We help you keep it, with no charge to you.
Our help comes with no charge to you. You never pay us.
We’ve run these programs at payers, with government agencies, providers, and startups. And our own families have been on Medicaid, fighting for the coverage and care they qualified for. That’s why we built something that works for the member and the plan at the same time.
We help the member get and keep coverage — and help the Health Plan and Providers receive the right level of payment for the care delivered through every renewal.
Adults who have Medicaid — and qualified for coverage because of their income, not a disability or pregnancy — must now prove 80 hours a month of work, school, or service. Most who lose coverage lose it to paperwork, not because they no longer qualify.
People whose health makes it impossible to meet the work-requirement hours are exempt — but starting in 2028, a diagnosis alone won’t prove it. They’ll need a documented file.
Most first-time SSDI/SSI claims are denied. Until the award comes through, the person waits — and the covered care often does not match the level needed.
of disability claims are denied on the first try. That’s the gap we close.
Worried about losing Medicaid? We help you keep it, with no charge to you.
Paid below the care you deliver because a member’s disability award or dual-eligible status was never secured? We fix the classification and keep payment matched to real levels of care.
Our why. The people the system fails most — people living with disabilities, the medically frail, and people and families who depend on Medicaid — have earned their coverage and deserve a system that delivers it. We exist to change it.
We see our purpose as the power to change lives by ensuring no one loses coverage or care to a broken system, and every provider is paid fairly for delivering it.
To be the best and most innovative company at removing barriers to coverage and care.
Four different paths into healthcare — through payers, government agencies, providers, and startups — and families of our own who have depended on Medicaid and SSI. One shared focus: making sure the most vulnerable get the coverage and care they’ve earned.
Over a decade at Optum and UnitedHealthcare, helping build the nation’s largest payment integrity organization and leading growth across its Medicaid, Medicare, Employer and Individual, and Military and Veterans businesses. Since then: Cityblock Health, Evernorth (Cigna), more than a decade on PROVAIL’s board (its first woman board chair), and today Washington Market President of Together Health.
Fourteen years with Evergreen Life Services across home health, home care, and long-term services and supports, then Vice President of Clinical Services for Complex Populations at UnitedHealthcare Tennessee. Later Managing Principal at Health Management Associates and Chief Growth Officer at Liberty Healthcare, where her IDD and LTSS assessment work mirrors the documentation Determined Care builds today.
More than two decades in behavioral health, payer strategy, and healthcare delivery, including senior roles at UnitedHealth Group, Aetna, and Evernorth Behavioral Health, where she was Chief Growth Officer. Founder of STLTH CNSLTNG, an advisory practice for healthcare startups; JD/MBA, Quinnipiac University.
A growth career built on selling into health plans and state programs: Optum, product leadership at Level2, Director of Strategy & Solutions at UnitedHealthcare Community & State, and Director of National Payer Sales at Kinetik. Today she leads growth at Thrive Mobile, selling into Medicaid plans; board member, NEMTAC.
We streamline the steps to submit the documentation you need.
The new Medicaid rules require some individuals, based on your income and the status of your medical needs, to provide documentation reflecting 80 hours each month of work, school, or volunteering, or a combination.
Who has to show work hours →You may not have to work these hours. We help you submit the documentation required to get approved for the disability exemption.
Who does not have to →We help you provide the documentation to support your disability. This helps you get the right support and help you need from the Social Security Administration.
Talk to us →Use your phone. Get a text when something is due. A real person helps you.
Your information is safe. We are HIPAA compliant. HIPAA is the law that protects your health information.
Medicaid is for people with low income. The rules depend on who you are.
| Who you are | Income limit |
|---|---|
| Adults 19 to 64 (called expansion adults) | Up to $1,835 a month for one person. That is about $22,025 a year. For two people: $2,489 a month. |
| People with a disability, people who are blind, or people 65 and older | Many states use the SSI limits: about $994 a month in income and $2,000 in savings. Some states allow more. |
| Children, people who are pregnant, and parents or caregivers | The limit is different in each state. |
Amounts are for 2026 in the 48 states and D.C. Alaska and Hawaii are higher.
These 40 states and Washington, D.C. have expanded Medicaid. Adults 19 to 64 with low income can qualify:
These 10 states have not expanded Medicaid:
In these 10 states, most adults without children cannot get Medicaid because of income alone. Georgia, Tennessee, and Wisconsin have limited programs for some adults. Work rules can apply there too. Ask us about your state.
Adults 19 to 64 in the first group. That is income up to $1,835 a month for one person. Starting January 2027, they must show 80 hours a month of work, school, or volunteering, or a mix.
These people must still meet the income rules. They just do not have to show work hours:
Medicaid for children and for people 65 and older does not have these work rules.
No. Our help comes with no charge to you. You never pay us.
You may not have to work. Starting in 2028, your state may ask for documentation proving you can’t work. Just having a diagnosis may not be enough. We help you get the documentation. Your state may call this being “medically frail.”
Apply on your computer or phone in a few minutes. There is no charge to you.
Nothing to print, nothing to mail. Most people finish in one sitting within just a few minutes. If you stop, we save your place and remind you to come back.
We count down to your due date. We remind you.
Renewal shouldn’t be a surprise. We track your deadline, verify what the state needs from records you already have, and tell you the moment something is due.
Medicaid pays by classification. When a member’s disability award, dual-eligible status, or medically-frail exemption was never secured, you’re paid for less care than is needed.
of disability claims are denied on the first try. Until the award comes through, members stay classified below the care you deliver. That’s the gap we close.
Hours verified and exemptions documented at every cycle, so members who qualify aren’t lost to paperwork.
SSDI/SSI and dual-eligible status secured — for Medicaid plans and Dual Special Needs Plans — and the rate cell set to match, before payment, not after.
We reach members directly, in their language. Your care managers get status, not a task list.
The 2028 standard is coming. A diagnosis alone won’t prove medical frailty; states will need a documented file. We build it now and re-verify it every cycle.
Right classification, right payment, every renewal — without adding work to your team.
Match claims and SSA data.
Assemble the file to the state’s criteria from claims, SSA records, and the member’s providers.
Submit through the state’s or plan’s channel and align the rate cell.
Every 3–6 months, by state.
Send a de-identified claims extract for one segment. In 30 days you get the opportunity sized on your own members and your state’s criteria.
Request a No-Cost Data AssessmentThe opposite. Every determination is backed by a documentation file built to the state’s own criteria — we’d rather stand behind fewer, well-supported members than a number that doesn’t hold up later.
No. Payment-integrity review happens after a claim is paid. We work earlier in the cycle, changing the classification before the rate cell is set — different point, different data, no overlap.
That variation is the product, not a complication. We maintain a state-by-state library of criteria, forms, and timelines, and keep it current as rules change.
We do, directly, in the member’s own channel. Your team gets status updates, not a task list — and consent language is reviewed with your compliance team before any member is contacted.
Some plans should. The honest test is whether you’ll still be maintaining a state-by-state criteria library and a recurring re-attestation calendar for every member a few years from now — that’s usually where internal builds stop scaling.
Yes. We operate as a HIPAA business associate: a Business Associate Agreement is executed before any protected health information moves, we request only the data fields a determination requires, and consent language is reviewed with your compliance team before any member is contacted.
