California Medi-Cal Plan Deploys AI Agent for Enrollment Calls

AI voice agents handle Medi-Cal renewals

When Vanessa Barahona received a call from "Angelica" about renewing her Medi-Cal coverage, the conversation felt natural. Angelica spoke Spanish, rescheduled when Barahona had a work conflict, and guided her through the paperwork process. Only later did Barahona realize she had been speaking with an AI program.

Kern Family Health Care, the largest Medi-Cal provider in Kern County, California, deployed the Careforce AI system in late 2023 to manage enrollment renewals. The software has since placed more than 800,000 calls to the plan's 387,000 members, according to details first reported by KFF Health News. Kern County has one of the state's highest Medi-Cal enrollment rates, with an estimated 52 percent of residents relying on the safety net program.

The health plan spent approximately $370,000 on the Careforce software, which officials say would otherwise require hiring 40 full-time workers at an estimated cost of $2.4 million. No existing positions were eliminated, according to Kern Family representatives.

Why it matters

The deployment comes as Medicaid programs nationwide face dramatic administrative changes. Under the One Big Beautiful Bill Act signed by President Donald Trump, mandatory work requirement documentation takes effect in 2027, and most Medicaid patients must now renew enrollment twice yearly instead of annually. Health plans have a financial incentive to maintain enrollment through managed care contracts, while simultaneously seeking cost efficiencies. The technology raises questions about oversight, algorithmic bias, and the balance between automation and human judgment in healthcare access decisions.

How the system works

The AI agent, named Angelica, operates in more than 30 languages and can conduct full conversations with patients. It helps members schedule appointments with human staff who verify paperwork accuracy before submission to county officials for eligibility determination. The software runs continuously, allowing patients to call back at convenient times.

Emily Duran, CEO of Kern Health Services, said the plan coordinated closely with Kern County's Department of Human Services to access data showing when member eligibility expires. County workers are stationed inside Kern Family's Bakersfield facility to assist walk-in patients.

Kern Family's April 2024 renewal rate reached 94.9 percent, significantly higher than the roughly 40 percent rate after pandemic-era automatic renewals ended. Duran noted the result exceeded internal expectations.

Regulatory and workforce concerns

California's Department of Managed Health Care allows Medi-Cal plans flexibility in renewal processes, including AI tools, but holds plans responsible for compliance with privacy and data security regulations. State rules still prohibit managed care plans from soliciting new enrollees; only county officials determine eligibility.

Mark Duggan, a Stanford University economics professor who has studied Medicaid for three decades, said regulators must guard against insurers using such technology to cherry-pick patients. Broader concerns about AI in healthcare include treatment denials, workplace surveillance, algorithmic bias, and transparency.

Careforce CEO Huzaifa Sial, who previously worked on AI solutions at UnitedHealthcare and Optum, said the software addresses what he calls a "hidden execution problem" — people who qualify for coverage but struggle to navigate enrollment processes. The company also works with Central California Alliance for Health on similar implementations.

Kern Family officials say the AI primarily handles renewal outreach for now, though it has begun making welcome calls to new members and answering basic benefit questions. The generative AI system can learn and adapt to new tasks.

These details were first reported by KFF Health News in collaboration with Capital & Main.