Eligibility accuracy at the speed your caseload now demands.
CaseVue gives state Medicaid, SNAP, and human services agencies a case-level risk score, the factors behind it, and the sources that support it — so your staff spend review time where it matters and every determination rests on verified evidence.
The rules changed. The caseload didn't shrink. The staff didn't grow.
H.R. 1 asks state agencies to do more verification, more often, with the same people: six-month redeterminations for expansion adults, work-requirement tracking, address and duplicate-enrollment checks, and tighter eligibility rules that took effect October 1, 2026 — all under improper-payment scrutiny that isn't getting lighter.
Caseworkers already juggle too much information, complex program rules, and policies in constant motion. The result is predictable: backlogs, procedural denials of people who are eligible, and errors that surface only in audit.
Redetermination frequency
Expansion adults move from annual to six-month renewals on January 1, 2027 — twice the eligibility work per case.
Factors per determination
Identity, residency, household composition, earned and unearned income, resources, other coverage, work-requirement status — each with its own data source.
To first findings
CaseVue returns initial results on a defined sample within about a week of receiving a usable case file.
Verify. Score. Explain. Decide.
CaseVue sits alongside your eligibility system — it does not replace it. Determinations stay with your agency and rest on the applicable requirements and supporting evidence.
Intake
Your case data arrives through a secure transfer under a data agreement your agency controls — access, handling, retention, and disposal included.
Verify
Each case is supplemented with authorized third-party data and assessed on the relevant factors: identity, residency, household, income, assets, and other health coverage for coordination of benefits.
Score
A case-level risk score with the contributing factors and supporting sources — so staff can tell verified information from discrepancies and from information that is simply missing.
Decide
Your eligibility and program-integrity staff act on a prioritized, documented picture — and keep the determination where it belongs.
Built for program integrity and for access — at the same time.
Risk scoring works in both directions. It surfaces cases that need a second look, and it clears the ones that don't — so eligible families aren't lost to paperwork while reviewers chase the wrong files.
The same engine behind every CoverMe determination.
More than thirty years ago our founder developed a process that brings together intake, verification of applicant information, third-party data acquisition, algorithmic risk scoring, and weighted decision support. It has since been applied in dozens of states and across hundreds of providers and insurers — in Medicaid, long-term care, and food assistance.
Providers know it as the CoverMe Confidence Score. States have used it for years as the engine behind eligibility reviews and backlog clean-ups; CaseVue is that same verification and scoring under its own name, pointed at your caseload instead of a single admission.
Every demonstration delivers
A defined-sample demonstration, not a procurement.
Most states begin with a 1,200-case demonstration. Your agency selects the population — Medicaid or SNAP — and we agree the data requirements, any participant assessments, and the delivery schedule before anything moves. Initial findings are targeted within one week of receiving a usable case file. The demonstration is a fixed fee; any broader implementation is scoped separately around the populations, capabilities, and integrations you choose.
Scope a Demonstration →- No system replacement — CaseVue works beside your eligibility platform
- Secure transfer — governed by a data agreement with your agency
- Optional decision-support inputs — structured-interview and credibility assessments through specialist partners, only if you choose
- Leadership involvement — our founder stays directly involved through the review of findings
From backlog to defensible.
Manual review alone
- Backlogs grow as redetermination volume doubles
- Eligible people lose coverage to procedural denials
- Ineligible cases are found only in audit — after payment
- Reviewers can't tell missing information from wrong information
With CaseVue
- Review effort goes to the cases that carry risk
- Verified cases move quickly — access protected
- Every score is explained and sourced for the file
- Documentation that stands up to federal review
Frequently Asked Questions
Does CaseVue replace our eligibility system?
Which programs does CaseVue cover?
What eligibility factors are assessed?
Does CaseVue make the eligibility decision?
How is our data protected?
How does a demonstration start?
See what CaseVue finds in 1,200 of your cases.
A defined sample, a fixed fee, and a working session with your staff to decide what comes next.
Request a Demonstration →