Connecting Back
In our first blog, we explored the new eligibility and redetermination demands created by the One Big Beautiful Bill Act and how AxisCore and AxisConnect can streamline compliance and member retention. Building on that foundation, this entry shifts focus to another critical requirement, community engagement tracking, which adds new operational and member-facing complexities for Medicaid plans.
Community engagement requirements are poised to transform how states and MCOs interact with members and track compliance. HealthAxis is focused on ensuring these processes are equitable, efficient, and auditable, helping payers maintain coverage for eligible members while meeting CMS reporting mandates.
What changed
H.R. 1 adds a federal community engagement requirement for Medicaid’s expansion population: able-bodied adults must document at least 80 hours per month of work, education, work programs, or community service (or a qualifying income threshold equivalent), with verification at application/redetermination and ongoing reporting. Hardship exceptions are permitted but narrowly framed; states cannot waive the requirement and must demonstrate operational readiness, with limited, time-bound exemptions from full implementation.
Even before federal mandates, some states were already preparing 1115 waiver strategies to operationalize work/community engagement rules. Those efforts, now overtaken or reshaped by national requirements, reveal the breadth of systems and workflow change needed: attestation capture, third-party verification, monthly reporting, good-cause/hardship review, and appeals.
Operational risks for plans
Plans will contend with: (1) a surge of monthly compliance documentation, (2) heightened member confusion (what counts, how to report, when to appeal), and (3) downstream churn when members fail to document in time. Tracking exemptions (medical conditions, parental status, short-term hardships) and aligning notices to new state templates will require configurable, rules-driven systems plus trained staff to manage edge cases.
Where HealthAxis Comes In
HealthAxis is purpose-built to help payers navigate the challenges of community engagement tracking. By combining technology and service capabilities, we deliver the agility, compliance, and member-centric support plans need to meet federal requirements while reducing risk of disenrollment.
AxisCore + AxisConnect: purpose-built for the new requirements
AxisCore Modules:
- Exemptions & Hardship: Structured workflows to document medical deferrals, caregiving, and short-term hardships, coupled with evidence retention for audits.
- Compliance Analytics: Cohort-level dashboards to spot non-reporters, identify high-risk subpopulations, and automate outreach triggers before coverage loss.
AxisConnect Services:
- Member Support BPaaS: Dedicated agents, language access, and omnichannel reminders timed to each member’s reporting window.
- Program Consulting: State-specific rules mapping, forms and notice design, and appeals support playbooks to stabilize membership during implementation.
This is where the BPaaS model provides real value. By giving payers visibility into the end-to-end processes, HealthAxis can help them anticipate and mitigate disruptions. AxisConnect delivers the oversight and collaboration needed to stay responsive, while AxisCore supplies the data and visibility that make informed decisions possible. Together, they create a foundation where payers can adapt quickly, support providers, and reduce member confusion.
Outcome
By combining configurable CAPS capabilities with BPaaS operations, HealthAxis helps plans minimize avoidable disenrollments, maintain compliance evidence, and reduce administrative abrasion to members, all while meeting the federal cadence for verification and exception handling.
Author:
President and CEO of HealthAxis
