Medicaid Exemption Screener

Use this skill when someone needs to reach a list of benefits enrollees before a deadline and find out which of them are already exempt or already compliant - not to remind them that paperwork is due, but to ask the questions that decide it.

It wraps the apps/typescript/still-covered engine in this repository: ex parte clearing, wave planning by deadline and paperwork risk, one CALL-E call task per person, fail-closed classification, and a human worklist. An agent can drive a whole campaign without reimplementing any of it.

The problem this solves

From 1 January 2027, most adults aged 19-64 on Medicaid must show 80 hours a month of qualifying activity, or about $580 a month in earnings, to keep coverage (P.L. 119-21 section 71119; CMS interim final rule CMS-2454-IFC). Nine categories are exempt.

The evidence is unambiguous about what goes wrong. Arkansas ran a work requirement in 2018: more than 18,000 people lost coverage in seven months with no significant change in employment, because the people who lost coverage were overwhelmingly already working or already exempt and simply never completed the reporting (Sommers et al., NEJM 2019). In the 2023-24 unwinding, 69% of disenrollments were procedural.

So the job is not "remind them." The job is ask them, in a language they speak, and put a reviewable packet in front of a caseworker for everyone whose answers suggest they qualify.

When To Use

• A state agency, health plan, or community organisation has a consented enrollee list with coverage check dates approaching, and wants to know who is exempt or compliant before the deadline.
• The user asks to "screen," "check who qualifies," "find who is exempt," or "reach people before they lose coverage."
• A prior campaign was interrupted and must be resumed without double-dialling anyone.
• The user wants to rehearse the calls, hear the script, or show a stakeholder what the calls sound like without spending credits - run the dry-run path, which needs no key and places no call.

When Not To Use

• Do not cold-call people who have not consented to be contacted about their coverage. This engine assumes a consented enrollee list and refuses rows whose consent column is not yes.
• Do not use it to make or communicate a benefits determination. The agent is explicitly forbidden from telling anyone they are exempt; every verdict is a proposal awaiting a human.
• Do not use it for marketing, enrolment sales, plan switching, or lead generation.
• Do not run a live campaign without the user's explicit confirmation that the list is real, authorized, and consented, and without an allowlist during rehearsal.
• Do not invent rules. If the user's state has its own exemption list, edit the rules file - do not let the agent improvise policy on the call.

Core Workflow

1. Confirm consent and authorization. The user should say plainly that this is their own enrollee list and that these people agreed to be contacted about their coverage. If they cannot, stop.
2. Load the list and let the data clear whoever it can. Run plan first, always. It places no call, prints who the state's own record already clears, shows the wave order, and prints the exact task text that would be spoken. See references/registry-format.md for the CSV columns and references/cli.md for the commands.
3. Review the rule file. rules/federal-2027.json holds the threshold, the plain-language explanation, and all nine exemptions with their question text and order. If the user's state differs, edit the JSON. See references/rules-and-questions.md.
4. Rehearse in dry-run. run against the bundled fake CALL-E server exercises webhooks, retries, idempotency and the full worklist with no network and no credentials.
5. Go live only on explicit confirmation. Live mode requires SC_MODE=live, a CALLE_API_KEY, and --confirm. Set SC_LIVE_ALLOWLIST for any rehearsal so a real enrollee cannot be reached by accident. Read references/safety.md before this step, every time.
6. Hand over the worklist, not a verdict. Report outcomes as proposals: how many were cleared without a call, how many look exempt and need a caseworker's review, how many are at risk, how many could not be reached and need a letter. Never tell the user that someone "is exempt."
7. Resume rather than re-run. If a campaign was interrupted, resume settles pending calls and re-places refused tasks with their original idempotency keys. Re-running run is not the way to recover, and resume on a finished campaign places no new call at all.

The Rules That Are Not Negotiable

These are enforced in code, not just in the prompt. Do not try to work around them.

• Ex parte first. Anyone the state's data already clears is never called.
• Fail closed. Silence, ambiguity, a cut-off call, or a health condition without a daily-activity limitation produces needs_review - never an exemption.
• Identity before disclosure. Nothing about Medicaid or coverage is said until the person confirms their birth year, and the agent never says the year first.
• The voicemail must not mention Medicaid. Validated when the state file loads.
• Three calls, maximum, per person, per campaign. A hard cap independent of configuration.
• A refused API request is not_attempted, never unreachable. Our failure never becomes the person's verdict.
• Live campaigns start from the CLI only. The dashboard returns 403.

See references/safety.md for the complete boundary list, including what the agent may never ask for.

Worked Examples

references/examples.md walks through: a clean dry-run campaign and how to read its output; a Spanish-language call end to end; the person whose condition does not limit daily activities and why that becomes needs_review; the agent overclaiming an exemption and the correction call that follows; a platform outage; and a resumed campaign.

Reporting Results

Summarize in this shape, and in this order:

• cleared by state data, no call needed
• may qualify for an exemption - packet waiting on a caseworker
• may already meet the requirement - needs to report hours
• at risk - navigator callback booked
• needs review / could not be reached - letter and community outreach
• how many had never heard of the rule before the call

That last number is usually the one a programme director cares about most, and it is the one only a conversation can produce.