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In 2024, leaders at Kern Family Health Care (KFHC), a Medi-Cal managed care plan serving the Bakersfield area, worried that hundreds of thousands of their members would lose health care coverage the following year. During the COVID-19 pandemic, relaxed enrollment rules allowed 70% of their members to renew automatically each year, meaning they could disregard the often burdensome renewal applications they received in the mail.
But starting on July 1, 2025, the auto-renewal policy ended, and those application forms again became critical for 270,000 people enrolled in the KFHC plan. A lapse in coverage would interrupt essential access to primary care, prescription medications, behavioral health services, and treatment for chronic conditions. For people with low incomes who already faced challenges navigating a complex health care system, the impact could be life-threatening.
With the aid of Careforce, KFHC renewed 96% of their members during the first year, compared to 38% before using the AI platform.
Members who needed to renew their eligibility generally received a call from staff at KFHC alerting them to complete the forms. But with two-thirds of their enrollees suddenly at risk of disenrollment, there were not nearly enough workers to reach and support everyone. Eager to keep patients connected to the care they needed, the health plan’s chief information officer, Cesar Delgado, began testing an AI platform called Careforce to call members, answer questions, and connect them to KFHC staff.
The results were impressive, he said. With the aid of Careforce, KFHC renewed 96% of their members during the first year, compared to 38% before using the AI platform. “It’s almost unheard of to reach such a high renewal rate for Medi-Cal plans,” Delgado said. “Traditionally, people think of AI outreach as a ‘robocall’ with a pre-played message, but this technology is nothing like that.”
Careforce uses autonomous AI agents that call, text, email, and use software systems to reason and complete tasks independently. A voice agent named Angelica uses a HIPAA-compliant platform to access enrollee data, so it knows exactly what each member needs to do. Speaking in each enrollee’s preferred language, Angelica explains why renewal is needed and tells them when their current coverage will expire.
The agent asks several questions to pinpoint the information needed to complete the application. Have they changed jobs? Has their household size changed? Based on the answers, Angelica directs them to webpages where they can enter the needed details.
Chatting with an Agent
Angelica can also answer questions about how and where to provide proof of income, asset verification, and more. If a member is struggling to communicate in the language Angelica is speaking, the bot detects the language they are trying to use and converses in that.
If Angelica is unable to answer a question, it arranges a hand-off to a staff member at KFHC or schedules an in-person visit with a staff member. If an enrollee is not available to talk, the agent asks them to provide a convenient time to call back. The service is available round the clock and communicates in any one of 29 languages.
Soon after launching a Careforce pilot program, conversations with Angelica appeared to be working. More members began visiting the facility for help completing renewal forms. Pleased with those early results, KFHC leaders began using the platform regularly to contact members needing reenrollment. The positive feedback from members was overwhelming, Delgado said.
“People called and wanted to speak to Angelica because she was so helpful,” he said.
For Careforce founder and CEO Huzaifa Sial, success at KFHC was an encouraging sign that AI-powered voice agents could reduce barriers to care for Californians navigating coverage in a language other than English.
As health plans confront unprecedented administrative burdens, strategies to streamline reenrollment processes are needed now more than ever. Automatic renewals are less common than in the past. As a result of H.R. 1, the budget bill that rewrote eligibility rules for the Medicaid program nationwide, starting Jan. 1, 2027, many enrollees will need to document 80 hours per month of employment or community engagement to maintain coverage.
“Low-income populations are significantly less likely than most Americans to get the care they need, and I believe one of the main reasons for this is that health plan workers are buried in administrative work,” said Sial. “We are building autonomous digital agents that can have very natural conversations with people and take time to answer questions.”
AI Agents Streamline Enrollment
Angelica contacts thousands of members a day for KFHC. Staff can focus on interacting with those who need additional help to complete their renewal rather than spending hours each day leaving messages for people.
“The AI tool is not replacing what staff do, but rather shifting what they do,” Delgado said. Angelica starts reaching out about renewal status three months before benefits expire. That is two months earlier than the practice before Angelica showed up, when a limited number of staff could make the calls.
KFHC recently started using Careforce to help members schedule labs, yearly visits, and preventive diagnostic screenings such as colonoscopies and mammograms. The plan also offers members transportation to appointments, and Angelica schedules their rides.
The AI platform alerts organizations if members say they are not satisfied with interactions with Angelica. Staff can listen to the recording and de-escalate the situation by following up with members. That lowers the risk that members will file grievances with the state, said Alonso Hurtado, senior director of corporate services at KFHC.
Careforce AI agents have made more than 1.2 million calls to KFHC members, of which more than half were in Spanish. By helping organizations achieve high reenrollment rates, health plans maintain state funding tied to membership numbers.
Improving Health for Patients
Ritter Center, a federally qualified health center in San Rafael, that serves unhoused, medically complex patients, recently started using Angelica to contact patients about medical appointments. “Our team struggled to reach people with cold calling,” said Sehrish Khan, the center’s director of clinical compliance.
In 2024, Angelica started contacting hypertensive patients in need of a blood pressure screening. The AI agent helped them schedule the appointment and connected them with a Ritter staff member if questions arose that the agent could not handle. If their blood pressure was found to be high, a provider could prescribe medications and recommend dietary adjustments.
Angelica helped 73% of Ritter Center’s patients achieve blood pressure control, compared to 62% the previous year. The outreach also helped more patients with diabetes achieve blood sugar targets. As a result, health plans awarded the center incentive dollars tied to quality improvement performance goals.
Preparing for the Future
Recognizing the urgent demand for Medicaid redetermination assistance and the need for new tools to support it, CHCF invested $500,000 in Careforce. Health plans, FQHCs, and specialist providers in five counties are using the platform, including the Central California Alliance for Health and Kern County Department of Public Health. Sial hopes to expand further in the next year. Sial’s previous work in the health care industry, which included calculating risk scores to predict costs and care for health plans, fueled his interest in building an AI platform.
“Health plans use math and science to figure out how to provide care, but the problem is that many people never even come in to receive care,” he said. “I started thinking about how AI could help more people access health providers, particularly among vulnerable populations who are non-English speaking and lack a support system.”
Integrating new technology into existing health systems can often take months, but the Careforce team helps organizations customize their AI agents and incorporate them into workflows in several weeks. With enrollees required to prove Medi-Cal eligibility every six months starting in January 2027, CHCF leaders are eager to support health plans and providers that want to experiment with AI platforms to address new H.R. 1 rules.
“Careforce is one of the first companies building AI agents for safety net organizations,” said Stella Tran, senior program investment officer at the CHCF Innovation Fund. “The platform was designed to support workflows that often live across fragmented data systems and vary from clinic to clinic. The feedback so far shows that this technology can solve organizations’ urgent problems by engaging their patients and members at scale.”
As new federal rules threaten to push thousands of Californians out of coverage, Careforce offers a glimpse of AI’s potential to help people served by the safety net. When deployed thoughtfully as a tool used by a dedicated staff, AI can help health plans meet unprecedented administrative demands without leaving behind the Californians who rely on it most.
