← All 71 domains
benefitsexecutiveL4
Healthcare
Determine Medicaid, CHIP, and Marketplace APTC/CSR eligibility; manage enrollments, redeterminations, special enrollment periods, and fair hearings.
HHS CMS / state Medicaid agencies · Health and Human Services
99.8%
Coverage rate
3
Programs
5
Journeys / flow steps
Enter this domain
Three roles. One product surface. Citizen applies, staff adjudicates, admin configures.
Programs
Medicaid
Medical assistance / managed care coverage
~45d · insurance
CHIP
Child health insurance coverage
~45d · insurance
APTC
Lower QHP premiums and cost sharing
~1d · insurance
AI capabilities
- Intelligent plan matching
- Automated enrollment coordination
- Preventive care scheduling
Citizen flow
- Detect qualifying life events
- Compare coverage options
- Enroll or transfer coverage
- Schedule follow-up actions
Operator flow
- Review conflicting coverage
- Coordinate plan selection support
- Escalate medically urgent cases
Primary statutes
- 42 USC § 1396 et seq. (Medicaid Title XIX)
- 42 USC § 1397aa et seq. (CHIP Title XXI)
- 26 USC § 36B (premium tax credit)
- 42 USC § 18001 et seq. (ACA Marketplace)
Why this domain is unique
MAGI vs non-MAGI methodologies, expansion-state cliffs, APTC tied to SLCSP and tax reconciliation, and insurance enrollment (not cash allotments) make healthcare distinct from generic FPL plugins.