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Service Line 5: Medicaid Application & Recertification Support

Caring Connections Alliance offers a high-impact, CHW-led Medicaid navigation service designed to shield clinical providers from the growing administrative fallout of recent federal reforms that have made Medicaid enrollment and retention more complex. With the passage of new legislation introducing frequent recertification, work documentation requirements, and stricter eligibility compliance, many rural and underserved patients are at imminent risk of coverage loss and care disruption—even when clinically eligible. Our trained Community Health Workers (CHWs) provide in-person or remote assistance with Medicaid applications, redetermination forms, documentation collection, and navigation of new work verification protocols. This service ensures that eligible patients remain enrolled and able to access care, while allowing providers to maintain financial viability and avoid revenue leakage tied to lapses in coverage.

Clinical and Operational Benefits:

• Preserves Medicaid coverage for high-risk patients vulnerable to disenrollment
• Prevents appointment cancellations and care gaps due to sudden insurance loss
• Reduces the administrative burden on front-desk staff, social workers, and care teams
• Stabilizes access to chronic care, behavioral health, prenatal care, and specialist referrals
• Builds patient capacity to navigate new work-related compliance standards

Cost Abatement & Reimbursement Alignment:

• Protects practice revenue by reducing uncompensated care events tied to failed renewals
• Decreases avoidable ED utilization caused by mid-treatment coverage termination
• Ensures documentation supporting:

    o Z59.7 (insufficient welfare or public insurance support)
    o Z56 series (employment-related risks relevant to work requirement compliance)
• Supports organizational performance under:
    o Medicaid MCO quality contracts
    o Value-based payment programs where continuous coverage is critical for attribution, PMPM revenue, and performance metrics
    o State 1115 waivers requiring documentation of SDOH barriers to enrollment
This service is essential for rural primary care providers, perinatal and behavioral health networks, FQHCs, and Medicaid-aligned health systems now facing higher administrative risk under the new law. Caring Connections Alliance enables providers to focus on care delivery—while our CHWs protect the coverage continuity your patients and practice depend on.

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