Every procedurally-disenrolled member is premium you stop earning.
When H.R.1's work requirements take effect, your capitation revenue depends on whether eligible, enrolled members understand what they have to do — and whether they claim the exemptions they already qualify for. Most won't lose coverage because they stopped working. They'll lose it because a notice was confusing, a deadline was missed, or an exemption was never claimed. We run the member-communications layer that prevents that.
Capitation stops the day the member disenrolls — for any reason
Procedural disenrollment is not a compliance failure on your part. But the revenue loss lands on your books the same way. The model is straightforward: subject members × PMPM × procedural disenrollment rate × months off coverage. At scale, that number is material.
The OBBBA changed more than just the work-hours requirement. It cut the eligibility redetermination cycle for expansion adults from annually to every six months. That doubles the administrative moments each year when an eligible, enrolled member can fall off your book of business over a piece of paperwork. The revenue model your actuaries built assumed one renewal per year. It now faces two.
Our free calculator lets you run this with your plan's actual subject-member count. The inputs are the same ones your CFO and VP of Government Programs are already tracking.
The member-communications functions your team can't staff at deadline speed
Your member-services team handles inbound calls and standard renewals. What it typically doesn't have — staffed, tested, and ready by August 31 — is the outbound, multilingual, exemption-focused engagement layer H.R.1 demands. That is what we bring.
Plain-language multilingual member notices
CMS-compliant enrollee notices rewritten to a 6th-grade reading level — in English and Spanish at native quality — so members understand exactly what they must do, by when, and how to claim an exemption. Delivered mail-ready and print-production-ready.
Managed omnichannel outreach
Mail, SMS, and IVR sequenced around your member-services calendar and tied to a retention KPI. Outreach stops the moment a member responds. TCPA-compliant consent and opt-out management included.
Exemption-claim campaigns
The members most likely to disenroll procedurally are the ones who qualify for an exemption but don't know it: caregivers, members in treatment, medically frail. We run targeted campaigns to surface and document exemption eligibility before the coverage loss happens.
Comprehension testing before launch
Every notice set and outreach script is tested for member comprehension before it reaches your population. We don't ship copy that a member can't act on.
Response and exemption-claim reporting
Channel-level response rates, exemption claims captured, and disenrollment-risk segmentation — so your government-programs team can show the actuary and the regulator exactly what coverage was protected, and how.
Equity and language-access reporting
Reach and response disaggregated by language, geography, and disability — the data your state contract and your own DEI commitments require, without building the analytics infrastructure yourself.
You can staff this internally — the question is whether you can staff it by August 31
This is an honest comparison. Some plans have the in-house capacity. Most do not, at the speed the deadline requires.
What building in-house requires
- A plain-language health communications writer with Medicaid member-notice experience
- A bilingual Spanish editor — native quality, not machine translation
- A CMS-compliance reviewer who knows the June 2026 Interim Final Rule
- An omnichannel outreach manager for mail, SMS, and IVR
- TCPA compliance and consent management for SMS
- A data analyst to build the retention KPI reporting layer
- Vendor contracts and procurement for print and telephony
Each of these is a real hire or a real contract. With a June 30 notice-window open date, the runway to stand this up is already short.
What plugging us in looks like
- One engagement — we bring the full team: content, language access, compliance, outreach, data
- We work alongside your existing member-services operation, not around it
- No new hires, no vendor-management overhead for print or telephony
- CMS-compliant notices built to your state's approved requirements
- English and Spanish at native quality; additional languages on request
- KPI reporting your government-programs team can hand to the regulator
- Notice & Outreach Rapid Pack deliverable in 2–3 weeks
We have submitted a proposal to a state Medicaid agency for this exact scope. References available under appropriate confidentiality terms.
The member-notice window is June 30 – August 31, 2026. Federal enforcement begins January 1, 2027. The procurement and vendor-selection cycle is happening now.
Four ways to start — from a two-week sprint to a managed program
Most plans start with a fixed-scope, fast engagement that delivers something usable before August 31, then decide whether to expand to managed outreach. All engagements are priced transparently; no multi-year commitment required to begin.
Aug 31 Notice & Outreach Rapid Pack
$25–50K · 2–3 weeksCMS-compliant, plain-language member notices in English and Spanish, SMS and IVR scripts, and exemption one-pagers — built and delivered inside the federal member-notice window. The fastest way to have a compliant, member-ready outreach package in hand before August 31.
- CMS-compliant notice set (mail + SMS + IVR)
- English and Spanish, native-quality
- Exemption one-pagers for the most common categories
- Comprehension-tested before delivery
Procedural Disenrollment Risk Audit
$25–75KA structured review of your current member-notice approach, exemption capture rate, and outreach coverage for your H.R.1 subject population — with a gap analysis, multilingual sample notice pack, and a prioritized remediation roadmap your government-programs team can act on.
- Member-journey gap analysis against CMS requirements
- Exposure quantification by language, geography, and exemption category
- Multilingual sample notice pack
- Prioritized remediation roadmap
Churn-Prevention Pilot
$50–150K · 90 daysA 90-day multilingual outreach and exemption-claim campaign for your H.R.1 subject population, tied to a measured retention KPI. Includes channel sequencing (mail, SMS, IVR), exemption outreach for eligible-but-confused members, and a retention reporting package at close.
- Full omnichannel campaign (mail, SMS, IVR)
- Exemption-claim outreach for caregiver, medical, and other categories
- Retention KPI: disenrollment rate vs. control
- 90-day reporting package
Engagement Layer, Managed
$25–100K / monthYour ongoing multilingual member-retention outreach program, run and measured for you. We maintain the notice cadence, manage channel sequencing across mail, SMS, and IVR, refresh exemption campaigns as your population shifts, and deliver monthly retention reporting — so your team stays focused on member services rather than managing outreach operations.
- Monthly omnichannel outreach — mail, SMS, IVR
- Ongoing exemption-claim campaigns
- Monthly retention KPI reporting
- Notice updates as CMS guidance evolves
Tell us your plan size and we'll estimate your premium exposure — same day.
Share your approximate subject-member count and we'll send back a quick read on your exposure and the fastest compliant path to August 31. No obligation, no procurement required to talk.
- We reply within one business day
- We can engage directly with your plan or through your state prime contractor
- References from our state Medicaid agency proposal available under confidentiality
- Free calculator at /calculator.html if you want a number before we talk
Thank you — your request is in. We'll reply within one business day.
See your premium at risk — before the August 31 notice window closes
Enter your subject-member count, your PMPM, and your estimated procedural disenrollment rate. The calculator returns your annual capitation at risk, the retention ROI on a member-communications program, and the payback period. Takes about two minutes.
Common questions
How much premium does an MCO lose to procedural disenrollment under H.R.1?
A plan with 100,000 subject members at $450 PMPM and an 18% procedural disenrollment rate has roughly $100 million in annual capitation premium at risk. Our free calculator lets you run this with your own numbers.
Why does OBBBA double the churn risk for MCOs?
Under the new law, expansion adults must renew eligibility every six months instead of annually. That doubles the administrative touchpoints where an eligible, enrolled member can fall off coverage over paperwork — and doubles the premium exposure per year.
Can your engagement layer connect to our existing member-services stack?
Yes. We work alongside your existing member-services operations — we don't replace them. We bring the plain-language content, multilingual production, omnichannel outreach sequencing, and exemption-claim capture that most plan member-services teams don't have staffed at the speed the August 31 deadline demands.
How quickly can you deliver notices before the August 31, 2026 deadline?
The Aug 31 Notice & Outreach Rapid Pack is designed for this: CMS-compliant, English and Spanish notices, SMS and IVR scripts, and exemption one-pagers delivered in two to three weeks.