NEWS
NM one of handful of states using AI to implement new federal Medicaid work requirements
Health Care Authority official says only humans will decide actual eligibility
New Mexico is one of six states that has begun using artificial intelligence to comply with a major Medicaid overhaul contained in the 鈥淥ne Big Beautiful Bill Act鈥� that President Donald Trump signed last year.
That鈥檚 according to that surveyed state officials across the county about how they intend to meet requirements contained in the bill ahead of the Jan. 1, 2027, deadline.
Only New Mexico and five other states 鈥� Missouri, Maryland, Arkansas, Kansas and Oklahoma 鈥� have started using AI to implement new federal requirements, though 21 states are still deciding whether to use the technology, according to the survey.
Under the new bill, most adult recipients of Medicaid, the nation鈥檚 low-income health insurance program, will to state officials that they have worked, volunteered or attended school at least 80 hours a month to continue receiving health insurance.
Collecting and verifying that information to keep people insured is 鈥渟uper complicated,鈥� said Paula Morgan, chief information officer of the Health Care Authority, which administers Medicaid. She said using AI is necessary to help process an expected deluge of pay stubs and other materials, while also ensuring the state is complying with new federal regulations.
鈥淥ur main goal is to make sure that eligible people keep the benefits that they鈥檙e eligible for, that the families in New Mexico keep the health coverage that they need,鈥� Morgan said. 鈥淎nd as we lean on automation, the first thing we want to do is help alleviate any of the disruption to those benefits, the procedural burdens that folks may be feeling.鈥�
State officials told Kaiser Family Foundation that the Health Care Authority would use artificial intelligence for document processing, merging datasets and 鈥渂ack-end鈥� automation, as well as to help identify cases where recipients are exempt from the new work requirements.
Morgan said the authority will use AI tools to help verify pay stubs and other documents recipients submit as proof of eligibility, like volunteer-hours timesheets or college class schedules. The technology will also help link an existing Medicaid eligibility system with a newly launched Medicaid claims system called Turquoise Claims.
鈥淭hat鈥檚 why we鈥檙e using multiple levels of AI and automation, in general, to be able to look at the multiple ways that folks are able to verify and be compliant,鈥� she said.
Morgan stressed that the authority is not allowing artificial intelligence to determine eligibility. That decision rests with humans.
鈥淎I is not making decisions,鈥� she said. 鈥淭he AI that we are developing is assisting our caseworkers as they work with New Mexicans to make sure that New Mexicans get the benefits that they鈥檙e eligible for. So caseworkers are making decisions. People are making decisions.鈥�
