Accuracy, efficiency, and economy are now the standard for eligibility. CaseVue is how states meet it.
Federal rules now ask every state to verify more, decide faster, and spend less doing it — with a record that stands up to review. CaseVue verifies each case in real time — identity, residency, citizenship, income, hours, assets where required, existing coverage, and more — and turns those results into a risk score with the factors and sources behind it, so verified cases clear quickly and staff judgment goes where it is needed. The determination stays with your agency.
More verification, tighter timelines, the same workforce — and a clear way to get ahead of it.
Eligibility rules narrowed — in effect now
Federally funded Medicaid and CHIP now exclude several lawfully present immigrant categories. Every affected case is redetermined and every new application screened against the narrower list — accurately, the first time. Our October 1 briefing →
Six-month redeterminations
Expansion adults renew twice a year. Twice the verification volume is manageable when verified cases clear automatically and staff attention goes to the cases that need it.
Work & community engagement
Eighty hours a month, verified, with exemptions for parents, the medically frail, and others identified and documented. Done well, eligible people keep coverage and the record speaks for itself.
Program integrity, every day
Address verification, cross-state duplicate checks, and improper-payment scrutiny all tighten. Documentation that satisfies federal review becomes routine when every decision carries its sources.
Every risk score starts with verified data.
Each case is checked, in real time, against authorized sources. Every check comes back one of three ways — verified, discrepant, or missing — and those results are what inform the risk score. Verification repeats at renewal and whenever a source changes, so a case that was clean in January is still clean in July.
Who the person is
Identity: name, date of birth and Social Security number match, and date of death.
Where they live
Residency and address, and whether the same person is enrolled in another state.
Whether they qualify
Citizenship or immigration status, household composition, and pregnancy, disability, or caregiver status where it drives an exemption.
What they earn and own
Income (earned, unearned, self-employment), employment and employer, work and community-engagement hours, and assets where the program requires it, including look-back transfers for long-term care.
What already covers them
Existing insurance, Medicare, other state Medicaid, and third-party liability for coordination of benefits.
Eligibility verification and case-level risk scoring, built for the standard states are held to
CaseVue reviews your case information, supplements it with authorized third-party data, and returns a risk score with the contributing factors and supporting sources. Your staff see at a glance what is verified, what is a discrepancy, and what is simply missing. It works with your eligibility system — nothing is replaced — and determinations remain with the agency.
How CaseVue works →- Accuracy — identity, residency, citizenship, household, income, hours, assets, and existing coverage, verified in real time against authorized sources
- Efficiency — verified cases clear fast; staff time goes to the cases that call for judgment
- Economy — fewer improper payments, less manual review, no system replacement
- Control — Medicaid, LTC Medicaid, or SNAP; secure transfer and a data agreement on your terms; determinations remain with the agency
Contact us for a demonstration.
Your agency selects the population — Medicaid or SNAP. 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.
You receive a case-level assessment for every record, a findings report on discrepancies and differences from existing determinations, an assessment of where manual review can be reduced, and a working session with your eligibility and program-integrity staff to decide whether broader use is warranted. Fixed fee; broader implementation scoped separately.
Scope a Demonstration →Designate a lead
One member of your team works with us on sample population, scope, and the data agreement.
Transfer the sample
Your sample arrives by secure transfer. No integration required for the demonstration.
Review findings together
Scores, factors, sources, and a working session — then your call on what comes next.
Built by people who've worked in government and understand the process.
CoverMe's founder is a former state health and human services commissioner. More than thirty years ago he developed the process that brings together intake, verification, third-party data, algorithmic risk scoring, and weighted decision support. It has since been applied in dozens of states — in Medicaid, long-term care, and food assistance.
States have relied on it for years without our name on it. CaseVue puts a name on the work we have always done for the agencies that run the program. Meet the team →
MedicaidMatters.org — plain-language help you can point people to
Our free consumer initiative explains how to apply, renew, and keep Medicaid under the new rules, state by state, in plain English. It collects no personal information and links every action to the official state site — a resource your call center and outreach partners can share without hesitation.
Visit MedicaidMatters.org →Looking for provider solutions instead?
If you work for a provider organization rather than a state agency, our provider tools start with real-time Medicaid eligibility at intake. See provider solutions →
Contact us for a demonstration on your own cases.
Request a demonstration, or download the overview to share with your team.