HR 1 and Medicaid redetermination
Help eligible members keep their Medicaid coverage
Rovicare helps health plans, providers, and community organizations coordinate redetermination support. Identify members needing help, organize outreach, track missing information, and follow renewal progress.
Renewal requirements are changing. Start preparing your teams now with a focused, measurable pilot.
Outcome source: state eligibility file, received 10/28. Submission, active coverage and same-plan retention are reported separately.
Capabilities
- At-risk member identification
- Eligibility checks
- Renewal outreach
- Document tracking
- Shared follow-up
Outcomes we help you pursue
- Fewer coverage gaps
- Better care continuity
- Preserved capitation revenue
- Lower administrative costs
- Stronger renewal readiness
Keep eligible members connected to coverage and care
Rovicare brings renewal dates, outreach, document needs, assistance, and follow-up into one shared workspace. Health plans, providers, and community partners can see what is missing, who is helping, and which cases still need attention.
For health plans, the workflow supports coverage continuity and visibility across participating providers. For FQHCs and integrated providers, it helps organize renewal assistance alongside care delivery, reduce repeated follow-up, and limit disruption when coverage is at risk.
The coverage continuity challenge
Missed notices, incomplete documentation, and unresolved barriers can interrupt coverage and care. Prepare your teams for renewal demands and HR 1-related changes to Medicaid renewal and community engagement requirements with a coordinated approach to member support. Requirements vary by state and population, so we scope each program against current official guidance.
Member renewal journey
Identify members approaching renewal, check available coverage information, and prioritize those needing assistance. Track outreach, document needs, submission progress, and verified outcomes.
- Renewal due
- Outreach
- Document assistance
- Submission tracked
- Outcome verified
Exception path: Pending and unknown outcomes stay open and visible until a verified decision is recorded.
| Stage | What the team does | Evidence or next action |
|---|---|---|
| Identify and assign | Reconcile roster, renewal dates, payer, clinic and assigned owner | Source and timestamp for renewal date; named case owner |
| Check and prioritize | Use individual or batch coverage checks through configured payer connections | Coverage response and date; no renewal decision is inferred |
| Reach and assist | Use configured SMS, email, AI voice or staff outreach; arrange assistance | Contact attempts, successful engagement, preferred language, callback or appointment |
| Prepare documents | Track a case checklist; collect records; authorized staff review | Missing documents, responsible person and next follow-up date |
| Submit with authorized help | Assistors or other authorized staff submit through the applicable process | Submission receipt, reference or staff-recorded evidence |
| Resolve requests | Track state requests for additional information | Due dates, action owner and evidence supplied |
| Verify and close | Record the actual decision and coverage dates | Verified renewal, loss reason, pending or unknown; same-plan status tracked separately |
Health plan, provider and community roles
Health plan teams organize cohorts and monitor progress. Providers identify patients needing assistance during care encounters and manage assigned follow-up. Community partners help resolve barriers and connect people with authorized assistance. State agencies determine eligibility. Shared ownership helps prevent duplicated outreach and missed tasks, without treating platform activity as a state decision.
- Health plan: cohorts, prioritization, progress monitoring
- Provider and FQHC: assistance during care encounters, assigned follow-up
- Community partner: barrier resolution, authorized assistance
- State agency: eligibility determination
Outreach and document tracking
Assign each unresolved need to a team member, record contact attempts, and track the next step. Keep missing documents and approaching deadlines visible to the people responsible for follow-up. Staff review potential exemptions and supporting evidence.
Verified outcome dashboards
View renewals due, successful contacts, unresolved barriers, submission status, and verified coverage outcomes. Separate pending and unknown cases from confirmed renewals so teams act on the right information. Application submission, Medicaid coverage, and same-plan retention are reported as separate measures, each with its source and date.
Outcome source: state eligibility file, received 10/28. Submission, active coverage and same-plan retention are reported separately.
ROI illustration
Evaluate additional covered member months, outreach effort, and implementation cost using your own assumptions. Capitation preserved is shown separately from contribution margin, and projected value is kept distinct from verified results.
Renewal business case (health plan view)
Licensing + implementation + integrations + usage + operating effort
Enter your assumptions to see the model
All required fields, including a nonzero cost, are needed. No preset savings are assumed.
Projected value using your assumptions. Gross capitation and its derived contribution are never added together. Verified results come from actual renewal decisions.
Implementation
Start with a defined cohort and named case owners. Map the current process, load approved source data, configure work queues and outreach, test sample cases, and train users. Launch the agreed workflow and review engagement, case progress, staff effort, and verified outcomes before expanding. Let us scope your implementation.
Frequently asked questions
More answers on our FAQs page.
Review your renewal process with us
Let us review your renewal process and the roles of your provider and community partners. We will identify a focused workflow and measures for a practical pilot.