The Medicaid program has long been a lifeline for millions of Americans, ensuring that those in need have access to essential healthcare services. However, the COVID-19 pandemic exposed significant challenges within the system, particularly related to maintaining continuous enrollment and managing the influx of new applications. In response, Congress enacted the Families First Coronavirus Response Act (FFCRA), requiring Medicaid programs to keep individuals continuously enrolled through the end of the COVID-19 public health emergency (PHE). This policy was a crucial step in preventing mass disenrollment during the crisis, but it also introduced new complexities that public sector agencies had to navigate.

With the PHE’s conclusion on March 31, 2023, millions of Medicaid enrollees faced the risk of losing their coverage. Over 13 million individuals were disenrolled, with 71% of them losing coverage for procedural reasons, not because they were ineligible. This massive disruption underscored the need for a more robust, efficient, and citizen-focused Medicaid service infrastructure.

For public sector agencies tasked with managing these services, the question became clear: How can we better serve our constituents and ensure that no one falls through the cracks? The answer lies in leveraging advanced technology to streamline processes, reduce errors, and enhance the overall experience for both citizens and staff.

Untangling Medicaid’s Complexities

Challenges Faced by Citizens:

Communication Gaps: Constituents often need help finding a single, reliable source of information. This leads to confusion and delays in accessing critical services.
Document Handling: The process of submitting, modifying, or renewing applications is cumbersome, particularly for those who lack digital literacy or access to technology.
Manual Processing Delays: Paperwork bottlenecks result in extended wait times, leaving many without coverage when they need it most.

Challenges Faced by Public Sector Agencies:

Public sector agencies across the United States are under increasing pressure to provide timely, accurate, and accessible services to their constituents. In the context of Medicaid, these challenges are particularly pronounced.

Resource Allocation: Caseworkers are overwhelmed with basic queries, diverting their attention from more complex, high-priority cases.
Manual Document Processing: The sheer volume of documents that need to be reviewed manually increases the likelihood of errors and slows down the entire process.
Operational Inefficiencies: The reliance on outdated processes and technologies hampers the ability to respond swiftly to constituent needs.

These challenges highlight the need for a transformative approach that not only addresses the immediate concerns but also lays the foundation for a more resilient, future-proof Medicaid service delivery system.

Reimagining Medicaid with AI-Driven Solutions

Quantiphi, in partnership with Google Cloud Platform, has developed a suite of solutions designed to address these challenges head-on. Our approach is grounded in the belief that technology should be a tool for empowerment—enabling agencies to serve their constituents more effectively and equitably.

Transforming Citizen Services with AI

Virtual Agents: In today’s fast-paced world, citizens expect immediate, round-the-clock access to services. Quantiphi’s AI-powered virtual agents provide 24/7 conversational self-service, allowing constituents to address their needs without human intervention. These agents guide users through the Medicaid renewal or application process, answering questions about eligibility, deadlines, and required documents.

Impact:
By automating these interactions, agencies can significantly reduce the volume of calls that require human assistance, freeing up staff to focus on more complex issues.

Insights: Understanding the pain points in the Medicaid application process is crucial for continuous improvement. Our solution includes robust analytics tools that capture key insights from citizen interactions. Agencies can identify the most common challenges and take proactive steps to address them, whether through process improvements or by refining the virtual agents’ capabilities.

Impact:
These insights empower agencies to optimize their operations, ensuring that constituents receive faster, more accurate assistance.

Agent Assist: When a query requires human intervention, the agent must be equipped with the right tools to resolve it quickly and accurately. Quantiphi’s Agent Assist solution provides real-time, step-by-step support during calls, guiding agents through complex issues and ensuring constituents receive the help they need without unnecessary delays. This solution can be integrated with a GenAI-powered internal search tool, enabling agents to quickly access relevant information from internal databases.

Impact:
This approach improves the accuracy of responses and reduces the average handling time, enhancing overall efficiency.

Generative AI Infobot: Quantiphi has integrated Google Cloud’s Generative AI capabilities into our Virtual Agents, creating an Intelligent Agent that can access and interpret information from a variety of sources, including agency websites and internal databases. This ensures that constituents receive the most accurate and up-to-date information, even for more complex queries.

Impact:
The Intelligent Agent enhances the capabilities of the virtual agents, allowing them to handle a broader range of queries with greater accuracy and efficiency.
Simplifying Paperwork with AI
The manual processing of documents is one of the most significant bottlenecks in Medicaid service delivery. Quantiphi’s Document AI solution, powered by Google Cloud, automates this process, reducing the burden on staff and accelerating the entire workflow. Key features include:
- Document Quality Assessment: Automatically requests resubmission if the document quality is insufficient, ensuring that only clear, legible documents are processed.
- Document Classification: Automatically detects the type of document submitted and flags any missing documents, streamlining the review process.
- Entity Extraction: Extracts relevant data from supporting documents and verifies it against the information provided in forms, reducing the likelihood of errors.
- Form Data Validation: Cross-references the data submitted in forms with backend systems to ensure accuracy before proceeding.
- Agent View: Provides a comprehensive overview of all submitted documents and forms, enabling staff to monitor progress and address any issues promptly.
- Auto Upload: Seamlessly integrates documents and data into the Case Management System, with built-in analytics for ongoing monitoring.
- Language Support: Handles documents in multiple languages, ensuring that all constituents, regardless of language proficiency, can access services.
The Power Duo: Contact Center AI + Document AI

The integration of Contact Center AI (CCAI) and Document AI creates a powerful end-to-end solution. For example, a chatbot deployed on the agency’s website can guide users through the submission of documents, providing immediate feedback on incomplete or unclear submissions. This not only speeds up the resubmission process but also ensures that documents are processed correctly the first time.

Real Stories of Medicaid Transformation

Missouri Department of Social Services

The Missouri Department of Social Services faced challenges in managing constituent interactions, particularly in scheduling appointments and answering queries. Quantiphi deployed a telephony and chat virtual agent to automate these processes, integrating Generative AI capabilities to provide a seamless, conversational experience. The solution also included advanced security features such as Speaker ID and Multi-factor authentication to prevent fraud.

Impact:
This solution resulted in a 70% reduction in wait times and projected savings of $15M-$23M over five years, demonstrating the tangible benefits of automation and AI-driven solutions.

Department of Health, Central USA

Quantiphi partnered with a Department of Health in central USA to address challenges related to Medicaid service delivery. By deploying virtual agents and Document AI, we helped significantly reduce processing times and improve the overall citizen experience. Our solution included a multilingual chat interface that provided support in English, Spanish, and Vietnamese, ensuring that all constituents had access to the services they needed.

Impact:
The implementation led to a marked improvement in service delivery, and equity to constituents with different language requirements, coupled with faster response times and greater accuracy in document processing.

Moving Medicaid Forward

The challenges facing Medicaid services are significant, but they are not insurmountable. With the right technology and strategic approach, public sector agencies can reimagine the way they serve their constituents. Quantiphi’s AI-powered solutions, built on Google Cloud, offer a clear path forward, enabling agencies to enhance efficiency, reduce errors, and improve the overall experience for the citizens they serve.

We invite you to explore how these solutions can transform your organization. Get in touch with our experts to learn more about how we can help you better serve your community. Discover Quantiphi’s expertise in delivering solutions for the public sector here.