Maintain Member Eligibility
With new redetermination and work requirements, maintaining member eligibility for Medicaid insurance coverage will become a primary social need. As the leaders in solving social needs, we identify barriers and remove obstacles that prevent people from accessing the care they deserve.
Personalized engagement for all members, direct support for high-risk population
We create an N of 1, culturally tailored, personalized member experience, powered by our Right Touch engagement model that drives results through our deep relationships within a curated network of community-based organizations (CBOs) across the country.
With our solution for addressing new work and redetermination requirements for Medicaid members, we leverage our deep experience reaching and engaging with health plan members to drive action.
By strategically stratifying members according to risk and complexity, we ensure that the right information reaches the right members, at the right time.
Thought leadership
GroundGame.Health experts weigh-in on the new redetermination and work requirements for Medicaid members, and provide deep insights on the impacts, and how to navigate these changes.
White Paper: How Medicaid payers can prepare
Big changes are coming, and payers need to act now. Learn from the experts how to navigate the upcoming Medicaid work requirements landscape.
Under the Same Sky: Jackie Prokop
Abner Mason spoke with Jackie Prokop, Associate Principal, HMA, who discussed the complexities of designing and deploying work requirements programs based on her firsthand insights from Michigan's 2020 rollout.
Under the Same Sky: Jacey Cooper
Abner Mason spoke with Jacey Cooper, President, Precision Health Strategies, who drew examples from her extensive background in transformational initiatives, outlining three critical strategies for states and health plans navigating this evolving landscape.
Under the Same Sky: Karen Shields
Abner Mason spoke with Karen Shields, CEO of KMS Health Consulting, who provided key lessons learned from her experience with the rollout of the Affordable Care Act (ACA) as well as Medicaid unwinding.
Under the Same Sky: John Morales
Abner Mason spoke with John Frias Morales, an analytics expert, who discussed how states and health plans can avoid built-in bias and design systems that help Medicaid beneficiaries retain their health insurance coverage.
Under the Same Sky: Jessica Kahn
Abner Mason spoke with Jessica (Jess) Kahn, Partner at McKinsey based out of Washington, D.C. Jess shared practical advice drawn from her decades of experience in state and federal government and in her current role as a partner at McKinsey.
Article series
GroundGame.Health's own Syam Adusumilli, Chief Evangelist and Head of Strategic Partnerships, has initiated a series of articles with useful perspectives and insights on these new requirements.
1A: The New Social Contract: From Safety Net to Trampoline
The One Big Beautiful Bill Act represents more than budget policy, it's a fundamental reordering of the relationship between citizens and their government.
1B: The New Stakeholders: Who Implements the Distributed Social Contract
When work becomes a condition of healthcare coverage, responsibility spreads far beyond government agencies.
1C: The Systems View: How Work Requirements Create Unpredictable Outcomes
When Arkansas implemented Medicaid work requirements in June 2018, state officials anticipated promoting employment and personal responsibility. What they got instead was 18,000 people losing coverage in ten months — with no measurable increase in employment.
2A: Building Verification Systems that Work: Technology’s Role in the Reciprocal State
When 18.5 million people must document 80 hours of activity monthly, system design becomes social policy.
2B: Exemption Systems and the Boundaries of Obligation
Who shouldn't have to work, who decides, and how do we know?
2C: The Human Layer: Agency, Advocacy, and Community Engagement
Systems don't implement themselves — people make them work, or make them fail.
3A: What Health Insurers Can Do: Turning Enrollment Volatility Into Care Continuity
The question isn't whether work requirements are good policy. The question is what operationally competent managed care organizations do when policy creates volatility that threatens both business models and population health.
3B: The 14-month Implementation Checklist: What MCOs Must Do Now
The plans that execute well aren't those with the most resources. They're those that started earliest and iterated fastest. Start now.
3C: Managing the Multiple Burdened: Care Coordination when Medical Risk, Social Complexity,and Administrative Barriers Converge
Effective MCO response doesn't create ten different programs. It creates flexible, adaptive support systems that accommodate intersectional complexity
4A: The Expansion Redetermination Challenge for Adults
Redetermination for adults goes beyond monthly work verification, serving as a periodic, comprehensive review of Medicaid eligibility, including income, household changes, and continued compliance with work or exemption requirements.
4B: When Redetermination Meets Reality
What happens when Medicaid redetermination deadlines collide with mental illness, disability, and caregiving? For thousands of expansion adults, a six-month cycle meant to verify eligibility becomes a recurring crisis costing coverage, health, and sometimes lives.
4C: Building Redetermination Infrastructure for Expansion Adults
States face a 14-month deadline to overhaul Medicaid systems for 18.5 million expansion adults. Semi-annual redetermination isn’t just a policy shift, it’s a capacity crisis requiring new technology, staffing, and coordination across every stakeholder.
4D: When the Disability Itself Prevents Documentation: Autism, IDD, and the Redetermination Penalty
For adults with autism and intellectual disabilities and their caregivers, the six-month Medicaid redetermination cycle isn’t just paperwork, it’s a barrier that punishes the very conditions exemptions are meant to protect.
7A: The Exemption Architecture
Exemption rules are more than paperwork. They reflect choices about trust, capacity, and the purpose of safety nets, shaping whether Medicaid work requirements expand opportunity or restrict coverage.
7B: The Verification Architecture
The Verification Architecture is the arena where states confront the choice between trusting systems or trusting people, a decision that defines not only administrative design but the very balance between oversight, burden, and coverage stability.
7C: The Coordination Architecture
The sequencing of bureaucratic processes determines whether compliance unfolds as a stable transition or fractures into systemic failure.
7D: The Delegation Architecture
Building Medicaid delegation systems means more than logistics. It requires attention to safe harbors, constitutional limits, and liability protections that determine whether employers, providers, and schools can truly participate.
