On January 1, 2027, Medicaid coverage gets harder to keep. New federal rules will require able-bodied adults aged 19–64 to complete 80 hours of work or community activity each month – with eligibility verified every six months. For the approximately 18 million members affected, navigating this process will be complex, confusing, and easy to fail – not because they are ineligible, but because the paperwork gets in the way.
For health plans and managed care organizations, the stakes could not be higher. Procedural disenrollment – losing members due to missed deadlines or incomplete documentation rather than actual ineligibility – is both a human tragedy and a financial crisis waiting to happen.
The Scale of the Problem
The numbers are stark. Analysis of a sample 1.8 million-member Medicaid plan suggests that a 10% disenrollment rate could mean nearly $940 million in lost annual revenue and $80 million in churn-related administrative costs. Scaled across the industry, broader disenrollment scenarios could represent up to $125 billion in financial exposure for health plans and their MSO partners.
Major managed care organizations have already felt the impact of earlier redetermination cycles. The damage to member populations, risk pools, and value-based performance is real — and the 2027 requirements will intensify the pressure. Plans that do not act now risk repeating that experience at a greater scale.
More outreach is not the answer. Smarter, two-way engagement is.
From Outreach to Real Engagement with Florence
Florence, the Safe AI Nurse, is proven to automate engagement and management of Medicaid members. It combines validated protocols with safe AI. Florence is proven to drive better outcomes and free up staff across key chronic conditions.
- Proactively reach members via SMS with plain-language renewal reminders, deadline alerts, and step-by-step guidance
- Answer two-way questions in real time – about income verification, address changes, exemptions, and documentation requirements
- Capture structured eligibility data through guided conversations and flag incomplete submissions before deadlines
- Escalate high-risk or non-responsive members to care managers for targeted human follow-up
Florence is already embedded in care management workflows at health plans and community health organizations, demonstrating measurable improvements in member engagement and retention.
Protecting Members, Protecting Performance
The 2027 cycle is a test. Plans that engage members now will protect their population, their risk pool, and their revenue. Plans that don’t will repeat the losses of earlier cycles.
See how Florence multiplies your care team –
