Despite major investments in Medicaid, members continue to face fragmented systems, administrative complexity, and barriers to accessing healthcare, benefits, and social services. Too often, support comes after coverage is lost, housing becomes unstable, or a health crisis occurs.
Earlier this year, through the California Health Care Foundation’s Bold Ideas initiative, Pair Team and BluePath Health developed AI-Powered Advocates for Medi-Cal. The paper proposed using AI-powered navigators to help people access and retain coverage, understand the benefits they qualify for, navigate healthcare and community services, and receive support before problems become crises.
To identify a practical path from concept to implementation, Pair Team and BluePath Health convened a salon-style dinner in New York City with leaders from government, health plans, providers, philanthropy, and technology to discuss what it would take to test and implement the AI-Powered Advocates concept. Three questions framed the discussion: Where could this approach create the greatest value? What would responsible implementation require? And how do we move from concept to practice?
A Bold Idea for Medicaid
The discussion reinforced the central premise of the paper. AI-powered navigators could help people access and retain coverage, understand the benefits they qualify for, navigate healthcare and community services, and receive support before problems become crises.
For example, someone receiving a Medicaid renewal notice could receive help understanding what it means, completing the renewal, and identifying other services they qualify for, such as food assistance, transportation, or legal aid. Instead of responding after coverage is lost or a crisis develops, support begins earlier.
What Would It Take to Succeed?
Participants were equally clear about what would need to be true for this approach to succeed. AI should support people, not replace them. Trust, transparency, privacy, governance, and human oversight need to be built in from the beginning.
High-quality, interoperable data will also be essential. AI-powered navigators can only support people if they have access to accurate, timely information.
Where Could New York Benefit Most?
New York already has many of the programs people need. The opportunity is to help members stay enrolled and connected to the services they are eligible for.
Approximately 62% of New York City residents do not have enough resources to meet the city’s true cost of living. Across New York State, nearly 877,000 people who are likely eligible for SNAP are not enrolled, leaving an estimated $1.1 billion in federal benefits unclaimed each year. At the same time, an estimated 233,000 New York City residents are expected to lose health coverage following changes to the Essential Plan, with Medicaid work requirements and more frequent eligibility checks taking effect in January 2027. Together, these figures illustrate the need to help more people access and retain coverage and connect to the healthcare, benefits, and community services they are eligible for.
One example discussed during the evening was New York City’s Right to Counsel program. More than 80% of represented tenants have remained in their homes, yet many eligible residents do not know about or access this legal support. AI-powered navigators could help make those connections sooner, improving housing stability, continuity of care, and health outcomes.
The conversation also highlighted existing infrastructure that could support implementation. Participants discussed whether trusted entry points such as NYC311, New York City’s central non-emergency government information and service line, could help connect residents to AI-enabled navigation and support while building on programs New Yorkers already know and use.
A Practical Path Forward
The discussion identified a practical path to begin testing the concept in New York City. Rather than immediately attempting a large-scale implementation, participants supported starting with focused, high-value use cases.
Potential approaches discussed included building on trusted public infrastructure, such as NYC311 and using existing public-private partnerships to test AI-powered navigators in real world settings. Together government, healthcare organizations, philanthropy, and leading technology partners could test the concept, learn from implementation, and build the evidence needed for broader adoption.
The Time to Test Is Now
Changes underway in Medicaid, including implementation of HR1, make this work more important than ever. As states focus on keeping eligible people enrolled and connected to the healthcare, benefits, and community services they need, the policy context makes this the right time to test new approaches that improve the member experience while reducing administrative burden.