A lower-risk approach to Community Engagement Verification (CEV)

Community engagement requirements under HR1 are coming fast, and states are feeling the pressure. Aggressive timelines, evolving CMS guidance, limited staffing and the risk of member churn are making implementation especially complex.

In our recent Community Engagement Verification demo, we walked through a practical, data-first approach designed to help states meet HR1 requirements without disrupting existing eligibility systems or staff workflows.  

States are facing a perfect storm of challenges as HR1 moves forward:

• Compressed implementation timelines, with guidance still evolving
• Complex system impacts across eligibility, MMIS, call centers and data exchanges
• Staff capacity constraints with no new funding
• High risk of coverage loss for individuals with unstable work or housing situations
• Limited alignment across Medicaid, SNAP and TANF work requirements

Across conversations with states nationwide, one message is consistent: Community engagement verification must be accurate, efficient and minimally disruptive.  

At the heart of our approach is a simple idea: Use trusted data first and ask members for documentation only when absolutely necessary.

The solution prioritizes automated verification using data sources states already rely on, such as:

• Wage and workforce data
• SNAP and TANF participation
• Education enrollment and other approved third-party sources

When data supports compliance or an exemption, verification may be completed using existing data sources, helping limit additional paperwork and follow‑up for staff and members.

Rather than rebuilding eligibility systems or introducing new staff tools, the Community Engagement Verification solution works alongside existing platforms.

Here’s how it all fits together:

• Eligibility systems remain the system of record.
• Verification requests are sent to a dedicated verification service.
• Results, including reason codes, flow directly back into existing eligibility workflows.
• Staff see everything where they already work, with no new logins or dashboards.

This design helps reduce certification risk and workflow disruption while keeping accountability with the state.  

In cases where data alone can’t confirm compliance, such as volunteer activities, the solution supports a mobile-friendly, WCAG-compliant member portal.

Through the portal, members can:

• Report work, education or volunteer activities
• Submit exemption or hardship information
• Upload documentation from any device
• Track verification status

The portal uses document intelligence to help members submit the right information the first time, reducing back-and-forth and call center volume. And because it’s modular, states can use it only where it makes sense or not at all.  

AI plays a targeted, transparent role in the solution:

• Extracting key data from documents
• Flagging incomplete or outdated submissions
• Supporting staff review with confidence indicators

AI is not designed to make eligibility decisions or deny benefits. Every result is intended to be traceable and reviewable, supporting audit processes and avoiding black boxes.

Why states are paying attention to Community Engagement Verification solutions:

• Lower risk: Designed to avoid major eligibility system rebuilds
• Quick value: Enables accelerated implementation
• Flexible: Adaptable as CMS guidance evolves
• Staff friendly: Minimal retraining or workflow changes
• Member centered: Reduces unnecessary paperwork and administrative touchpoints that can contribute to member experience challenges