A Medicaid managed care plan in California's Central Valley is using an artificial intelligence voice agent to call members and walk them through coverage renewals, an approach the plan says does the work of 40 full-time employees at a fraction of the cost, and one that arrives just as federal Medicaid eligibility rules tighten nationwide.
Kern Family Health Care, the largest Medi-Cal provider in Kern County, has spent about $370,000 on software from Careforce, a San Francisco startup. The program, called Angelica, calls members in their preferred language, tells them a renewal is due, asks what has changed in their household or employment, directs them to the right forms, and schedules an in-person appointment with plan staff when needed. It speaks more than 30 languages and operates at all hours.
For households, this is not an abstract technology story. Under the budget reconciliation law enacted last year, most adults ages 19 to 64 who gained Medicaid through the Affordable Care Act expansion must document at least 80 hours per month of work, school, job training, or community service, with the requirement applying at the first renewal after January 1, 2027. Most enrollees will also renew twice a year instead of annually. An estimated 52% of Kern County residents rely on Medi-Cal, among the highest rates in the state.
The Scale of the Outreach Problem
The number that explains why plans are turning to automation is the renewal rate. Under pandemic-era federal rules, about 80% of Kern Family's enrollments renewed automatically. As those protections expired, that figure was cut roughly in half.
Since the plan began using the software late last year, it has placed more than 800,000 calls to its 387,000 members. Kern Family estimated it would have needed about $2.4 million in staffing costs to match that volume. Plan officials say no workers lost jobs and that full-time staff was redirected toward the more complex parts of the process, including verifying that applications are complete before they go to county eligibility workers.
Kern Family's Medi-Cal renewal rate in April was 94.9%.
The Paperwork Problem Behind Coverage Losses
The reason outreach matters more than it might appear is that most people who lose Medicaid under eligibility changes are not found ineligible. They are dropped for procedural reasons: a missed deadline, an unreturned form, an outdated address, incomplete documentation.
California's own projections illustrate the scale. The California Health Care Foundation, summarizing state estimates of the work requirement's reach, reported that as of May the state Department of Health Care Services estimated 4.8 million Medi-Cal enrollees fall into the category subject to the requirement, with 2.2 million expected to qualify for an exemption. The department also estimated that 1.1 million enrollees will lose coverage by 2029 to 2030 because of the requirement, and has said it is concerned that many losses will stem from added administrative burden rather than ineligibility.
The historical marker is stark. During the pandemic coverage unwinding, California processed roughly 11 million redeterminations and about two million people were disenrolled. A review of lessons from the Medi-Cal unwinding found that 66% of those disenrollments were procedural rather than based on a finding of ineligibility. That is the failure mode outreach is trying to prevent, and it is the reason a phone call reminding someone about a form is not a trivial intervention.
MedicalDaily previously reported on how the federal work rule took legal effect and what states must do next.
Oversight, Limits, and Open Questions
California regulators say they are watching AI use in health plans. Anthony Cava, a spokesperson for the state Department of Managed Health Care, said Medi-Cal plans have flexibility in how they handle renewals, including with AI tools, but remain responsible for ensuring the technology complies with state and federal rules on patient privacy and data security. The state attorney general's office has issued legal advisories reminding healthcare entities that existing consumer protection law applies to AI.
Structural limits are built into the arrangement. Only county officials determine eligibility. State rules still prohibit Medi-Cal plans from soliciting new enrollees, so plans may contact existing members about renewals but not recruit. Kern County has stationed workers inside Kern Family's Bakersfield facility to answer enrollment questions in person, and the plan and county exchange data on when members are due for renewal and when contact information changes.
Independent voices have raised concerns. Mark Duggan, a Stanford University economics professor who has studied Medicaid for 30 years, told KFF Health News that the technology needs oversight, citing a long-standing worry that insurers could use such software to cherry-pick patients. Duggan also said the best-case outcome is helping people stay enrolled when they do not realize the rules are changing, noting the program is not easy to navigate.
Emily Duran, chief executive of Kern Health Services, which administers the plan, said the organization was initially uncertain how members would react to an AI caller but concluded it needed the added capacity given existing staffing limits. Careforce chief executive Huzaifa Sial described the arrangement as a combination of AI and human staff rather than a replacement.
What Enrollees in Any State Should Do This Month
Whether or not your plan uses AI, the actions that protect coverage are the same, and they are unglamorous.
Confirm that your state Medicaid agency has your current mailing address, phone number, and email. Most preventable coverage losses begin with a notice that never arrived. Open mail from your state Medicaid office or county human services department even when it looks routine, and note any deadline printed on it.
Begin keeping documentation of work, school enrollment, job training, or community service hours now, before reporting begins. Pay stubs, school registration, and volunteer verification letters are the kinds of records that satisfy documentation requirements. State agencies will try to verify compliance automatically from data they already hold, and only enrollees they cannot verify will need to supply proof.
If you believe you qualify for an exemption, including for pregnancy, caregiving responsibilities, disability, or a substance use or serious mental health condition, find out how your state expects that exemption to be documented. Exemption categories are defined in federal statute, but verification processes vary.
If you receive a call claiming to be from your health plan, you can hang up and call the member services number printed on your insurance card to verify. Legitimate plans will not object.
Finally, be aware that an AI caller is not an eligibility decision. Only your county or state agency determines whether you keep coverage.
Frequently Asked Questions
What is the AI agent actually doing? Calling Medi-Cal members about upcoming renewals, asking what has changed in their household, directing them to the right forms, and scheduling appointments with human staff.
Can an AI decide whether I keep Medicaid? No. Only county eligibility workers determine Medi-Cal eligibility. The plan's role is outreach and application support.
When do work requirements start? The documentation requirement applies at an enrollee's first renewal after January 1, 2027, for most adults 19 to 64 in the Medicaid expansion group.
How many hours must I document? At least 80 hours per month of work, education, job training, or community service, unless you qualify for an exemption.
Why do people lose coverage if they are still eligible? Missed deadlines, unreturned forms, and outdated contact information. In California's pandemic unwinding, 66% of those who lost Medi-Cal were disenrolled for procedural reasons.
Is my information protected? Plans remain responsible for complying with state and federal privacy and data security rules when using AI tools, according to the California Department of Managed Health Care.
What is the single most useful thing I can do now? Update your address and phone number with your state Medicaid office and start saving documentation of your work or exemption status.88
