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Community Engagement Verification: AI-powered compliance for Medicaid Work Requirement

Medicaid Work Requirements Strain State Operations

H.R.1 mandates Community Engagement Verification (CEV) for Medicaid expansion populations requiring states to collect, verify, and track employment, volunteer hours, training, and exemptions at scale. Most states are not equipped to absorb this demand.

90%+  

of Medicaid eligibility systems rely on legacy architectures not designed for modern compliance demands
72%  

of state Medicaid agencies cite manual document processing as a top administrative bottleneck
>~18M  

Medicaid expansion enrollees subject to new work requirement verification under H.R.1

Without an intelligent solution, states face surging administrative burdens, slower processing, inconsistent compliance decisions, and increased coverage disruptions while managing with constrained caseworker capacity and aging technology infrastructure.

The Infosys CEV Solution: Intelligent Compliance at Scale

Infosys Community Engagement Verification (CEV) is a modern, AI-powered platform purpose-built for H.R.1 compliance. CEV uses composable microservices architecture, machine learning, and intelligent automation to transform reactive compliance processing into proactive engagement without destabilizing existing eligibility systems.

Document Intelligence 

Automatically extracts hours, wages, and employer details from pay stubs, timesheets, and volunteer logs using HIPAA-compliant OCR—reducing manual review by up to 70%.
Predictive Compliance Scoring 

Analyzes submission history and behavioral patterns to identify at-risk beneficiaries early, enabling proactive outreach before coverage lapses occur.
Conversational AI 

An intelligent chatbot that answers questions, guides document submissions, and provides personalized next steps—reducing call center volume and improving beneficiary experience.
Resource Matching Engine 

Matches beneficiaries to relevant training, volunteer, and employment opportunities based on skills, location, and work history to support long-term compliance.
Caseworker Decision Support 

Dashboards with prioritized work queues, explainable AI risk scores, automated case notes, and one-click approval workflows for faster, more consistent decisions.
Modular Microservices Architecture 

Built API-first with event-driven design, CEV integrates with workforce agencies and can be deployed as a standalone service protecting existing eligibility investments.

Key Differentiators

  • Trusted AI: Responsible AI with guardrails, RAG, and human-in-the-loop oversight for explainability and fairness
  • HIPAA-Compliant: Certified HIPAA-compliant document processing using Amazon Textract and governed data pipelines
  • Open & Interoperable: No vendor lock-in; standards-based APIs interoperate with workforce agencies and managed care plans
  • Modernization Catalyst: CEV serves as the first step toward full Medicaid Enterprise modernization using the Strangler pattern
  • Reusable by Design: Reusable verification recipe extends to income, identity, and residency with no rework
  • Funding-Aligned: APD-ready with modular boundaries, cost allocation documentation, and measurable outcomes

Potential Benefits to your Agency

Up to 70%  

Reduction in release cycle time for CE changes
Up to 50% 

Up to 50% Fewer manual caseworker touches for determinations
>99.9%  

Platform availability during peak reporting periods
FOR THE AGENCY FOR BENEFICIARIES
  • Reduced administrative burden and processing time
  • Improved program integrity and audit readiness
  • Consistent, explainable compliance determinations
  • Scalable platform that grows with policy changes
  • Foundation for broader Medicaid Enterprise modernization
  • Timely, personalized guidance on compliance requirements
  • Proactive outreach before coverage is at risk
  • Self-service tools that reduce friction and confusion
  • AI-matched job training and community resources
  • Fewer coverage disruptions and unintended terminations

Contact Vijay_Ravichandran@infosys.com for a demo