AI company Eleos Health is helping Medicaid patients identify risks of being kicked off the program as a result of President Donald Trump’s sweeping tax package passed in July.
Eleos Health created the One Big Beautiful Bill Act (OBBBA) AI Scanner to proactively identify Medicaid beneficiaries’ risk of losing coverage based on the new, more restrictive requirements put in place by Republicans.
The OBBBA AI Scanner is integrated into Eleos’ existing AI scribe product and is free to customers. If a patient discloses changes to their work, marital status, diagnosis or age, for example, the AI Scanner will flag for the clinician that the change in circumstance may cause them to lose coverage.
Eleos customers are community behavioral health centers, nonprofit substance use disorder facilities, home health and hospice agencies that largely serve Medicaid populations. About 35% to 45% of behavioral health conversations are related to social determinants of health, which lends well to running the AI scanner in the background of patient conversations, Eleos co-founder Alon Joffe said.
Joffe said he hopes to give Medicaid beneficiaries a heads-up about potential coverage loss.
“There are still a lot of unknowns, but what I want to say to the Medicaid population and to the providers who treat them is you have superpowers to deal with this change,” Joffe said. “This population, they just don't know how to fill out all these forms. They don't know what the regulation means and what the regulation changed. And if we can empower them, it's going to change your life.”
Once providers are alerted about a potential Medicaid eligibility issue, they can connect with their internal billing or care navigation teams to help start the patient on their journey to maintaining coverage. Joffe said it’s key that the alert process carries through in the workflow so providers have an easy way to move the patient on to the next step.
Eleos began working on the scanner long before the OBBBA was passed on July 4. The company worked with the National Council for Mental Wellbeing, provider organizations and state associations to understand what the changes to Medicaid were likely to be.
The OBBBA AI Scanner can be tailored by provider organizations, which are more likely to understand local differentiations in Medicaid policy to make the AI tool more useful for their patients. Eleos will lean on its customers and national and state associations to keep track of the policies as they are implemented across the country.
“We stay very connected to what's happening on the ground, but we also learn from the field. [If] the organization tells us, ‘hey, no, I need to customize it, because I have something different with my county,’ we need to be able to provide them with these appeals,” Joffe said. “We don't claim to know it all … It's not a one-size-fits-all. Healthcare in the U.S. is highly local.”
There is a burgeoning market for AI products that assist organizations with the changes that OBBBA made to the healthcare system. Unite Us is touting an AI tool to apply for the $50 billion rural health transformation program, and the Coalition for Health AI has convened a tiger team to develop guidelines for AI products in the space.
To discern which vendor to work with, Joffe said that provider organizations should check if the vendor has worked in healthcare before or if they’ve moved into the market because of the opportunity the bill presents.
“OBBBA has created significant uncertainty for the behavioral health sector, and organizations need every possible advantage to navigate it,” said Chuck Ingoglia, President and CEO of the National Council for Mental Wellbeing, in a statement. “Properly deployed, purpose-built AI tools help organizations navigate an ever-changing landscape while also promoting the health and well-being of clients and communities.”