status using existing data (SNAP, wage data) before asking the beneficiary.
- Timeline: While the law takes effect January 1, 2027, beneficiary outreach must begin October 2026 (3 months prior). States may elect to implement sooner than the law requires.
The need for connectivity
Meeting these federal requirements and preventing procedural disenrollments relies on the active participation of multiple sectors. Each stakeholder plays a distinct role and has distinct data systems.
State agencies
To execute “ex parte” reviews, states need the technical capability to combine, ingest, and synthesize data from disparate sources. This involves pulling beneficiary information from internal systems (like SNAP enrollment and claims data) to automatically determine compliance or exclusions, minimizing the need for manual caseworker review. States also need external data (like income and job program participation) to make final determinations for individuals needing to meet the requirements.
Medicaid managed care organizations (MCOs)
MCOs are positioned to support member retention and continuity of care, as they did during the public health emergency Medicaid unwind. They hold claims and risk data that can support exemption determinations by the State. To assist members in finding qualifying activities and meeting requirements, MCOs need visibility into which members are exempt and which members may be at risk of non-compliance. This allows care managers to offer targeted outreach and navigation support.
Healthcare providers
With frequent beneficiary interactions, healthcare providers hold encounter data in their EHRs, are uniquely positioned to educate patients on the new requirements and connect them to qualifying activities as part of holistic care. Protecting coverage is also a financial imperative. Preventing churn reduces the risk of uncompensated care and ensures that treatment plans remain uninterrupted.
Community-based organizations (CBOs)
Local organizations, such as food banks and training centers, provide the volunteer and training opportunities necessary for members to meet the 80-hour requirement, and may track this data electronically or manually. For these hours to count toward eligibility, CBOs need a digital, streamlined way to attest to a member’s participation.
Beneficiaries
Medicaid beneficiaries are critical participants, and they need clarity and access. A simplified, mobile-friendly experience allows them to understand their status, find opportunities, and submit necessary documentation.
Connecting the ecosystem with existing infrastructure
Findhelp already connects millions of Medicaid members to support through existing relationships with MCOs, healthcare providers, state agencies, and a nationwide network of CBO programs and services. We provide the infrastructure that allows data to flow securely between these entities. We pair this infrastructure with user interfaces and integrations designed for the specific needs of each sector.
Our platform works by collecting, standardizing, and delivering the data:
- We provide simple, sector-specific tools for data collection, like free case management for CBOs, integrations with healthcare systems of record, and member file ingestion to display eligibility information.
- Our system standardizes this diverse information into the specific reporting formats required by the State. We do this today by mapping to standards like USCDI and the Gravity Project.
- We route the data back to the entity that needs it, giving States audit-ready files, MCOs updated member dashboards, and beneficiaries immediate confirmation.
By seamlessly connecting states, MCOs, providers, CBOs and beneficiaries, we ensure that community engagement activity is captured and counted. This improves the community engagement experience for stakeholders, and reduces the administrative burden on states, partners, and beneficiaries alike.
What’s Next?
Now that we have established the landscape, we need to look at how the process actually works for the people involved.
In Part 2 of this series, we’ll dive into the User Workflow, mapping the journey from the moment a beneficiary receives a notification to the moment their hours are verified. Later in the series we’ll cover Deployment Models (Part 3) and Data Infrastructure (Part 4).
