Across the country, Medicaid health plans are preparing for one of the most significant operational shifts since the end of the COVID-19 pandemic.
New federal Medicaid eligibility and redetermination requirements established under H.R. 1 will require organizations to rethink how they engage members throughout the renewal process. And we’re only five months out. States have to have the new Medicaid work requirements and six-month redeterminations for expansion adults in place by January 1, 2027. For plans, that means renewal cohorts start moving through the new process this fall — not next year.
The challenge extends well beyond compliance.
Health plans must now identify eligible members earlier, communicate more frequently, simplify renewal activities, and reduce avoidable procedural disenrollment—all while managing staffing shortages, rising administrative costs, and increasing expectations for member experience.
For many organizations, simply expanding call center staffing is no longer a sustainable strategy.
Instead, health plans are looking for scalable approaches that combine operational expertise with intelligent automation to improve member engagement while preserving the human connection when it matters most.
At COPE Health Solutions, we’ve spent decades partnering with health plans to improve healthcare operations, quality performance, financial sustainability, and member outcomes. Our experience spans Medicaid operations, managed care, care management, quality improvement, risk adjustment, population health, and healthcare analytics. We understand that successful Medicaid retention requires more than technology—it requires an operational strategy grounded in how health plans actually function.
That’s why we developed ARCi.
ARCi is designed to help health plans modernize Medicaid redetermination by expanding outreach capacity, engaging members through the communication channels they prefer, supporting eligibility renewals, and seamlessly integrating with existing Member Services operations.
Members can receive personalized outreach through phone, text, and email; receive renewal reminders; complete portions of the renewal process; upload documentation; and transition seamlessly to a live representative whenever additional assistance is needed.
Rather than replacing Member Services teams, ARCi extends their reach by automating routine interactions and allowing staff to focus on higher-value conversations that require empathy, judgment, or complex problem-solving.
This approach enables health plans to improve renewal completion rates, reduce avoidable Medicaid attrition, preserve Medicaid coverage for eligible members, and protect financial performance without proportionally increasing administrative burden.
The future of Medicaid member engagement is not about replacing people with technology. It’s about equipping healthcare organizations with smarter operational tools that strengthen existing teams, improve the member experience, and help more individuals maintain the coverage they depend on.
As the Medicaid landscape continues to evolve, organizations that successfully combine healthcare operations expertise with intelligent automation will be best positioned to navigate regulatory change, improve member retention, and deliver better outcomes for the communities they serve.
COPE Health Solutions is proud to partner with health plans in building the next generation of Medicaid retention strategies—helping organizations preserve coverage, modernize operations, and improve the health of the populations they serve.
If you’re evaluating how your organization is positioned for what’s ahead, we’d welcome the opportunity to talk through it — and show you ARCi in action along the way.
Schedule a briefing to review your Medicaid redetermination strategy and see how ARCi could fit into your operations.