The One Big Beautiful Bill Act (OBBBA) introduces the broadest set of Medicaid eligibility changes in more than a decade. These updates expand both the number and complexity of requirements states must implement, with a sharper focus on verification and compliance. States are now responsible for monitoring more data points across more systems, which significantly increases the workload for administrative staff and IT teams alike.
To meet these demands, agencies must be able to support and verify new, extensive eligibility requirements while ensuring beneficiaries continue to receive timely access to care.
New requirements necessitate IT investments
Meeting the need for increased eligibility verification will require significant investments in both IT systems and staff capacity. Manual processes alone cannot keep pace with the added workload, and outdated systems lack the flexibility to adapt quickly. States need modern solutions that automate verification, streamline data exchange, and reduce the time caseworkers spend on manual checks.
At the core of these new processes is one critical need: complete and accurate data. Eligibility verification relies on having a trusted view of each individual’s information, pulled from multiple sources that often conflict or overlap. Without the right tools, agencies risk delays, errors, and non-compliance with regulations.
The challenge is compounded by the nature of client data, which is often fragmented across disparate agency systems. Employment data, immigration status, residency records, and health program participation may all live in different silos, making it difficult to reconcile quickly and accurately.
A modern, comprehensive identity data solution is essential. By unifying records across systems and automating identity resolution, agencies can support these new requirements while easing the burden on staff. This allows caseworkers to focus on higher-value activities instead of wrestling with duplicate, incomplete, or conflicting data.
Verification of work requirements
Under OBBBA, all states must require Medicaid expansion enrollees, unless exempt, to complete 80 hours per month of work or community engagement activities. Verifying these activities demands frequent data exchange with workforce agencies, employers, and other reporting systems—often with inconsistent formats or incomplete information.
An identity solution ensures that beneficiary records are consistently matched and updated across these sources, even when demographic details differ. By automating identity verification, agencies can reduce the manual effort required to track compliance, minimize errors, and more efficiently support enrollees in meeting the new standard.
More frequent eligibility determinations
Expansion states must now verify eligibility for enrollees every six months instead of annually, effectively doubling the workload for caseworkers. This accelerated cycle puts significant strain on systems already stretched thin.
An identity solution can ease this burden by automatically reconciling beneficiary records at each redetermination point. Instead of staff spending hours manually checking records, automated identity resolution provides an accurate, up-to-date view of eligibility. This not only reduces processing time but also improves the accuracy of determinations, ensuring that beneficiaries who remain eligible continue receiving uninterrupted care.
Prevention of duplicate enrollment across states
OBBBA requires states to establish a system to reduce duplicate enrollments by cross-checking with other states. This introduces new challenges, as beneficiary data often varies across systems—addresses change, names are spelled differently, and employment or household information may not align.
A modern identity solution enables states to unify historic and current person data, creating a consistent record that can be matched across systems. Modern APIs and industry-specific connectors meeting HL7 and FHIR standards make it easier to exchange enrollment data with other states, while advanced matching capabilities ensure that records align even when details don’t match perfectly. The result is stronger program integrity and fewer improper payments due to duplicate coverage.
Immigration status checks
OBBBA also narrows which immigrants can receive Medicaid or CHIP, limiting eligibility to lawful permanent residents who have met the five-year waiting period, Cubans and Haitians with specific statuses, and individuals from Micronesia, Palau, or the Marshall Islands. Verifying these statuses requires pulling from multiple federal systems, including USCIS and ICE, which maintain a complex data-sharing process.
An identity solution can bridge this gap by connecting to these disparate sources and reconciling the information into a single, trusted record. It also accounts for the unique challenges of working with foreign names, which may appear differently across systems or change due to marriage—a frequent occurrence as marriage-based green cards make up a large portion of immigration statuses. By automating identity matching across these complex data sources, agencies can confidently determine eligibility while reducing manual effort.
Address verification
States are now required to update enrollee address information using reliable data sources such as the National Change of Address Database and managed care entities. This is particularly challenging for lower-income individuals and families, who tend to move more frequently, making it harder to ensure records remain current.
An identity solution can automatically verify and update addresses by pulling from authoritative sources, reconciling discrepancies, and ensuring beneficiary records always reflect the most accurate information available. This reduces returned mail, prevents coverage gaps, and helps states maintain compliance with federal requirements.
Ongoing program integrity reviews
CMS will continue conducting reviews to assess a state’s program integrity and compliance with OBBBA requirements. For many agencies, preparing for these reviews requires significant time and effort, often pulling staff away from other priorities.
A modern identity solution provides a single source of truth for beneficiary records, showing a complete history in one place. This makes audit preparation more straightforward and ensures agencies can demonstrate compliance quickly and confidently. By reducing the manual lift of program integrity reviews, states free up staff to focus on serving beneficiaries rather than assembling audit documentation.
How Verato helps
Meeting these new eligibility requirements necessitates a modern identity infrastructure. Verato provides the trusted, enterprise-wide identity data foundation states need to manage increased administrative demands with confidence. The following sections show how Verato supports each of the new mandates, from work requirement tracking to address verification and program integrity reviews.
Accurate identity resolution at scale
Verato’s technology creates a single, golden record for each Medicaid beneficiary, eliminating duplicates and ensuring each individual is uniquely identified—even across state lines—to detect and resolve cross-state duplicates and improper enrollments. Unlike traditional matching algorithms, Verato Referential Matching® compares individuals to Verato’s proprietary, continuously updated database spanning 30 years. This enables multiple records to be matched to one individual even when addresses, phone numbers, or other identifiers differ.
The cloud-native platform allows integration across states using modern APIs, meeting HL7 and FHIR standards for trusted, scalable data exchange. Not only does this streamline sending requested data, but it also accelerates integrating data from outside sources, no matter if they are incomplete or outdated.
Real-time verification and data quality
Verato integrates seamlessly with state eligibility and case management systems to instantly verify beneficiary identity. This real-time verification eliminates delays in enrollment and ensures applicants are correctly matched to their records, even if demographics differ. By resolving identity discrepancies at the point of entry, agencies can speed up eligibility determinations and reduce manual review workloads.
The platform also supports ongoing, automated eligibility re-checks to keep beneficiary data accurate between determination cycles. Instead of relying on point-in-time validations, agencies can maintain up-to-date records that reflect life changes such as moves, name changes, or household shifts. This continuous monitoring improves program integrity and reduces administrative burden while complying with more frequent eligibility check requirements.
Enhanced program integrity and compliance
Verato makes it easy to monitor for fraud, waste, and abuse enterprise-wide by flagging bad actors and watching if they return, even if they reapply to a different program or with different demographics, such as a new address, phone number, or married/maiden name. Verato’s patented approach to referential matching overcomes these attempts to mask their identity and helps flag cross-program or future fraud, waste, and abuse attempts.
Our identity solution also ensures audit readiness with a complete and trusted beneficiary history. The platform makes it easy to see unified beneficiary records across programs while freeing up staff that would otherwise spend hours pulling records for audits.
Seamless integration with existing systems
Verato offers pre-built connectors for the major Medicaid MMIS, case management, and analytics platforms agencies already rely on. These integrations eliminate the need for custom development and reduce friction in deploying new identity capabilities. By connecting directly to existing systems, agencies can unlock a more complete view of each beneficiary without disrupting current workflows or retraining staff.
Because the platform is cloud-native, deployment is rapid and requires minimal IT resources to maintain. Agencies benefit from automatic updates, high availability, and the scalability needed to handle surges in eligibility redeterminations or application volumes.
Summary: Key benefits for state Medicaid agencies
Verato gives state Medicaid agencies the identity foundation needed to comply with OBBBA’s expanded eligibility verification requirements with confidence. By reducing manual eligibility reviews, preventing duplicate enrollments, and improving data accuracy, agencies can improve operational efficiency and realize meaningful cost savings. At the same time, beneficiaries experience faster, more reliable determinations, ensuring that coverage is delivered efficiently and accurately to those who need it most.
Book a strategy session with one of our identity experts to review how Verato can help you meet OBBBA requirements.
