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Community Engagement & the January 1, 2027 deadline
Everything here in one place, plus how the module works:
Explore Community Engagement Verification
When do Medicaid community engagement requirements take effect?
Federal community engagement requirements take effect January 1, 2027. States are standing up verification and reporting capability now so they are ready on day one.
What are Medicaid community engagement requirements?
Medicaid community engagement requirements establish qualifying activities and reporting requirements for certain Medicaid beneficiaries. States must determine who is subject to the requirements, verify qualifying activities and exemptions, communicate with members, and maintain documentation supporting their decisions.
What is community engagement verification?
It confirms whether a Medicaid enrollee meets participation requirements — work, education, volunteering, or a qualifying exemption — and records the result for compliance. These are the rules many people call work requirements.
Who is subject to Medicaid community engagement requirements?
Community engagement requirements apply to certain Medicaid beneficiaries, with federal law establishing populations and circumstances that may qualify for exemptions. States need processes to identify subject populations and exemptions using reliable information before requiring members to take additional action.
How can states verify exemptions from community engagement requirements?
States can evaluate available administrative and program data to identify individuals who meet applicable exemption criteria. Automating those checks can reduce manual reviews and unnecessary reporting for members whose exemption can already be established.
What data sources can states use for community engagement verification?
Depending on program rules and data availability, states may use sources such as wage records, Supplemental Nutrition Assistance Program data, Temporary Assistance for Needy Families data, Medicaid claims, and other state or federal information. The goal is to use reliable information already available before asking members to provide it again.
Can community engagement verification integrate with an existing Medicaid eligibility system?
Yes. Community engagement verification can operate as a modular capability connected to an existing eligibility environment. This allows states to add verification, exemption, reporting, outreach, and audit capabilities without rebuilding their core eligibility system.
Can CITIZ3N help us meet the January 1, 2027 deadline?
Yes. Verify: Engage is purpose-built for community engagement compliance, and CITIZ3N can stand up capability in 90 days or less by integrating with your existing eligibility and enrollment systems.
What is CITIZ3N Government Solutions?
CITIZ3N provides modular technology for government agencies administering Medicaid, Health & Human Services, State-Based Marketplaces, and other government health programs. Our solutions support eligibility verification, community engagement, program integrity, enrollment, payments, and Marketplace administration.
How is CITIZ3N related to Softheon?
CITIZ3N is a Softheon brand focused specifically on government agencies and government health programs. It brings Softheon’s healthcare technology experience into modular solutions designed around public-sector requirements.
Does CITIZ3N work with state Medicaid agencies?
CITIZ3N works with state Medicaid programs on eligibility verification, community engagement, program integrity, and related operational needs. Solutions are designed to integrate with existing state environments rather than require a complete system replacement.
Does CITIZ3N support State-Based Marketplaces?
CITIZ3N provides modular and end-to-end technology for State-Based Marketplaces, including shopping, enrollment, payments, data, and administrative capabilities. Agencies can configure the platform around their existing marketplace environment and operating model.
Can CITIZ3N technology integrate with existing government systems?
Yes. CITIZ3N uses a modular approach designed to connect with existing eligibility, marketplace, and government technology environments. This allows agencies to add capabilities without automatically replacing their core systems.
The Verify Platform
For the full platform picture — modules, integration, and deployment:
See the Verify Platform
What is CITIZ3N Verify?
Verify is CITIZ3N’s modular platform for community engagement, eligibility verification, and program integrity. It includes Verify: Engage, Verify: Eligibility, and Verify: FWA.
What is Verify: Engage?
Verify: Engage supports Medicaid community engagement implementation, including verification, exemptions, member reporting, outreach, documentation, and audit-ready reporting. It is designed to connect with existing eligibility systems and support configurable state requirements.
What is Verify: Eligibility?
Verify: Eligibility automates identity, residency, income, employment, asset, and other eligibility verification processes. It helps agencies reduce manual work while providing the information staff need to make eligibility decisions.
What is Verify: FWA?
Verify: FWA supports post-payment program integrity by analyzing data and identifying potentially suspicious activity for further review. Risk assessment and scoring help teams focus investigative resources where they are most needed.
What is an Asset Verification System (AVS)?
An Asset Verification System helps Medicaid agencies verify financial assets as part of eligibility determination requirements. AVS technology can automate data collection and verification, reducing reliance on manual documentation and review.
How does Medicaid asset verification work?
Asset verification compares applicant or beneficiary information against available financial data to help determine whether program requirements are met. Automated verification can return relevant information to eligibility workers while maintaining documentation of the verification process.
What data sources can Verify use for eligibility verification?
Verify is designed to support verification using multiple authoritative data sources based on the program and use case. Available sources and integrations depend on the agency’s requirements, existing systems, and applicable data-sharing agreements.
Can Verify automate Medicaid eligibility verification?
Yes. Verify: Eligibility can automate verification steps that would otherwise require staff to collect and review information manually. Cases that require additional review will remain with agency staff rather than forcing every case through the same manual process.
How does Verify integrate with Medicaid eligibility systems?
Verify is designed as a modular layer that can exchange data with an agency’s existing eligibility environment. Agencies can add verification capabilities while maintaining their existing core system and workflows.
How does Verify support Medicaid program integrity?
Verify combines verification, data analysis, risk assessment, and documented workflows to help agencies identify information that requires additional attention. Verify: FWA extends that approach into post-payment analysis and program integrity.
Does CITIZ3N offer a State-Based Marketplace?
Yes. The Marketplace platform supports enrollment, billing, and operations for state exchanges, including SHOP for small employers and ICHRA administration.
What technology does a State-Based Marketplace need?
A State-Based Marketplace requires capabilities for shopping, eligibility and enrollment, account management, payments, notices, data exchange, reporting, and administration. The specific architecture depends on which functions the state manages directly and which capabilities connect to other systems.
Can CITIZ3N replace or modernize an existing State-Based Marketplace platform?
CITIZ3N can support both modular modernization and broader Marketplace implementations. States can address specific technology gaps or evaluate a more comprehensive platform based on their existing environment.
Can CITIZ3N integrate with an existing State-Based Marketplace?
Yes. CITIZ3N’s modular architecture allows Marketplace capabilities to connect with an existing technology ecosystem. This gives states flexibility to modernize specific functions without automatically replacing the entire Marketplace.
What marketplace functions can CITIZ3N support?
CITIZ3N supports capabilities across shopping, enrollment, payments, data exchange, member experiences, and Marketplace administration. The specific configuration can be tailored around a state’s program and existing technology.
Does CITIZ3N support marketplace enrollment, billing, payments, and reconciliation?
Yes. CITIZ3N technology supports core marketplace operations including enrollment, billing, payments, and reconciliation. These capabilities can work together as part of a broader marketplace operating environment.
Can CITIZ3N support both individual and small business Marketplace programs?
Yes. CITIZ3N supports individual Marketplace programs as well as SHOP, a white-labeled small business solution. ICHRA capabilities can also support individual coverage arrangements within the broader Marketplace ecosystem.
What is a modular State-Based Marketplace platform?
A modular marketplace allows states to implement or replace individual capabilities without treating the entire Marketplace as a single technology component. This gives agencies more flexibility to improve around existing systems.
How fast can CITIZ3N deploy?
CITIZ3N can stand up Medicaid capability in 90 days or less, working alongside your current systems rather than requiring a rip-and-replace.
Does CITIZ3N integrate with our existing systems?
Yes. Components are modular and designed to drop into your existing eligibility, enrollment, and system-integrator stack through standard interfaces.
Security & Compliance
Full frameworks, architecture, and documentation for your reviewers:
Visit Trust & Compliance
Does CITIZ3N meet government security standards?
Yes — HIPAA, ARC-AMPE, SOC 2 Type 2, NIST 800-53, and Section 508. Full evidence and documentation are on the Trust & Compliance page.
How does CITIZ3N avoid wrongful denials in program integrity?
HAL keeps a human in the loop. AI surfaces anomalies and patterns; trained staff review and make the determinations, so automation supports decisions rather than making them.
How do we contract with CITIZ3N?
Through the GSA Multiple Award Schedule. CITIZ3N is a GSA MAS contract holder (Contract #47QTCA26D006Q), so eligible state and local agencies can purchase through GSA's Cooperative Purchasing Program using a pre-negotiated federal vehicle your procurement team already recognizes. CITIZ3N also contracts directly and delivers as a partner inside a system integrator's award. Contract-vehicle details and compliance documentation are on this page; for anything else, contact our team.
Is CITIZ3N a prime or a partner?
Both. CITIZ3N delivers as a prime and also drops modular components into a system integrator's delivery as a partner.
What is HAL?
HAL is Human-Augmented Learning — CITIZ3N's approach to AI where models assist and people decide. It is woven through the Verify modules and never operates autonomously.
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