HR1, also known as the One Big Beautiful Bill Act, significantly revised eligibility and enrollment processes for Medicaid and the Supplemental Nutrition Assistance Program (SNAP) benefits. With deadlines starting December 31, 2026, agencies must begin modernization efforts now to prevent costly delays.
Health and human service agencies must take a thoughtful approach to these policy updates to help ensure compliance while continuing to deliver quality services. Six strategies include:
1. Redesign processes for community engagement
Community engagement is one of HR1’s most significant shifts. Health and human services must redesign workflows to track and verify work requirements, including identifying people who are exempt. This change will require new types of evidence and verification, affecting application processing and renewal procedures.
Configurable workflow engines and rules-based systems offer the flexibility to integrate automation without overhauling systems. We can learn from recent state experiences with work requirement implementations. In some states, applicants faced complex verification requirements and enrollment barriers. Platforms couldn’t respond quickly enough to policy changes.
By prioritizing system flexibility and simplifying processes, agencies can reduce errors and improve benefits delivery, ensuring that both caseworkers and beneficiaries have better experiences.
2. Start targeted outreach early
Agencies must have an effective outreach plan to inform enrollees of changes and build trust with them during times of significant change. Data-driven, multi-channel outreach can reduce coverage gaps for eligible individuals.
Health and human services agencies must tailor messages for different populations, communities, and communication channels, including social media. Outreach should explain what’s changing with a clear call to action and timeline. Automated communications (e.g., texts, emails, AI-powered chatbots) can help keep beneficiaries engaged and enrolled.
Agencies can apply CMS State Unwinding Best Practices as they develop outreach strategies. One example from this report is Tennessee’s digital outreach with its Medicaid program, TennCare. During the unwinding of Covid benefits, TennCare developed targeted digital advertising campaigns on social media and search engines to reach specific populations. These efforts led to a 107% increase in renewal responses, a 29% increase in website traffic, and the creation of 16,000 new online accounts in just three months.
3. Use flexible technology
Flexible technology platforms and partners can help agencies adapt their processes for efficiency. Social Security Scotland was recognized for its digital transformation project with the Scottish Child Payment (SCP). By automating processes, such as evidence verification checks and decision-making, Social Security Scotland helps families avoid lengthy applications and waiting times. The system reduced processing times by a reported 58% with a 95% user satisfaction score.
4. Build integrated data systems
To meet community engagement requirements and to support more frequent eligibility checks, agencies must identify relevant data sources and establish data-sharing agreements. Agencies should prioritize mapping data sources that support both verification and exemption determinations.
Electronic verification may suffice in most cases, but agencies must develop alternative workflows for situations that require manual documentation, including volunteer work, gig employment, and self-employment.
Leveraging integration and automation will be essential for reducing manual effort and enhancing accuracy throughout the eligibility process. States like South Carolina, for example, are implementing work requirements under a waiver, advancing data integration, and demonstrating how proactive planning can enable automation and lessen administrative burdens.
5. Use automation and AI
Meeting these requirements may increase the administrative complexity and workload for caseworkers. To address the potential increased risk of errors, agencies can automate new workflows to enable no-touch or low-touch processing for applications and renewals.
Automation and artificial intelligence (AI) in verification workflows can help minimize manual input, reduce errors, and improve data accuracy across all eligibility processes. When integration is unavailable, agencies can explore AI tools to support eligibility verification. For example, using AI across a range of verification documents, such as IDs and pay stubs, can reduce manual tasks and support low-touch processing.
6. Enable self-service
Self-service portals are essential tools for reducing manual effort and supporting caseworkers who are likely to see higher workloads. Self-service portals give beneficiaries greater control and access to manage their own cases more efficiently, improving their experience.
By combining document upload capabilities with AI, agencies can automatically extract and validate data, reducing the need for manual review and accelerating verification timelines. Faster verifications mean quicker processing, helping prevent coverage loss from manual delays.
AI-powered assistants can also play a critical role in guiding citizens through the changes introduced by HR1. These tools can help individuals understand new eligibility requirements, identify what documentation may be required, and answer common questions, reducing confusion and improving engagement without placing increased burden on the agency.
Modernizing to meet evolving demands
Medicaid directors face increasing pressure from policy changes, budget constraints, and workforce challenges. HR1 brings complexity and aggressive implementation timelines that demand agility, accuracy, and efficiency from government agencies. It is no small task to navigate this terrain while maintaining quality and accessibility for eligible people who depend on benefits and services.
But technology companies are partnering with the Centers for Medicare & Medicaid Services (CMS) to support the implementation of community engagement and system improvements. The industry recognizes it will take collaboration to ensure eligible individuals can successfully navigate new policy requirements under HR1.
With a strategic approach and the right combination of modern platforms, automation, and expert services, agencies can flex to meet evolving policy demands.
About Mike Hall
Mike Hall, Chief Product Officer, Cúram by Merative, is the author of this article. He is a strategic product leader with deep expertise in State social services, fraud prevention, and data science. He has led large-scale initiatives to modernize eligibility and enrollment systems, strengthen program integrity, and prevent fraud across Medicaid, SNAP, TANF, and other public programs.
