Today, Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment services often lag behind those offered for qualified health plans (QHPs). This gap persists despite many dedicated agency staff and leaders working overtime to provide Medicaid/CHIP customers with the same quality and dignity in their health insurance journey as QHP enrollees. A 2024 Centers for Medicare & Medicaid Services (CMS) report revealed that less than half of Modified Adjusted Gross Income (MAGI) enrollees nationwide are processed within 24 hours, and even fewer receive no-touch eligibility. We’ve spoken with states experiencing Medicaid contact center first-call resolution rates under 10%, states for whom Medicaid care plan enrollment at the time of eligibility is virtually unheard of, and states facing the pressure of penalties or lawsuits for Medicaid/CHIP timeliness or accuracy rates.
In our experience, these issues are rooted in both technology and process. It isn’t uncommon for Medicaid programs to still run on mainframes or similar technology, and many rely on manually intensive processes that lack comprehensive self-service options for applicants, community-based organizations (CBOs), or providers. This creates a system that requires considerable coordination between agency staff, customers, and partners, increasing the risk of errors and delays in service. To add to this, Medicaid systems can be difficult and expensive to change.
Vimo® has helped 32 states improve eligibility, enrollment, and human services programs, achieving nearly 22 million no-touch eligibility determinations, assisting states in serving up to 130% more customers, and improving same-day eligibility determinations by 80%.
Our experience has also taught us that if it can be done for the QHP journey, it can be done for the Medicaid/CHIP journey. With our solutions, states across the country have achieved high quality service levels, unmatched accuracy, and fast results in their QHP and Medicaid/CHIP eligibility and enrollment services. We’ve achieved these outcomes through our state-based exchange technology solution, which offers integrated Medicaid assessment and determination options, and by leveraging our longstanding experience in Medicaid consulting and business process redesign. In our state-based exchanges offering Medicaid services, more than 70% (and growing) of MAGI enrollees achieve no-touch eligibility and enrollment, and of the remaining, almost 94% achieve first call/touch resolution – and we don’t think these numbers should be outliers.
That’s why we developed Medicaid Express: a comprehensive Medicaid eligibility and enrollment user portal suite that delivers real results.
Medicaid Express: Designed to Bridge the Gap Between the QHP and Medicaid Eligibility and Enrollment Journey
Medicaid Express transforms the Medicaid/CHIP eligibility and enrollment process, making it easy for first-time and returning applicants to apply for Medicaid/CHIP eligibility, receive quick no-touch determinations, and enroll in programs with accurate results and little agency intervention or support required. In addition, Medicaid Express makes it easy for consumers to shop for and select a Medicaid Managed Care Organization (MCO) plan the same day eligibility results are received. The shopping experience mirrors that of leading state-based exchange platforms, with features similar to those offered by web retailers like Amazon. With extensive self-service options and highly accurate, secure automation features, Medicaid Express facilitates a process that is faster and easier for customers, agencies, CBOs, and providers alike.
Modular by Design: Tailored to Every State’s Needs
Every state is unique, and with this in mind, Medicaid Express was designed from the ground up to be modular and configurable. Whether or not your state uses a state-based exchange model, and whether or not you wish to leverage an integrated call center, Medicaid Express can be deployed in the way that best fits your operational needs. States can adopt the full Medicaid Express suite or select only the components that meet their current priorities – from self-service customer portals to CBO and provider modules, from AI-powered worker tools to real-time reporting and compliance features. Medicaid Express is built to enable incremental adoption, making it possible to enhance current systems or replace them entirely on your state’s timeline, with minimal disruption.
Ready for OBBBA Community Engagement (Work) Requirements
With the passage of the One Big Beautiful Bill Act (OBBBA), many states now face new community engagement (work) requirements for certain Medicaid populations. Medicaid Express is designed to help states seamlessly implement and manage these requirements while minimizing administrative burdens or customer confusion. Our solution includes configurable modules that allow states to:
- Track, verify, and report work/community engagement activities as required under OBBBA, leveraging secure data integrations with workforce agencies and approved third-party documentation.
- Notify customers of requirements, deadlines, and new reporting obligations through automated, multilingual communications via web, mobile, email, and SMS.
- Provide self-service tools enabling customers to log and submit proof of qualifying activities, receive reminders, and access resources to help them meet engagement requirements.
- Support exemptions and good-cause claims via intuitive workflows for both customers and eligibility workers, ensuring compliance with federal guidelines and fair treatment of vulnerable populations.
- Generate compliance reports for agencies to fulfill state and federal oversight requirements with minimal manual intervention.
By integrating OBBBA community engagement functionality into Medicaid Express, states can modernize their approach to eligibility and enrollment while remaining fully compliant with new federal mandates.
No Wrong Door: Seamless Integration Across Programs
Medicaid Express is designed to fully support the “no wrong door” philosophy. Our solution ensures that applicants are connected to the right coverage and services, regardless of their entry point. Medicaid Express can receive and send referrals for programs like the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and others, enhancing the health care coverage continuum and providing a true single point of access for all essential benefits. This capability means that whether an individual applies for health coverage, food assistance, or cash benefits, their information is routed to the appropriate program for a holistic, customer-focused experience.
Key Features and Long-Term Benefits of Medicaid Express
Medicaid Express Offers Comprehensive Eligibility and Enrollment Features
| Consistently Fast Eligibility Results | With Medicaid Express, 80% of MAGI applicants receive eligibility results within 30 minutes or less and can compare, select, and enroll in an MCO the moment eligibility is determined. |
| Enhanced Accuracy with Comprehensive Verification Sources | Medicaid Express features unmatched measures for program integrity. The solution verifies information using a myriad of electronic sources, including permission-based methods that address otherwise challenging to reach information, such as income from gig workers, self-employed workers, and those on payroll systems not participating with traditional sources. |
| Ex Parte Renewals for Ongoing Coverage | To facilitate continuous coverage, Medicaid Express delivers an ex parte renewal decision to 80% of MAGI individuals through the same processes used at the time of application. |
| Customer Self-Service Options for Common Tasks | All Medicaid applicants have access to:
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| State Staff/Eligibility Specialist Support | Medicaid Express supports state staff and eligibility specialists with a designated user portal and comprehensive features, including Vimo’s Worker Assistant AI – a chatbot that provides tested, reliable information on policies and processes, reducing ramp-up time for new staff and keeping existing staff up to date. |
| Community-Based Organization Support | Medicaid Express also offers a portal specifically for CBOs, where they can easily submit applications on behalf of applicants, check the status of applications, communicate directly with the agency, and more. No other system in the U.S. currently provides this capability. |
| Provider Support | The Provider Portal allows authorized providers to submit Presumptive Eligibility requests and Emergency Medicaid requests and notify the agency of pregnant women and newborns. They can also check in on the status of every submission and securely communicate with the agency. All submissions are automatically processed, allowing for timely decisions and proper coverage, and ensuring providers get paid. Very few systems in the U.S. currently offer this capability. |
| Customer Service Center Assistance | Our Customer Service Center offers 24/7 service for common Level 1 questions. We auto-process 30% of requests with AI to provide faster resolutions to basic inquiries. |
| Easy Enhancements and Customizations | Medicaid Express was designed to make enhancements and customizations easy, so if states innovate with new programs and waivers, the solution is ready to support them. Vimo also has a policy group of staff from CMS and state leadership that stays abreast of changes in the Medicaid landscape, so we are prepared to consult on policy changes and help our clients stay current. |
| Extensive System Visibility and Reporting Features | With Medicaid Express, states receive a data tracking and reporting repository that makes accessing data for reports and analysis easy – both reports intended for external compliance and auditing purposes and those intended for internal assessment and development purposes. |
| Ongoing Compliance Reassurance | The solution meets government Americans with Disabilities Act (ADA) guidelines, is aligned with Medicaid Information Technology Architecture (MITA), adheres to the Minimum Acceptable Risk Standards for Exchanges (MARS-E), is System and Organization Controls (SOC) 2 compliant, and adheres to all modern standards for integration. Additionally, our teams stay informed and keep our solutions ahead of any changes in compliance requirements. |
Medicaid Express improves program integrity.
The vast majority of improper Medicaid and CHIP payments related to eligibility are due to a lack of documentation indicating that eligibility was properly determined and that verifications were correctly completed. With Medicaid Express, eligibility determination and verification processes are automated, so enrollment and renewals cannot move forward before the determination is complete, nor without proper verification and upload of necessary documentation. This approach creates a streamlined process that enhances program integrity. In addition, we provide regular updates to ensure that our products remain compliant as programs and policies evolve.
Medicaid Express reduces customer stress and unnecessary lapses in coverage.
By streamlining and automating much of the eligibility determination and renewal process and making it easy for customers to upload documents and receive redeterminations, Medicaid Express minimizes the amount of work required by customers while reducing lapses in coverage related to procedural errors. The solution also minimizes lapses caused by changes in eligibility by providing customers who no longer qualify for Medicaid/CHIP with comprehensive eligibility information for QHP subsidies, including advanced premium tax credits (APTCs) and cost saving reductions (CSRs). Customers are fully informed of their health insurance program options and can pursue any of them from their eligibility determination screen.
Medicaid Express enhances staff capacity, increasing work satisfaction and reducing turnover.
Many of the automated and integrated features of Medicaid Express not only simplify the customer experience – they also enhance agency capacity by reducing the amount of time staff spend completing basic, repetitive tasks or unnecessarily duplicating work. In our experience, this has a profound downstream effect: staff have more time to focus on complex tasks, which leads to better customer outcomes and often improves work satisfaction. As a result, burnout and turnover decrease, cultivating a more experienced, knowledgeable, and engaged team that is more likely to contribute to ongoing program development and success.
Medicaid Express offers agencies an outcome-oriented, future-proof, and cost-effective solution.
To ensure we’re delivering the results our clients want, we offer an outcome-oriented approach to contracts with accountability based on service-level agreements. We also offer a flexible, service-oriented architecture designed to adapt to specific and changing needs, and we provide our clients with regular updates and enhancements to ensure our products are not only consistently compliant but also provide the best possible solution to meet agreed-upon outcomes. Many of the updates and enhancements we offer come at no cost to our clients, leading to long-term savings. Medicaid Express also reduces fee-for-service (FFS) costs and costs related to administrative complexities.
Medicaid Express provides tangible results that position states as leaders.
The states already implementing elements of our Medicaid Express solution have seen promising results. In Missouri, we helped the Department of Social Services reduce call center wait times by 77% and reduced MAGI verification annual spend by $5 million. Virginia’s first year using our integrated state-based exchange and Medicaid solution led to a nearly 14% increase in enrollments, and in 2024, the Virginia Health Care Foundation reported “the lowest uninsured rates” the state had seen since the Foundation began tracking these numbers in 1996.
The gap between QHP and Medicaid/CHIP eligibility and enrollment services doesn’t have to be the norm. Medicaid Express helps agencies achieve faster, more accurate eligibility decisions and offers a user-friendly experience that leads to real results – and easily adapts to policy and program changes over time. In short, it’s tech for good.
To Learn More:
- Reach out to chat with us about how Medicaid Express can be customized to your agency’s operational needs and goals.
- Read about how our account transfer processes are paving the way forward in Medicaid/CHIP/QHP No Wrong Door functionality.
- Request our whitepaper on transitioning to a state-based exchange as a MAGI assessment or determination state.
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