{"id":44825,"date":"2026-08-04T15:45:06","date_gmt":"2026-08-04T10:15:06","guid":{"rendered":"https:\/\/banitoday.com\/ai-is-being-used-to-boost-medicaid-enrollment-but-not-without-concerns\/"},"modified":"2026-08-04T15:45:06","modified_gmt":"2026-08-04T10:15:06","slug":"ai-is-being-used-to-boost-medicaid-enrollment-but-not-without-concerns","status":"publish","type":"post","link":"https:\/\/banitoday.com\/hi\/ai-is-being-used-to-boost-medicaid-enrollment-but-not-without-concerns\/","title":{"rendered":"AI Is Being Used to Boost Medicaid Enrollment, but Not Without Concerns"},"content":{"rendered":"<p> <br \/>\n<\/p>\n<div>\n<p>Vanessa Barahona received a call this past spring from Angelica at Kern Family Health Care in Bakersfield, California, telling her it was time to renew her coverage under Medi-Cal, the state\u2019s version of Medicaid.<\/p>\n<p>Angelica helped Barahona, 41, schedule an appointment to complete her paperwork in person at Kern Family\u2019s offices before she submitted it to Kern County officials for approval. When Barahona had a conflict with her office-cleaning job, Angelica rescheduled the appointment. Barahona finished the process a little later than she\u2019d planned but early enough to avoid an interruption in her coverage.<\/p>\n<p>\u201cIt was easy. The fact that Angelica spoke Spanish when we were on the phone made it better,\u201d Barahona, whom KFF Health News met through Kern Family Health Care, said via a translator. \u201cIt felt like I was talking to a real person.\u201d<\/p>\n<p>She definitely wasn\u2019t.<\/p>\n<p>\u201cAngelica\u201d is the name assigned to an AI program deployed last year by Kern Family Health Care, the largest provider of Medi-Cal services in Kern County. An estimated 52% of residents there rely on the safety net program for health coverage, among the highest enrollment rates in the state.<\/p>\n<p>Kern Family has spent about $370,000 on the software <a href=\"https:\/\/careforce.ai\/\">from Careforce<\/a>, a San Francisco startup, to facilitate rapid and repeated outreach to members when it\u2019s time to renew their coverage \u2014 a process that is about to become more complex under new Medicaid eligibility rules established under Republicans\u2019 One Big Beautiful Bill Act, signed into law last year by President Donald Trump. Mandatory work requirement documentation will take effect nationally beginning in 2027, and under the GOP\u2019s new rules, most Medicaid patients will now have to renew their enrollment twice a year, rather than once a year.<\/p>\n<p>Kern Family and other similar health plans have an interest in keeping people enrolled, since they\u2019re paid through managed care contracts with Medi-Cal. They can also save money by using AI software to do what Kern says would otherwise require it to hire 40 full-time workers. Angelica does it at a fraction of the cost and without increasing payroll \u2014 or requiring Kern Family to navigate workers\u2019 rights issues or government-mandated workplace protections.<\/p>\n<p>Although Kern Family officials say no workers have lost jobs, the health plan, which is not unionized, estimated it would have had to spend $2.4 million in staffing costs to match the program\u2019s more than 800,000 calls to its 387,000 members since Kern Family began using Angelica late last year.<\/p>\n<p>As the federal government ended pandemic-era protections and states resumed screening people for Medicaid eligibility, health plans such as Kern Family began looking to technology to keep eligible people enrolled. Kern Family officials say that Angelica helps people, in their preferred language, set up appointments with the plan\u2019s staffers, who make sure that applications are filled out correctly and delivered to county health officials for verification and processing.<\/p>\n<p>Careforce CEO Huzaifa Sial said Kern Family is one of a few health insurers using his company\u2019s software to help boost its Medi-Cal enrollment, and the company is also working with the Central California Alliance for Health in much the same way. \u201cMost people don\u2019t know what they need, and if they do, they have a hard time getting there,\u201d Sial said. \u201cThat\u2019s the hidden execution problem that nobody sees.\u201d<\/p>\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" fetchpriority=\"high\" decoding=\"async\" height=\"805\" width=\"1270\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?w=840\" alt=\"A website screengrab of a woman with dark hair and a black shirt smiling next to text that reads &quot;Endless Outreach &amp; Admin&quot; and &quot;Angelica AI Care Coordinator&quot;\" class=\"wp-image-2267245\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png 2788w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?resize=150,95 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?resize=500,317 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?resize=768,487 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?resize=1270,805 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?resize=1536,973 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?resize=2048,1298 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Careforce-screengrab_f4d2c6.png?resize=120,76 120w\" sizes=\"(max-width: 1270px) 100vw, 1270px\"\/><figcaption class=\"wp-element-caption\">\u201cAngelica\u201d is the name assigned to a conversational AI program deployed last year by California\u2019s Kern Family Health Care, the largest provider of Medi-Cal services in Kern County. Kern Family has spent about $370,000 on the software by Careforce, a San Francisco startup, to facilitate rapid and repeated outreach to members when it\u2019s time to renew their coverage. (Screengrab of Careforce.ai)<\/figcaption><\/figure>\n<p>The rise of AI in the healthcare industry has prompted worries about who\u2019s overseeing these tools and whether people are being improperly <a href=\"https:\/\/news.stanford.edu\/stories\/2026\/01\/ai-algorithms-health-insurance-care-risks-research\">denied treatments<\/a> or <a href=\"https:\/\/www.statnews.com\/2023\/11\/14\/unitedhealth-algorithm-medicare-advantage-investigation\/\">cut off from care<\/a>. Unions have raised concerns about workplace surveillance and the <a href=\"https:\/\/calmatters.org\/economy\/technology\/2026\/07\/kaiser-nurses-workplace-surveillance-ai\/\">prioritizing of savings over safety<\/a>. Polling shows <a href=\"https:\/\/www.politico.com\/newsletters\/politico-technology-california-decoded-preview\/2025\/04\/15\/exclusive-poll-shows-voters-are-wary-of-ais-upsides-00290081\">widespread fear<\/a> over AI-driven job losses and growing income inequality, while health policy researchers have also <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11612599\/\">raised red flags<\/a> about algorithmic biases, transparency, data privacy, and safety risks.<\/p>\n<p>Mark Duggan, a Stanford University economics professor who has studied the Medicaid system for 30 years, said one long-standing fear is that insurers could use such software to cherry-pick patients for coverage.<\/p>\n<p>\u201cWhen you have a new technology like this, you need to police it,\u201d Duggan said.<\/p>\n<p><strong>Complying With Regulations<\/strong><\/p>\n<p>California health plan regulators say they are tracking AI use closely, and the state attorney general\u2019s office has <a href=\"https:\/\/oag.ca.gov\/system\/files\/attachments\/press-docs\/Final%20Legal%20Advisory%20-%20Application%20of%20Existing%20CA%20Laws%20to%20Artificial%20Intelligence%20in%20Healthcare.pdf\">sent reminders<\/a> to healthcare entities about their obligation to follow consumer protection rules.<\/p>\n<p>Anthony Cava, a spokesperson for the state\u2019s Department of Managed Health Care, said Medi-Cal health plans have flexibility in how they handle member renewals, including with the use of AI tools. But plans are responsible for ensuring that technology complies with state and federal regulations, including patient privacy and data security, he said.<\/p>\n<p>Last year, the agency, foreseeing the huge volume of reenrollments that were going to be required in the state, began allowing managed care plans to contact members about renewals. State rules still prohibit Medi-Cal health plans from soliciting new enrollees, and only county health officials determine eligibility.<\/p>\n<p>Emily Duran, CEO of Kern Health Services (which administers Kern Family), said that the plan worked closely with the Kern County Department of Human Services to obtain some data, allowing Kern Family to know when a member\u2019s Medi-Cal eligibility will expire.<\/p>\n<p>The health plan, in turn, lets the county know anytime it receives updated demographic or contact information for its Medi-Cal members. And the county has stationed workers inside Kern Family Health Care\u2019s main facility in Bakersfield to answer enrollment questions for people who walk in to finish their paperwork.<\/p>\n<div class=\"wp-block wp-block-kff-shared-newsletter  wp-block-kff-shared-newsletter--background-white\" data-type=\"kff-shared\/newsletter\" data-align=\"center\">\n<div class=\"wp-block-kff-shared-newsletter__container\">\n<div class=\"wp-block-kff-shared-newsletter__content\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\" alt=\"Newsletter Icon\" class=\"wp-block-kff-shared-newsletter__img\"\/><\/p>\n<div class=\"wp-block-kff-shared-newsletter__text\">\n<h4 class=\"newsletter__title\">\n\t\t\t\t\tEmail Sign-Up\t\t\t\t<\/h4>\n<p class=\"newsletter__description\">\n\t\t\t\t\tSubscribe to KFF Health News&#8217; free Morning Briefing.\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n<p>\u201cThey have a leadership group that is very innovative and forward-thinking,\u201d Vanessa Frando, the chief deputy director of Kern County Human Services, said of Kern Family. The agency also works closely with other Medi-Cal providers in the county, Frando said.<\/p>\n<p>Duran said the health plan was initially concerned about how Angelica would be received.<\/p>\n<p>\u201cWe had to set the tone to really be open to the idea, because you hear \u2018AI\u2019 and you\u2019re like, \u2018Oh, yeah, Jeff Bezos laid off 100,000 people because of that,\u2019\u201d Duran said. \u201cBut we are already stretched thin. We need this functionality to be much more effective and augment our efforts.\u201d<\/p>\n<p>Duran said Kern Family\u2019s leadership and staff bought in after seeing a demonstration.<\/p>\n<p>Today, it would take 40 Kern Family employees, each working 40 hours a week, to match Angelica\u2019s calls to remind people to reenroll and talk them through what is involved, according to Jackie Byrd, a spokesperson for the health plan. The AI program\u2019s settings are constantly adjusted to match the capacity of Kern Family\u2019s full-time staff.<\/p>\n<p><strong>Full Conversations With AI<\/strong><\/p>\n<p>Barahona said she received a Medi-Cal packet in the mail but didn\u2019t think about it until Angelica called days later. That exchange highlights one of local and state health officials\u2019 biggest concerns \u2014 that people who\u2019ve grown accustomed to automatic renewals aren\u2019t aware of the reenrollment requirements.<\/p>\n<p>Angelica speaks more than 30 languages and can answer lengthy questions. In samples of actual conversations provided to a reporter, Angelica sounded lifelike at first, although more than once cross-talk with a patient caused the program to pause suddenly. Barahona said it took her a minute before she realized she wasn\u2019t speaking with a human, but she ended up having a full conversation with Angelica.<\/p>\n<p>Duran said Kern Family was able to redirect full-time staff to focus on the more complex parts of the Medi-Cal process, such as making sure the patients\u2019 information is complete and up to date. The Angelica software also operates at all hours, making it easier for patients to call back at their convenience. Another version, David, is used internally to help staffers navigate the technology.<\/p>\n<p>\u201cThis will always be, in my opinion, an AI-human combination,\u201d said Careforce\u2019s Sial. Working with AI solutions for more than a decade at UnitedHealthcare and Optum, Sial said, he saw an opportunity to improve the enrollment process by helping people organize their paperwork.<\/p>\n<p>Kern Family\u2019s Medi-Cal renewal rate in April was 94.9%, delighting the plan\u2019s officials, who feared a significant drop-off from patients who\u2019d gotten used to being automatically renewed over the past several years. By comparison, Duran said that about 80% of enrollments had automatically renewed under federal pandemic-era rules, but that figure was cut in half as those protections began to expire.<\/p>\n<p>Kern Family officials say there could be other uses for Careforce\u2019s software in the future; Angelica, like other generative-AI large language models, can learn and adapt to new situations and requests.<\/p>\n<p>Cesar Delgado, Kern Family\u2019s chief information officer, said Angelica is already being used to make general greeting calls to new members and can discuss plan benefits and answer basic questions. But Kern Family officials say the program\u2019s primary purpose, for now, is limited to contacting patients whose Medi-Cal eligibility is coming up for review.<\/p>\n<p>Duggan, the Stanford professor, said Angelica could help Kern Family minimize the number of Medi-Cal enrollees who lose coverage as federal requirements take effect.<\/p>\n<p>\u201cThe best-case scenario is helping people to stay on when they don\u2019t realize that things are changing,\u201d Duggan said. \u201cIt\u2019s not an easy program to navigate.\u201d<\/p>\n<p><em>This article was produced in collaboration with <\/em><a href=\"https:\/\/capitalandmain.com\/\"><em>Capital &amp; Main<\/em><\/a><em>, an independent, California-based nonprofit investigative news publication that reports on inequality, climate change and other issues.<\/em><\/p>\n<\/div>\n<p><br \/>\n<br \/><a href=\"https:\/\/kffhealthnews.org\/medicaid\/medicaid-work-requirements-medi-cal-ai-agents-reenroll-careforce-california\/\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vanessa Barahona received a call this past spring from Angelica at Kern Family Health Care in Bakersfield, California, telling her it was time to renew her coverage under Medi-Cal, the state\u2019s version of Medicaid. Angelica helped Barahona, 41, schedule an appointment to complete her paperwork in person at Kern Family\u2019s offices before she submitted it [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":44826,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[270],"tags":[],"class_list":["post-44825","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-2"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.10 - aioseo.com -->\n\t<meta name=\"description\" content=\"Vanessa Barahona received a call this past spring from Angelica at Kern Family Health Care in Bakersfield, California, telling her it was time to renew her coverage under Medi-Cal, the state\u2019s version of Medicaid. 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