hequity.ai reads clinical data — ADT feeds, EHR records, county files — and surfaces exemptions before the renewal deadline. No manual chart review. No missed members.
Built for Medi-Cal health plans, public health systems, community clinics, ECM providers, and counties.
Member 4471-08
Example record · synthetic data
Six-month renewal period
See how hequity.ai finds Medi-Cal exemptions in clinical data before renewals come due.
What's at stake in California
Medi-Cal members who may be disenrolled by full implementation in June 2028, including normal churn to Covered California.
DHCS H.R.1 Implementation Plan, Jan 2026Projected to lose coverage because of work requirements alone, by 2029–30.
DHCS May 2026 Medi-Cal Local Assistance EstimateOf 4.8 million subject to the work requirement, projected to qualify for an exemption. Each one still has to be identified.
DHCS May 2026 Medi-Cal Local Assistance EstimateShare of procedural disenrollments that are avoidable with timely outreach and correct exemption documentation.
California Health Care Foundation, 2025Health plans and counties rely on claims to identify exempt members. But the most common exemptions — inpatient stays, SUD treatment, pregnancy, serious illness — show up in ADT feeds and EHR records weeks before a claim is filed, if a claim is filed at all.
Retention work fails on volume: thousands of charts to read, packets to assemble, and members to reach every six months. hequity.ai puts models and agents on each step, so care managers and navigators spend their time on decisions and conversations.
Reads discharge summaries, progress notes, and problem lists to find treatment, frailty, hospitalization, and reentry evidence that structured fields miss.
Ranks every member each month by the chance of a paperwork loss, using returned mail, past lapses, hours gaps, and days to renewal.
Assembles the county-ready exemption packet: fills the forms, attaches minimum-necessary evidence, and queues it for one-click human approval.
Plain-language text and voice reminders in Medi-Cal threshold languages. Answers renewal questions any hour and hands off to a navigator when a person is needed.
Briefs a community health worker before each visit, suggests the next best step, and drafts the CHW visit documentation for billing.
Turns pay stubs, gig app screenshots, and volunteer letters into a structured 80-hour monthly log the county can accept.
Continuous monitoring of ADT feeds, EHR records, and county data for signals that match DHCS exemption categories.
Automated work queue for navigators and care managers, prioritized by renewal urgency and exemption confidence.
Structured exemption packets assembled from clinical evidence, ready for DHCS submission or plan review.
Renewal calendars, at-risk lists, and procedural-loss tracking, lined up with the metrics DHCS will publish.
Population-level scoring that identifies which members are most likely to lose coverage without intervention.
HL7 FHIR and flat-file connectors for ADT, EHR, SAWS, CalHEERS, and care management platforms.
Five steps, fully coordinated — from the first clinical signal to a confirmed renewal outcome.
ADT feeds, EHR records, and county files flow into hequity.ai through HL7 FHIR or flat-file connectors.
Each signal is evaluated against 13 DHCS exemption categories. Confidence scores are assigned per member.
High-confidence exemptions surface in the navigator work queue, ranked by renewal urgency.
Clinical evidence is compiled into a DHCS-aligned packet, ready for submission or plan review.
Renewal status is tracked through SAWS and CalHEERS. Retained members are logged for reporting.
Paste or edit a note. The reader highlights exemption evidence and maps it to the H.R.1 rules. This browser demo uses simplified pattern matching on synthetic notes; the production reader uses language models with human review.
Exemption found
Packet Agent drafts the county packet with this evidence cited and queues it for care manager approval.
Illustrative only, based on the DHCS H.R.1 Implementation Plan (January 2026). Counties make all eligibility decisions, and federal guidance on medical frailty is still being finalized.
Every procedural disenrollment is a lost member and lost premium. DHCS expects plans to lead retention outreach.
County-operated plans and health systems carry the largest share of expansion adults subject to work requirements.
Clinics see the clinical signals first. hequity.ai turns those signals into exemption documentation before the renewal deadline.
Enhanced Care Management teams are already embedded with high-risk members. hequity.ai adds exemption detection to their workflow.
County social services and public health departments hold address, income, and case data that closes gaps in plan records.
Jan 1, 2027
Work requirements begin
Q1 2027
First renewal wave
Mid-2027
Reporting ramp
Jan 2028
Age expansion
Jun 2028
Full implementation
All PHI is processed under BAA. Data is encrypted in transit and at rest. Access is role-based and audited.
SUD treatment records are handled under the stricter consent requirements of 42 CFR Part 2, not just HIPAA.
Member data is used only for retention workflows. It is never sold, shared with third parties, or used for any other purpose.
Every exemption detection, navigator action, and packet submission is logged with timestamps for DHCS reporting and plan audits.
We'll walk through your member population, your current data connections, and what a retention workflow would look like for your organization.
Prefer email? Write to hello@hequity.ai
Data connections, navigator placement, and contact refresh take time to stand up. The plans and systems that start now will be ready. The ones that wait won't.
No commitment required. White-glove onboarding. No hidden fees.