For state Medicaid agencies
Benefits continuity for state Medicaid agencies.
Verify and enroll eligible residents, and keep them covered through redeterminations, without adding headcount, with an audit-ready record behind every determination.
Why now
H.R.1's Medicaid community-engagement requirement takes effect January 1, 2027.
States must determine who is subject to the requirement, and whether they're compliant, deemed compliant, or excluded. They must verify it from available data, run outreach and cure workflows, and keep auditable records. All on systems that were never built for this.
Figures are CMS estimates accompanying the interim final rule implementing H.R.1's Medicaid community engagement requirement: Medicaid Program; Community Engagement Requirement for Certain Individuals (CMS-2454-IFC), published June 3, 2026; requirements effective January 1, 2027.
What you get
An audit-ready compliance record for every member.
Mirza turns the engine's work into a single exportable record your team and your auditors can stand behind. Built to drop into agency systems, MCO workflows, or your integrator's environment.
Built for the hard cases
For state Medicaid agencies and managed care organizations navigating H.R.1: Mirza surfaces the clinical evidence behind medical frailty exemptions before disenrollment notices go out. Claims data captures diagnoses. The new work-ability standard requires something different. Mirza bridges that gap using clinical documentation infrastructure that no eligibility system can reach, delivering a clean evidence feed to states without managing EHR data directly.
- StatusSubject, compliant, deemed compliant, excluded, or needs outreach.
- EvidenceThe data sources and documents behind every determination.
- Rules & reviewThe logic applied, plus human-review actions and consent history.
- Audit trailEvery step timestamped, from first data check to final output.
Delivered as structured output, straight to your system of record.
Data first, member burden last
Verify what can be verified before asking anyone to prove it.
Regulators call it ex parte verification: use the reliable data you already have before shifting the burden of proof onto members. Mirza makes that the default order, and routes the hard cases to people, not dead ends. Then we widen the check itself: Mirza brings work-activity and medical-frailty evidence the system doesn't already hold, so more people clear before anyone is asked for paperwork.
Confirm identity & consent
Establish the person, the household, and what data may be accessed, and by whom.
Check reliable data first
Evaluate status against state, plan, payroll, and income data, plus the sources Mirza brings: live payroll and gig-platform connections for work activity, and medical-frailty evidence from clinical documentation that claims-based systems can't reach.
Apply rules, exceptions included
Compliant, deemed compliant, excluded, or needs outreach, with logic for medical frailty, caregiving, and hardship built in.
Ask only when needed
Request a document only when reliable data falls short, and send sensitive, low-confidence cases to human review.
When outreach is needed, it meets members where they are: reminders and guided follow-ups in the member's language, on the channels they already use. A conversation that starts on one channel can continue on another without starting over. Progress is saved, and documents uploaded once are reused across every program.
Procurement
The deadline is fixed. The acquisition path doesn't have to be slow.
CMS-2454-IFC requires states to verify community engagement compliance, and identify medically frail and other exempt members, by January 1, 2027. Most eligibility systems were never built to do this, and no standard E&E module does it today. States without a tool in place may qualify for expedited or sole-source acquisition under their procurement rules. Our government team prepares the documentation your procurement office needs, including the technical justification.
- TodayJune 2026
- Acquisitionvehicle · APD · sole-source
- Integration~8 weeks · data agreements
- Outreach & cure livebefore first determinations
- Jan 1, 2027requirement effective
Working backward from January 1: states that start acquisition this quarter run outreach and cure workflows before the first determinations are due.
APD support
We prepare Advance Planning Document-ready documentation (scope, cost allocation, and the federal funding pathway for E&E system enhancements) so your team isn't drafting it from scratch.
Through your integrator
Already mid-contract with a systems integrator? Mirza drops into integrator-led programs as the verification, exception, and compliance layer. No procurement reset required.
Medicaid Program; Community Engagement Requirement for Certain Individuals (CMS-2454-IFC), 91 Fed. Reg., published June 3, 2026. Requirements apply beginning January 1, 2027. Exemptions include medically frail individuals, pregnant and postpartum women, certain caregivers, Tribal members, and veterans with a total disability rating. Sole-source and expedited acquisition availability varies by state procurement law. Mirza provides supporting documentation; your procurement office determines the vehicle.