Cracking the Code: How Digital Startups Can Successfully Engage Medicaid Populations

83M Americans. A $918B Opportunity. Are You Building for It?

For startups, this is a costly opportunity to deliver scalable, high-impact innovation. But to succeed, your product must be purpose-built for the unique realities of Medicaid users. 

Engagement is key for tech solutions to actually have an impact. Medicaid supports over 82 million low-income Americans, about 1 in 5 Americans (down from pandemic peaks). Thanks to various policy changes, economic factors, and healthcare needs this population is growing.

Yet digital health solutions often fall flat in this vital sector. Why is that?

Because they don’t account for barriers Medicaid users often face:

• Low digital literacy

• Inconsistent access to Wi-Fi or smartphones

• Language, accessibility, and cultural barriers

• Distrust of institutions

• Competing social and economic stressors

If you’re building for scale, but not for access, you’re missing the most mission-critical audience in U.S. healthcare. Designing for them requires intentional inclusion, trust-building, and deep contextual awareness.

Backed by case studies and proven strategies, these tech-geared engagement best practices help you reach underserved communities where it matters most.

Proven Best Practices to Engage Medicaid Populations

1. Co-Design with Communities and CBOs

Involve Medicaid members and local community-based organizations (CBOs) in design and testing as soon as possible.

Tip: Establish Community Engagement Councils to guide outreach and design improvements.

Case Study: Tytocare partnered with CBOs to provide culturally tailored onboarding and remote care kits in Texas, meeting all KPIs for Medicaid engagement.

Source: Tytocare

2. Build and Signal Trust From Day One

Medicaid users are disproportionately impacted by privacy concerns and systemic mistrust.

• Be transparent about data use (“We never share your data without permission”)

• Earn trust with HIPAA compliance, clear consent flows, and non-profit partnerships

• Use trusted messengers: referrals from health plans, clinics, or peer networks

• Trust = higher engagement, especially in sensitive areas like behavioral health or maternal care.

Case Study: Carenet Health leverages trained agents to increase Medicaid activation through human-first outreach.

Source: Carenet

3. Prioritize Mobile-First and Offline-Ready Experiences

Smartphone access is high but mobile data is limited, and Wi-Fi is often unreliable. Email alone doesn’t cut it. Combat these barriers by combining texting (more immediate) with email and ensure translation into native languages.

Design for smartphones as the default, with offline capability and multiple support channels:

• SMS, live calls, chatbots for quick fixes and self serving, email, in-app messaging

• Simple, mobile-optimized flows

• Low-bandwidth and ADA-compliant UI

Case Study: The Digital Divide Response Project provided devices, data plans, and literacy training to bridge engagement gaps.

Source: Budget Equity, Portland.gov

4. Provide Live, Human Support

Automated chatbots and self-serve portals are not always sufficient. This population needs someone they trust to validate that what they are being promised isn’t “too good to be true.” Use trained support teams or existing relationships for outreach and onboarding, not just push notifications. Empathetic calls and live help foster trust and bolster digital fluency.

The conversations are also key to helping your product team discover product improvements.

• Offer real-time help via text or phone—ideally with bilingual support

• Train staff on trauma-informed and culturally sensitive communication

• Leverage peer navigators to guide users through onboarding and app use

Tip: Consider in-app “request a call” or “ask a question” buttons to keep friction low.

Case Study: States like Colorado used community health workers and digital navigators for direct app sign-up and benefit access.

Source: Maven Clinic, Penn Medicine

5. Segment and Personalize Communication

The chances of hooking this massive diverse population with one tagline is nearly impossible.

Go beyond demographics whenever possible! Use psychographic segmentation to tailor

content by motivations, behaviors, and preferences.

Case Study: AmeriHealth Caritas DC boosted telehealth use by 7.5x using segmented

messaging.

Source: Advisory Board

6. Offer Multilingual and Culturally Relevant Content

• Go beyond just translation—make content culturally resonant.

• Offer local language support (e.g., Spanish, Mandarin, Haitian Creole)

• Include visuals and tone that reflect users’ lived experiences

• Use plain language and avoid jargon

Tip: Use readability checkers and consider working with cultural liaisons or community health workers.

Case Study: mPulse Mobile’s AI-driven outreach supported translated, culturally appropriate messaging.

Source: mPulse Whitepaper, Gumbo

7. Use Conversational AI to Scale Personalization

AI-driven chat and text campaigns mimic human dialogue while reaching thousands.

Case Study: mPulse Mobile used Conversational AI to increase Medicaid member responses and follow-through.

Source: mPulse Case Study

8. Reminders & Nudges to Sustain Engagement

Tech nudges drive retention and action—especially when personalized effectively.

Case Study: Icario increased enrollment and app usage with gamified health reminders and tailored emails/SMS.

Source: Icario

9. Design for Low Literacy and Accessibility

Startups often fall into the trap of designing for the tech-savvy user they know. Medicaid

beneficiaries, however, face unique social, economic, and behavioral challenges that limit their digital experiences.

Build a more inclusive and intuitive UX with:

• 6th-grade reading level

• Audio/video instructions

• Clear icons

• ADA compliance

• Transparent privacy policies

Case Study: The University of Colorado Denver piloted a Medicaid digital literacy curriculum to guide design and content strategies.

Source: University of Colorado

10. Incentivize Well-Being Through Flexible Benefits

Offer prepaid wellness cards or milestone rewards to encourage app use and healthy

behaviors.

Case Study: InComm’s incentives helped close care gaps and increase engagement across

Medicaid populations.

Source: InComm

What Doesn’t Work

• Poor UX or complex sign ups → Low digital fluency means every extra tap or jargon-filled screen causes drop-off.

• Non-mobile friendly apps → Many Medicaid users only access tech via smartphones. Don’t prioritize desktop.

• No live help → Without live help, members get stuck and churn.

• Jargon-filled UX → Plain, simple language is key!

• One-size-fits-all messaging → Generic messaging alienates rather than engages.

• Ignoring lived experience → Tools that ignore real-life pressures (childcare, housing, mental health, admin changes) won’t feel relevant.

As always, measure the right metrics

Don’t just track downloads. Optimize for real outcomes and disaggregate to spot disparities.

• Look at activation, repeat usage, longitudinal retention

• Track appointment attendance, screening completions, or benefit utilization

• Disaggregate metrics by language, ZIP code, or plan type to uncover disparities

Engaging Medicaid populations takes more than an afterthought. If you want to scale equitably and build tech that truly matters, your product must take these best practices into consideration to truly be purpose-built for the unique reality of Medicaid users and measure accordingly.

BBB Watch: What Could Change Your Engagement Plan

The One Big Beautiful Bill Act (BBB), signed July 4, 2025, includes multiple Medicaid provisions that states and plans will be implementing over the next 12–24 months. Expect impacts on eligibility, financing, benefits, and partners you rely on for outreach.

Key items:

• Mandatory “community engagement” (work) requirements for certain adults starting as early as 2027; cannot be waived under §1115. Products must anticipate verification workflows, churn risk, and appeal flows. Congress.gov

• Tighter eligibility operations: new directives on duplicate enrollments, deceased enrollees/providers, and redeterminations may increase churn and documentation touchpoints your UX must handle. Congress.gov

• Financing changes: limits on provider taxes, restrictions on state-directed payments, and stricter §1115 budget neutrality will squeeze some plan/provider funds used today for incentives, navigation, and SDOH pilots. Congress.gov

• Family-planning network disruption: a 1-year ban on Medicaid payments to certain “prohibited entities” (e.g., qualifying reproductive-health providers) could remove familiar, trusted touchpoints for outreach in some markets. Congress.gov

Coverage impact, at a glance: CBO and other analysts project millions fewer insured by 2034 due to BBB, with a large share from Medicaid. (Estimates vary by release and scenario—from ~7.8M to ~11M more uninsured—driven largely by community-engagement rules and financing provisions.) Plan for increased churn and greater documentation friction in your flows. Congressional Budget Office, KFF, Forbes

What this means for builders:

• Treat eligibility verification & “proof of engagement” as first-class UX.

• Budget for more churn capture (win-back SMS trees, rapid re-enrollment help, and live navigators).

• Stress-test any incentive-heavy or provider pass-through models against reduced directed payments/provider-tax flexibility.

• Map alternate trusted messengers if local family-planning partners are restricted.