The independent source for health policy research, polling, and news.<\/p>\n
Vanessa Barahona received a call this past spring from Angelica at Kern Family Health Care in Bakersfield, California, telling her it was time to renew her coverage under Medi-Cal, the state\u2019s version of Medicaid.<\/p>\n
This story also ran on Capital & Main. It can be republished for free.<\/p>\n
Angelica helped Barahona, 41, schedule an appointment to complete her paperwork in person at Kern Family\u2019s offices before she submitted it to Kern County officials for approval. When Barahona had a conflict with her office-cleaning job, Angelica rescheduled the appointment. Barahona finished the process a little later than she\u2019d planned but early enough to avoid an interruption in her coverage.<\/p>\n
\u201cIt was easy. The fact that Angelica spoke Spanish when we were on the phone made it better,\u201d Barahona, whom KFF Health News met through Kern Family Health Care, said via a translator. \u201cIt felt like I was talking to a real person.\u201d<\/p>\n
\u201cAngelica\u201d is the name assigned to an AI program deployed last year by Kern Family Health Care, the largest provider of Medi-Cal services in Kern County. An estimated 52% of residents there rely on the safety net program for health coverage, among the highest enrollment rates in the state.<\/p>\n
Kern Family has spent about $370,000 on the software from Careforce, a San Francisco startup, to facilitate rapid and repeated outreach to members when it\u2019s time to renew their coverage \u2014 a process that is about to become more complex under new Medicaid eligibility rules established under Republicans\u2019 One Big Beautiful Bill Act, signed into law last year by President Donald Trump. Mandatory work requirement documentation will take effect nationally beginning in 2027, and under the GOP\u2019s new rules, most Medicaid patients will now have to renew their enrollment twice a year, rather than once a year.<\/p>\n
Kern Family and other similar health plans have an interest in keeping people enrolled, since they\u2019re paid through managed care contracts with Medi-Cal. They can also save money by using AI software to do what Kern says would otherwise require it to hire 40 full-time workers. Angelica does it at a fraction of the cost and without increasing payroll \u2014 or requiring Kern Family to navigate workers\u2019 rights issues or government-mandated workplace protections.<\/p>\n
Although Kern Family officials say no workers have lost jobs, the health plan, which is not unionized, estimated it would have had to spend $2.4 million in staffing costs to match the program\u2019s more than 800,000 calls to its 387,000 members since Kern Family began using Angelica late last year.<\/p>\n
As the federal government ended pandemic-era protections and states resumed screening people for Medicaid eligibility, health plans such as Kern Family began looking to technology to keep eligible people enrolled. Kern Family officials say that Angelica helps people, in their preferred language, set up appointments with the plan\u2019s staffers, who make sure that applications are filled out correctly and delivered to county health officials for verification and processing.<\/p>\n
Careforce CEO Huzaifa Sial said Kern Family is one of a few health insurers using his company\u2019s software to help boost its Medi-Cal enrollment, and the company is also working with the Central California Alliance for Health in much the same way. \u201cMost people don\u2019t know what they need, and if they do, they have a hard time getting there,\u201d Sial said. \u201cThat\u2019s the hidden execution problem that nobody sees.\u201d<\/p>\n
The rise of AI in the healthcare industry has prompted worries about who\u2019s overseeing these tools and whether people are being improperly denied treatments or cut off from care. Unions have raised concerns about workplace surveillance and the prioritizing of savings over safety. Polling shows widespread fear over AI-driven job losses and growing income inequality, while health policy researchers have also raised red flags about algorithmic biases, transparency, data privacy, and safety risks.<\/p>\n
Mark Duggan, a Stanford University economics professor who has studied the Medicaid system for 30 years, said one long-standing fear is that insurers could use such software to cherry-pick patients for coverage.<\/p>\n
\u201cWhen you have a new technology like this, you need to police it,\u201d Duggan said.<\/p>\n
California health plan regulators say they are tracking AI use closely, and the state attorney general\u2019s office has sent reminders to healthcare entities about their obligation to follow consumer protection rules.<\/p>\n