Coalition for Health AI (CHAI) Releases Best Practice Guides for Responsible AI in Medicaid Eligibility
New guidance, developed in coordination with leading health organizations and a broader team from across the industry, will help states manage influx of administrative demands tied to new Medicaid community engagement requirements
WASHINGTON, May 11, 2026 /PRNewswire/ -- Today, the Coalition for Health AI (CHAI) released two Best Practice Guides (BPGs) to help states, developers, and implementers responsibly deploy AI in Medicaid eligibility workflows while preventing inappropriate coverage loss as new requirements take effect. Co-chaired by the National Association of Community Health Centers (NACHC), Centene, HealthTech 4 Medicaid (HT4M), and Pair Team, the development of these guides was informed by experts representing more than 40 health organizations to ensure a consensus-backed, collaborative approach.
The BPGs focus on two use cases: enrollment and eligibility adjudication, some of the most operationally complex and high-stakes administrative demands. They provide practical, role-based recommendations for using AI responsibly to navigate Medicaid's new community engagement requirements under H.R.1. The release comes ahead of the U.S. Department of Health and Human Services (HHS) guidance deadline of June 1, 2026, and is intended as a practical resource for state agencies, vendors, and the broader Medicaid community as implementation begins. The guidance is designed to help organizations modernize eligibility operations while reducing the risk of procedural disenrollment and inappropriate coverage loss among eligible beneficiaries.
"We convened experts and organizations closest to this work – from community health centers to technology developers – because the people implementing these new Medicaid requirements needed clear and consistent guidance," said Brian Anderson, MD, CEO of CHAI. "The guides reflect nearly a year of rigorous, cross-sector collaboration and provide a clear set of best practices grounded in our responsible AI principles, with patient access, fairness, and human oversight at the center."
Community engagement requirements represent a significant operational shift for state Medicaid programs, moving from one-time eligibility determination to continuous compliance tracking across employment, training, education, volunteering, and exemption status. As states prepare for more frequent touchpoints, expanded documentation needs, and increased risk of procedural disenrollment, AI is poised to play a meaningful role in reducing administrative burden. This can only be done by pairing it with strong oversight, transparency, and safeguards.
"Community Health Centers (CHCs) are on the front lines of care for 52 million Americans, approximately 50% of whom rely on Medicaid. AI is becoming indispensable, especially for CHCs that need more to do more," said Kyu Rhee, MD, MPP, President and CEO of NACHC and a Tiger Team Co-Chair. "With roughly one in five CHCs already using generative AI and many more planning to adopt it, these guides underscore how AI can help cut administrative burden, navigate new Medicaid eligibility requirements, and strengthen revenue so more time and dollars go back into patient care."
The guides include use case examples, a catalog of community-developed AI interventions mapped to specific points in the workflow, and the multi-phase consensus methodology used to produce the guidance. Among the guides' recommendations: a prohibition on fully automated eligibility denials and disenrollment; a human-in-the-loop requirement for adverse actions; explicit guardrails against "default-to-denial" logic when data is missing or conflicting; confidence thresholds and audit trails for high-stakes determinations; and accessibility, multilingual, and non-digital pathways aligned with WCAG 2.2 AA, ADA, and Section 508.
"Frontline care teams and beneficiaries need AI that is accessible to people who may have language or digital literacy barriers, and be reliable and available on the beneficiaries' busy schedules," said Peter Morrison, MPH, MPA, Head of Growth at Pair Team and Tiger Team Co-Chair. "These guides reflect what we've learned operating at scale in safety-net settings: human-centered design, multi-modal availability, and clear escalation pathways to human support."
"Behind every eligibility determination is a human life — a mother trying to keep coverage for her child, an older adult managing chronic illness, a worker navigating instability," said Adimika Meadows Arthur, Founder and CEO of HealthTech 4 Medicaid (HT4M) and Tiger Team Co-Chair. "Responsible AI in Medicaid is not simply a technology issue; it is a moral and public trust issue."
The guides are the result of an extensive development process that launched at the NACHC EXPO in August 2025 and progressed through three phases of consensus voting from October 2025 through February 2026. More than 40 organizations contributed through robust review and feedback processes. Both BPGs are available for download here.
About CHAI
CHAI was started by clinicians. The coalition's mission is to build the broadest possible consensus across the health ecosystem to help ensure health AI is trusted, secure and safe. The CHAI membership is open and rapidly expanding. Today, we consist of more than 3,000 members including health systems, patient advocacy groups, academia, and a wide range of industry start-ups and incumbents. CHAI is committed to convening and dialogue to achieve consensus. There are no limits to who can join and participate. Learn more about CHAI membership at chai.org/membership.
About NACHC
The National Association of Community Health Centers (NACHC) is the leading national voice for America's Community Health Centers, advancing their role as employers, providers, and partners of choice in delivering affordable, comprehensive primary care. Founded in 1971, NACHC champions Community Health Centers in serving patients across the United States regardless of ability to pay. Learn more at nachc.org.
About HealthTech 4 Medicaid (HT4M)
HealthTech for Medicaid (HT4M) is a national nonprofit and mission-driven market enabler that advances innovation in Medicaid by fostering cross-sector collaboration. Through program development, ecosystem building, and policy and advocacy efforts, HT4M brings together entrepreneurs, payers, providers, policymakers, advocates, investors, and community leaders to accelerate equitable, high-impact solutions across the Medicaid landscape. Learn more at www.ht4m.org.
About Pair Team
Pair Team is a public benefit company reimagining Medicaid and Medicare as a connected care ecosystem through AI-enabled whole-person care management. Pair Team proactively manages care to close care gaps, bridge barriers, and connect people with personalized advocacy and support across social, medical and behavioral health. Pair Team's model blends human clinicians, empathy, AI-enabled technology, and local partnerships so that more people can reach their full potential. Learn more at pairteam.com.
Press Contact
Press contact for CHAI: [email protected]
Program / Tiger Team inquiries: Greg Shemancik, [email protected]
SOURCE Coalition for Health AI
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