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Your constituents should never have to ask…

ContactEngine proactively reaches out to your Medicaid and CHIP claimants through their channel of choice and transacts with them.

Millions Will Lose Medicaid Coverage When the COVID-19 Emergency Ends. Health Care Groups Are Scrambling to Fill the Gap

With 88 million people on Medicaid and CHIP benefits, several state insurance regulators believe it could take up to one year to fully finish redetermining eligibility for their Medicaid populations after the COVID–19 public health emergency (PHE) ends.

As many as 16 million low-income Americans, including millions of children, are destined to churn off Medicaid and CHIP when the nation’s PHE ends. As states face a herculean mission to sort out who no longer belongs on rolls that have swollen to record levels during the pandemic.


Gartner research reveals that a dynamic customer engagement (DCE) strategy enables customer service and support leaders to transform their service experience through personalized proactive conversations with customers."Shifting from reactive to proactive conversations is a game-changer, delivering nearly effortless experiences, reducing cost and increasing customer lifetime value,”- John Quaglietta, Senior Director Analyst, Gartner


The looming disruption is a little-noticed side effect of the coronavirus crisis, and it is stoking fears among some on Medicaid and their advocates that vulnerable people who survived the pandemic will risk suddenly living without health coverage. There is the potential political stain of presiding over a surge of poor, newly uninsured Americans, depending on how things go once states resume checking which Medicaid beneficiaries still qualify.

Proactive conversational AI by NICE ContactEngine can help states quickly redetermine eligibility by reaching out to beneficiary’s, and proactively taking them on an eligibility determination journey to get their benefits through their channel of choice – SMS, email or automated voice. Once redetermined, ContactEngine will continue the journey with constituents, recertifying them digitally to reduce churn in receiving Medicaid and CHIP benefits.

Medicaid and CHIP churn leads to health care barriers and administrative burdens. Churn is problematic for several reasons. Most people who churn off and on Medicaid and CHIP experience a gap in insurance coverage, leading to delayed and more costly care after they re-enroll. For states, processing terminations of coverage and then reprocessing applications from people recently terminated is an inefficient and costly use of staff time and administrative resources. States must plan now to Limit Medicaid Churn. There’s also evidence that churning leads to greater per member per month costs due to the lack of more cost-efficient, consistent care for people with chronic conditions.

ContactEngine understands why the constituents on or needing Medicaid and CHIP benefits need an easy method to get their benefits and keep them. ContactEngine scripts an outbound conversational dialogue journey to serve constituent’s specific intent(s) (needs). Through natural language understanding (NLU) ContactEngine understands the constituent’s natural language (NL) response to ContactEngine’s outreach and will take this individual on a specific journey to transact.

ContactEngine proactively engages constituents in human-like conversations through the channel of choice.

ContactEngine’s proactive outbound AI communication is about reaching out to people and serving them, automating the constituent’s journey rather than managing them when they inbound. Managing constituents when they inbound is a much harder job, firstly because you may not know their reason for contacting you, so it’s much harder to deal with by AI, and secondly, if the constituent is trying to call to get help and can’t get through the chance for a truly great constituent experience has already been missed.

Proactive communications as provided by ContactEngine are delivered as part of a seamless and elegant conversation across the whole constituent’s journey – a conversation that allows constituents to take transactions. Each individual conversation is done with individual context – both of all the proceeding conversations, as well as real-time knowledge of the constituent’s status provided by agency data feeds. 


  • Proactive engagements exceed 96% containment rate, avoiding agent or email communication
  • Conversational AI design proactively reaches out to a constituent resolving questions before they are asked
  • Interactions are dynamic and personalized based on what we know about the constituent translating to increased positive claimant experience resulting in call reductions
  • Resolutions can take the form of answering questions, triggering other automations, sending data back to Medicaid CHIP applications, or creating a support ticket to update current systems with the most current data
  • Ability to evolve experience design over time to adapt to user behaviors and trending topics 

Use cases - Get ahead of regular transactions

  • Application Navigation and Completion
  • Automated Interview Scheduling 
  • Approval or Denial Communications – Appeal Process
  • Renewal Certifications
  • Updates during long periods of processing
  • Upload images of documentation

Resolve experience interruptions

  • Benefits have stopped
  • Communication when documents are needed
  • Request wage protests, backdates, appeals
  • Impacts from quarter change
  • Impacts from industry specific policies

Transforming the Citizen Experience Across State Agencies

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