Company Blog

Three panels at this year's AHIP Annual Conference kept arriving at the same uncomfortable conclusion. A tough financial environment alongside a fast-approaching January 1, 2027 deadline. The plans best positioned to navigate new requirements under the “One Big Beautiful Bill” and H.R. 1 aren't scrambling to build something new… they’re continuously building on infrastructure from the past.

In June 2026, CMS released the interim final rule implementing the new Medicaid community engagement requirement created by Section 71119 of the Working Families Tax Cut (WFTC) legislation. This is the most significant change to Medicaid eligibility since expansion, and it introduces a work-or-activity requirement as a condition of coverage for many adult Medicaid members.

Medicaid notices come in many forms - coverage denials, fair-hearing rights, copay changes, plan assignments, service authorizations, and the annual renewal - but they share a problem: each one asks someone, often someone managing a chronic condition, working two jobs, or caring for a child, to understand what's happening and frequently to act on it.

Most of the conversation about H.R. 1 has focused on work requirements. But buried in the same law is a set of changes that will hit a different population just as hard - and with far less warning: older adults and people with disabilities who rely on Medicaid, Medicare Savings Programs (MSP), and Low-Income Subsidy to afford their healthcare.

On May 1, 2026, Nebraska became the first state to start Medicaid work requirements under H.R. 1. With CMS implementation guidance not due until June 1, the documents Nebraska DHHS has published - the Verification of Compliance Notice (VOCN) and the Individual Declaration Form (MLTC-118) - are the first concrete look at how a state will actually operationalize the new requirements.

For the last 2 years, we've been tracking the maturation of voice AI infrastructure closely. Only recently did we feel it had reached the right technical thresholds - on latency, contextual understanding, guardrails, and voice diversity - to deploy in a healthcare setting with confidence.

When we started Fortuna, we had a clear hypothesis: Medicaid navigation is broken, and a better consumer product would fix it. We were right about the first part. The second turned out to be more complicated.

Over two days at AHIP, three separate sessions converged on a consistent picture: H.R. 1 is landing on systems already under pressure. The January 1, 2027 deadline is real but implementation will be iterative for years, and the moment demands more from plans than any prior redetermination cycle.

Under the One Big Beautiful Bill Act (H.R. 1), many adults on Medicaid will soon need to regularly show proof of working, volunteering, or attending school to keep their Medicaid coverage. These are known as work requirements, or “community engagement requirements,” and they will take effect January 1, 2027.

We’re bringing AI-powered voice capabilities into Medicaid renewals - helping plans and states reduce call center load, lower caseworker burden, and ensure more members stay covered.

Two conversations at Medicaid Innovations - one focused on Medicaid renewals, the other on H.R. 1 implementation - kept circling the same realization: this is not an eligibility redetermination story. It’s a sustained compliance, verification, and communications challenge, landing on systems that are already under pressure.

Collaboration helps states deliver people-first digital engagement and real-time coordination so residents stay informed, enrolled, and supported across health, benefits, and human services systems.