Situation

After this Medicaid plan ran a two-month pilot in late 2025 that reinstated 673 MLTSS and ABD members, it was ready to scale. With the targeting infrastructure live and the first Smart Lists validated, the challenge became how to extend a system that’s working for MLTSS and ABD to also cover Medicaid Expansion without diluting performance when the expansion population is three times larger?

Care management teams are not the problem in Medicaid managed care plans. The people doing this work are skilled, mission-driven, and, in most plans, already stretched. When members fall through during redetermination, it is almost never because someone inside the plan fails to act. It is because they were given the wrong list. And sometimes no list at all.

At over $5,000 per member per month, each reinstated MLTSS member is worth 6.7 times an ABD member and 12.6 times a Medicaid Expansion member. Getting MLTSS targeting right was where the program’s financial return was won or lost.

Solution

The plan’s care management team had outreach capacity and clinical judgment. What they needed was a list that matched their effort to the right members at the right time. Agilian expanded portal automation across MLTSS, ABD, and Medicaid Expansion simultaneously. This produced monthly Smart Lists that gave care managers a single, prioritized, deduplicated file: the right members by 0/30/60/90-day urgency tier, routed to the right queue before reinstatement windows closed.

No plan IT involvement was required to maintain the system. Unlike static state files, each month’s list was built from live portal automation and cross-referenced 834 data. The state data infrastructure that compressed pilot setup to 72 hours continued to compound. Each cycle produced a more precise intelligence layer than the one before it.

The care team owned the outreach. Agilian owned the list. The plan owned the results.

Results

The numbers reflect a system built for precision, not volume. MLTSS represented less than 10% of reinstated members and generated 57% of premium recovered. Medicaid Expansion delivered the scale. MLTSS delivered the return.

"Agilian’s ability to provide accurate, actionable insights about members requiring renewal has allowed us to deploy our outreach specialists far more effectively. The engagement has already paid for itself.”  
— President, Northeast Medicaid Managed Care Plan

See what this working with Agilian can look like for your plan →