#USA #Medicaid #Verify #Stony Brook #CITIZ3N

An Innovative Solution for Medicaid Verification

As the deadline approaches for state Medicaid agencies to implement new community engagement verification requirements, CITIZ3N Government Solutions has unveiled vital updates to its VERIFY platform. Under the provisions of the recently enacted H.R. 1 (the 2025 Budget Reconciliation Act), state agencies have a monumental task ahead of them: verifying that adult Medicaid enrollees engage in at least 80 hours of qualifying activities each month, including work, volunteering, or education. The compliance deadline is set for December 31, 2026.

Automating the Verification Process

CITIZ3N's VERIFY solution is designed to alleviate the administrative burden of this verification task. By automating processes that would traditionally involve significant manual labor, the platform allows state agencies to quickly align with federal requirements. Rob Miller, the General Manager and Senior Vice President at CITIZ3N, emphasized the importance of having a reliable verification infrastructure ready for deployment amidst tight timelines. The platform aims to provide a robust solution that minimizes disruptions for eligible enrollees whose coverage could be at risk without proper verification.

VERIFY supports agencies by integrating with over a dozen data sources to facilitate real-time verification of community engagement activities, empowering caseworkers to focus on assisting beneficiaries rather than burdening them with data management issues. This integration is built upon a structured five-tier verification framework that utilizes advanced analytical tools to parse various compliance scenarios.

Framework Benefits and Features

The five layers of verification included in the solution comprise:
1. Categorical Exemptions: Identifying individuals automatically exempt from the requirements, such as pregnant women or caregivers.
2. Hardship Exemptions: Assessing members facing temporary hardship due to unemployment or disasters.
3. Cross-Program Exemptions: Using existing participation data from programs like SNAP to verify compliance.
4. Work Activity Verification: Stringently confirming activity hours via trusted databases on employment and education.
5. Member Attestation: When no data exists to affirm compliance, users can submit necessary documentation through the portal.

The platform adopts a color-coded risk scoring system to streamline decision making for caseworkers, ensuring timely responses during application, renewal, and ongoing coverage assessments. Moreover, states utilizing these automated verification systems have noted a significant reduction in manual casework, leading to fewer erroneous terminations of benefits for eligible individuals.

Addressing Pressures on Medicaid Agencies

Healthcare policy experts recognize the stress the revised verification timeline places on Medicaid agencies. With federal guidelines arriving after implementation needs start, having an effective verification system ready ensures states can meet compliance without hampering access to necessary benefits. The interconnectedness embedded within the VERIFY system alleviates the need for separate verification databases for similar programs like Medicaid, SNAP, and TANF, resulting in cost reductions and better inter-agency coordination.

The VERIFY platform also features an intuitive member portal that allows individual users to check their status, submit required documentation, and find information related to available job or volunteer opportunities.

Upcoming Demonstrations

CITIZ3N's team will present the capabilities of the VERIFY platform at several upcoming events:

• - NESCSO NERDS-3 Meeting in Washington, DC on November 13
• - NHCAA Conference in Nashville, TN from November 18-20
• - NAMD Annual Conference in Washington, DC from November 19-21

As a subsidiary of Softheon, a leading cloud-based health technology provider, CITIZ3N’s VERIFY platform embodies innovative approaches to streamline processes, thereby enhancing the overall efficiency of health benefit administration. More details on CITIZ3N and its offerings can be found at CITIZ3N.com/verify.