Medicaid Solutions for State Agencies
Maximus connects people to coverage and care through technology-enabled Medicaid eligibility and enrollment, community engagement, fair hearings, clinical services, and provider support for state agencies.
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Comprehensive solutions to help states navigate change, increase efficiency, and enhance member and provider experiences
Make requirements easier to understand, report, verify
As states prepare to implement community engagement initiatives to comply with Medicaid work requirements, they need to translate policy into practical operations. Maximus combines deep Medicaid expertise with proven member outreach, engagement, and operational support to implement programs, educate members, and simplify reporting and verification.
Our comprehensive solution combines technology, outreach, contact center operations, and compliance reporting so eligible members can navigate requirements and maintain coverage. Self-service reporting, proactive outreach, and personalized support enable states to improve program performance while advancing better member outcomes.
Improve accuracy before determinations are made
State Medicaid agencies face growing caseload complexity, evolving policy requirements, compliance expectations, and continued risk of procedural disenrollments. Traditional quality assurance often identifies issues only after action has been taken, creating rework, appeals, member notices, reinstatements, and additional administrative burden.
Accuracy Assistant™ moves quality reviews earlier in the Medicaid eligibility process by embedding policy guidance, discrepancy detection, and risk-based review into existing workflows. Staff can identify verification issues, resolve discrepancies, and focus reviews on higher-risk cases before determinations are finalized. The solution supports human decision-making, improves decision quality, strengthens program integrity, and reduces avoidable coverage disruptions.
Manage Medicaid appeals from intake to resolution
State Medicaid agencies often manage appeals and fair hearings through disconnected systems and manual processes. These conditions can make it difficult to coordinate work, maintain visibility, meet timeliness requirements, and respond to growing appeal volumes. As inventories and workloads increase, agencies need better tools and operational support to reduce bottlenecks and strengthen oversight.
Maximus manages the full appeals lifecycle through a unified solution that combines operational expertise, purpose-built technology, and AI-enabled decision support. The solution connects appeal intake, evidence management, hearing coordination, decision support, quality review, and operational oversight in a shared workflow. Staff receive clear next actions, while leaders gain visibility into performance, risk, and workload.
Community engagement implementation
States are moving from policy planning to program execution. Explore practical considerations for outreach, reporting, compliance, and member support as Medicaid community engagement requirements take shape.
Explore implementation insightsMaximus provides program implementation support, reporting and verification tools, outreach and education, compliance reporting, contact center operations, and self-service digital experiences, including a job board and digital health risk assessment to help members find work and identify needed health and social supports. These capabilities integrate with existing state Medicaid eligibility processes.
Members who need to meet the requirement can use a mobile-first self-service portal to report qualifying activity hours, request exemptions, and upload supporting documentation. States can also verify information electronically with employers and community organizations.
Maximus delivers outbound calls, text messages, mail campaigns, contact center services, and other communication channels that provide clear, accessible information about requirements, qualifying activities, exemptions, and deadlines.
Maximus provides self-service interactive voice response (IVR), web and mobile experiences, chat, email, inbound and outbound calls, and quality management. These channels give members multiple ways to access information and complete required actions.
Reporting capabilities give states visibility into program operations, member activity, compliance requirements, and engagement patterns. Agencies can use these insights to monitor performance and refine outreach and operations.
Discover our tech-driven Medicaid solutions
Simplified eligibility and enrollment
Streamlined application and enrollment processes enhance operational efficiency and strengthen customer engagement.
View our Medicaid case studies
AI for improved government CX
Discover how we use advanced technology to improve the quality assurance process at a large customer contact center for Michigan's Medicaid program.
Stronger provider networks
See how our support for Medicaid centralized credentialing in Ohio streamlined provider enrollments, improved data accuracy, and enhanced care access.
Access to home and community-based care
Learn how we expedited a complicated waiver application process from 90 to 30 days, helping older adults and people with disabilities access services and supports.
Explore our Medicaid perspectives
Medicaid FAQs
Maximus operates as a conflict‑free partner with no ties to health plans, providers, or payers. We deliver unbiased choice counseling to help Medicaid members select managed care plans that meet their needs. We provide objective, independent clinical assessments that help people and their caregivers navigate paths to services and supports.
Maximus supports provider network quality by simplifying onboarding, credentialing, and revalidation processes. Streamlined workflows reduce administrative friction, helping states attract new providers and retain existing ones — especially in underserved or high‑demand areas.
Maximus conducts PASRR Level I screenings and Level II clinical evaluations for individuals with serious mental illness, intellectual disability, or related condition — helping states comply with Centers for Medicare & Medicaid Services requirements and protect populations with complex needs.
Maximus combines appeals intake, evidence management, hearing coordination, decision support, quality review, and operational reporting in a shared workflow. This approach improves case visibility and supports timely, consistent resolution while keeping Medicaid program staff in control of decisions.
