States Can Automate Medicaid Community Engagement Verification With CITIZ3N's VERIFY Solution Ahead of December Deadline

Multistep framework improves eligibility verification process for enrollees, addresses states' compressed timeline to meet federal community engagement mandate by December 2026

STONY BROOK, N.Y., Nov. 12, 2025 /PRNewswire/ -- CITIZ3N Government Solutions, a technology provider for government agencies overseeing health benefits, announced updates to its VERIFY platform to align with new Medicaid eligibility requirements in H.R. 1 (the 2025 Budget Reconciliation Act). With VERIFY, state agencies can automate verification processes as they prepare to implement the mandate by the December 31, 2026 deadline.

New federal community engagement requirements call for states to confirm that certain adult Medicaid enrollees are participating in at least 80 hours per month of work or qualifying community activities, such as volunteering, education, or job training, or are exempt to maintain eligibility. CITIZ3N has enhanced VERIFY's capabilities and aligned the platform to the new federal and state community engagement requirements. VERIFY provides state agencies with the infrastructure to automate verification processes while reducing administrative burden and preventing coverage disruptions.

"With states facing a compressed timeline and limited implementation funding, having verification infrastructure that's tested against the latest requirements is critical," said Rob Miller, General Manager and Senior Vice President at CITIZ3N. "Our goal is to help states meet the mandate while protecting coverage for eligible members. Our platform gives people multiple ways to check their status and submit documentation, so they know exactly where they stand, what to do next, and how to get help. Automation works in the background so caseworkers can focus on members who need assistance rather than sorting through data."

VERIFY integrates with more than a dozen data sources to provide real-time verification of community engagement activities and eligibility across multiple programs. CITIZ3N's approach is based on a five-tier verification framework, leveraging proprietary agentic AI to work through these layers:

• Categorical Exemptions to identify members automatically exempt from work requirements (pregnant women, caregivers, individuals receiving disability benefits)
• Hardship Exemptions to review short-term hardship categories, such as residents in disaster areas or high-unemployment regions
• Cross-Program Exemptions by checking other public assistance programs like SNAP or TANF to verify compliance through existing participation data
• Work Activity Verification to confirm work or community engagement hours using employment, payroll, education, or wage data from trusted databases
• Member Attestation when no available data confirms compliance, documentation can be requested or self-attestation can be completed through an online portal, call center, or mail

The platform then uses color-coded risk scoring to help state caseworkers make informed decisions quickly, and its continuous monitoring capability means verification occurs at application, renewal, and throughout the coverage period. This data-first model mirrors the automated renewal process already used for income eligibility verification, enabling states to automate most eligibility checks. CITIZ3N customers using automated verification programs have reported significant reductions in manual casework as well as decreases in erroneous terminations of individuals' benefits.

"The implementation timeline creates real pressure on state Medicaid agencies," said Matt Salo, healthcare policy expert and former executive director of the National Association of Medicaid Directors (NAMD). "Federal guidance isn't expected until months after states need to begin planning, which means they need verification systems they can deploy quickly. Automated verification that connects to existing data sources will be necessary for states to meet the deadline without creating barriers to coverage for eligible individuals."

The platform also includes a member portal where individuals can check their status, submit documentation, file exemptions, and access information about employment and volunteer opportunities.

State agencies implementing the new requirements will also benefit from VERIFY's cross-program approach. Rather than maintaining separate verification systems for Medicaid, SNAP, TANF, and other programs, VERIFY creates a unified view across programs, reducing duplicate data queries and associated costs while improving coordination between agencies.

The CITIZ3N team will be demonstrating the VERIFY platform and its community engagement capabilities at the following upcoming events:

• The New England States Consortium Systems Organization (NESCSO) NERDS-3 Meeting in Washington, DC on Thursday, November 13
• The National Health Care Anti-Fraud Association (NHCAA) conference in Nashville, TN on November 18-20
• The National Association of Medicaid Directors (NAMD) in Washington, DC, on November 19-21

CITIZ3N is a subsidiary of Softheon, a leading cloud-based shopping, eligibility, enrollment, billing, and member management solution for health plans, their enrollment partners, and government agencies. For more information about VERIFY, visit CITIZ3N.com/verify.

About CITIZ3N
CITIZ3N Government Solutions is a premier provider of integrated, modular platforms specifically tailored for government agencies overseeing Affordable Care Act (ACA) Marketplaces, Medicaid, Health & Human Services (HHS) and Government Health Benefits for Employees. The collaboration between CITIZ3N and Softheon epitomizes a shared vision of promoting innovative solutions that enhance affordability, accessibility, and efficiency, thereby fostering healthier citizens. For more information on CITIZ3N's solutions, visit www.CITIZ3N.com.

About Softheon
Founded in 2000, Softheon's healthcare Software-as-a-Service (SaaS) and Business Process-as-a-Service (BPaaS) solutions solve complex challenges for health plans, their distribution networks, and government health agencies. Currently, Softheon's solutions serve over 100 health plans. Issuers and consumers in Small Group, ICHRA, Dental, Medicare, and Affordable Care Act (ACA) markets benefit from Softheon's technology that reduces administrative overhead and enhances user experiences. Softheon is an Agent and Merchant of Record that facilitates health insurance enrollment, administration, and renewal. Softheon is recognized as one of the World's Top HealthTech Companies of 2025 by TIME. For more information on Softheon's solutions, visit www.softheon.com.

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SOURCE Softheon