Ten million Americans will lose Medicaid coverage under OBBBA work requirements. A meaningful share of them qualify for a medical-frailty or caregiving-role exemption — but only if someone files the physician attestation. We built that workflow, at scale, with a real physician of record.
OBBBA adds work requirements for able-bodied adult Medicaid enrollees. States must verify compliance. Enrollees who fail verification lose coverage. For health systems, disenrollment is revenue lost and uncompensated care incurred. The exemption process is the relief valve — if you file.
Colorado, Georgia, and Texas have begun draft rulemaking. Your Medicaid director's FAQ page matters more than it used to.
The window to identify at-risk patients, flag exemption candidates, and pre-file attestations before first redetermination.
States begin applying work-verification. First redetermination cycles start rolling. Disenrollment begins.
Without intervention: 10M disenrolled nationally, ~$18M margin loss per 10K affected patients at a typical health system.
Three jobs, one platform. We identify who qualifies, Mira drafts the attestation, our medical director reviews and signs. Twenty-four-hour turnaround. Full audit trail.
Upload an anonymized patient list. Our eligibility engine cross-references ICD-10, medications, chart notes, and caregiving flags against OBBBA's six exemption categories. Output: a ranked list of candidates with likely-qualifying criteria pre-cited.
Mira is our Medicaid Intelligence Review Agent. She drafts the §1902(e)(4) exemption attestation in plain language, cites the supporting diagnoses and encounters, and formats for your state's required fields.
Our medical director reads every attestation Mira drafts. They sign within 24 hours or send back for clarification. Your compliance team gets a complete audit trail — prompt, draft, edits, signature, cryptographic provenance.
Mira is the AI agent. Our medical director is the physician. medfrail is the platform. Every exemption your health system files carries physician attestation. This is what physician-governed AI actually looks like — not a chatbot, not a form-mill.
Most AI in healthcare is anonymous. An output arrives, you have no idea what model produced it, what training data shaped it, or whether a physician ever looked at it. That's the surveillance-era default.
Mira is the opposite. She has a name, a scope, a version number, and a supervising physician. Her outputs carry cryptographic provenance. She never submits an attestation our medical director hasn't read. When an auditor asks "who made this decision?" — the answer is two humans and an agent, in that order.
That's the attestation era. It's the only form of AI that will survive the next ten years of healthcare audits.
Upload an anonymized patient list. In 24 hours we return a confidential report with:
No commitment. No PHI required (de-identified counts only). Reviewed by our medical director.
We'll follow up within one business hour to confirm file format and security requirements.
The economics of this product only work if your revenue protection exceeds our cost, meaningfully. Our pricing is structured so that's the only way anyone signs anything.
Yes. The statute's exemption categories (§1902(e)(4) and associated state-plan amendments) include medical-frailty, caregiving-role, disability, and related criteria. Each requires documentation — most commonly a physician's written attestation accompanied by supporting chart evidence. The question isn't whether attestation works; it's whether you have the capacity to file them at scale before your patients hit redetermination. That's what medfrail solves.
Our physician of record is a Board-Certified Internal Medicine physician licensed in all 50 states. They serve as physician of record for all medfrail attestations across the Managed and Self-Serve tiers. Having one physician sign every attestation means a single, consistent standard of review — and a single named physician an auditor can interview. Enterprise deployments use a multi-physician pool; our medical director remains the lead reviewer.
BAA is signed before any PHI is exchanged. Infrastructure is HIPAA-aligned AWS (us-west-2), with FHIR R4 ingestion, encrypted at rest (AES-256) and in transit (TLS 1.3). Mira operates in a private-cloud configuration; prompts and responses are logged to an immutable audit store with cryptographic hashes. SOC 2 Type II is in progress; we can provide current SOC 2 Type I, penetration test summary, and data-flow diagrams on request.
Yes. Managed tier includes native integration with Epic, Cerner, Athena, and Meditech via FHIR R4. Enterprise tier adds custom integrations. Self-Serve uses a CSV/XLSX upload portal for teams without direct integration yet. In all cases, the data contract is identical: de-identified ingest, attested-output return, full audit log.
Mira sends the draft back to the queue with a human-readable flag explaining the gap. A dedicated review specialist (Managed and Enterprise tiers) works with your team to either provide additional documentation or remove that patient from the cohort. No attestation is ever submitted without a physician signature, period.
From signed BAA to first batch of attestations: typically 10-14 business days for Self-Serve, 30-45 days for Managed (including EHR integration), 60-90 days for Enterprise (including state portal integration). The faster-start path for most systems is to request a Self-Serve pilot while Managed integration gets scheduled.
Same physician of record, same attestation infrastructure, different buyer. The consumer product at medfrail.com serves individual families directly at $99/attestation. This enterprise product serves health systems and Medicaid plans at scale. Both share the same clinical quality standard — every attestation is physician-signed.
Your Medicaid panel's first redetermination cycle is closer than your budget process thinks. The systems that identify, file, and protect ahead of the curve will keep their patients. The systems that don't will write uncompensated care into next year's variance report.
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