Maryland gets nonprofit support to implement new work requirements
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Code for America and other civic tech nonprofits are helping Maryland tackle tech, customer experience and workplace efficiency challenges to comply with new federal Medicaid rules.
States have 99 days left to prepare for Jan. 1, 2027, when work requirements for the federally funded and state administered Medicaid program go into effect. In the last three months before that deadline, one Maryland agency is partnering with Code for America to streamline the Medicaid eligibility determination and enrollment process.
The Maryland Health Benefit Exchange, which administers the state’s health insurance marketplace, will work with the civic tech nonprofit Code for America to modernize the agency’s technology, workflows and public communications in a bid to make compliance easier, Johanna Fabian-Marks, executive director of MHBE, told Route Fifty.
The partnership is part of Maryland’s efforts to comply with new Medicaid rules mandated by President Donald Trump’s One Big, Beautiful Bill Act that passed last July, which created work — or community engagement — requirements for the Medicaid expansion population. Under the requirements, beneficiaries ages 19 to 64 years must prove that they participate in employment, education programs or volunteer work at least 80 hours a month to maintain coverage under the public health program.
States are also required to certify twice a year beneficiaries’ compliance with the work requirements, essentially doubling the workload for residents and caseworkers to maintain Medicaid enrollment, Rebecca Piazza, executive director of safety net strategy at Code for America, told Route Fifty.
MHBE’s work with Code for America aims to “simplify the [Medicaid] program at the same time the program is becoming more complex,” she said.
The nonprofit will assist MBHE with upgrading internal technology and staff workflows, including designing digital tools aimed at reducing manual work, Piazza said.
For instance, Maryland officials are prioritizing finding ways to automate data verification tools that can expedite how caseworkers are able to determine a beneficiary's compliance or exemption from the work requirements, Fabian-Marks said.
Maryland will also focus on simplifying touch points with residents — such as government notices, forms and other communications about Medicaid — in an effort to make the application process easier under the new work requirements. As an example, Fabian-Marks pointed to revamping communications to include more plain language and user-friendly designs.
Other civic tech nonprofits Civilla and Public Policy Labs will provide assistance with redesigning Maryland’s online application and notices for the Medicaid program, respectively.
“It's really critical that these forms and notices are clear when running a program like Medicaid. Clearer forms and notices, maybe makes it faster to fill [them] out … but it also means that you probably have fewer calls coming into the call center because people aren't confused, and caseworkers need to send fewer follow-up notices” to enrollees who may have made a mistake in their application because they didn’t understand the complex requirements, Piazza said.
While Fabian-Marks believes Maryland is “on track” to meet the One Big, Beautiful Bill Act’s January deadline, the work MBHE is doing with Code for America also helps set the state up for future rule implementations, such as documentation requirements for residents engaging in work requirements starting Jan. 1, 2028, she said.
“I think we're going to continue facing implementation challenges, both from an internal perspective and from our consumer experience perspective,” Fabian-Marks said, but “one silver lining is the attention that [HR 1] is bringing to these eligibility processes, the opportunities that are arising for partnership with organizations like Code for America and multi-stakeholder collaboration across the state to figure out how we meet our objective of keeping people who are eligible in coverage.”