Public programs · Tidegate
Public programs

Put the evidence you already hold in front of every caseworker.

The Tidegate engine finds exemption and renewal evidence already in your claims, encounters and documents, and matches it to the right person across the programs your agency holds. Evidence findings with citations and match explanations are delivered to your case system for a caseworker to review. Your agency sets which matches a caseworker reviews, and no match can reduce or end anyone's coverage without a caseworker's decision.

Your eligibility system · Evidence CASE ••-2081
Provider letterFrom text your systems extract · matched on name and date of birthMATCH 0.96
End-stage renal diseasePage 1, “She has end-stage renal disease and receives dialysis three times weekly.”CONDITION · CONFIDENCE 0.93
Outside record, 3 pagesPartial name, no IDNEEDS CASEWORKER REVIEW
Delivered to your case system · a caseworker decides
Illustrative. Fictional case. See the caseworker evidence record.
SOC 2 Type I and HITRUST e1 in progress · Runs in a cloud account you control · BAA whenever our engineers access PHI · Never buys or sells data
JAN 1, 2027 Community engagement requirements, six-month renewals and new address checks begin by January 1, 2027, unless CMS grants a state more time.States must verify work requirements with data they already hold where possible, renew expansion adults every six months, and update addresses from sources such as postal change-of-address data and managed care plans to reduce duplicate enrollment. A national duplicate-enrollment system follows by October 1, 2029. Tidegate links each person across the programs, claims and eligibility records your agency holds, so those checks start from data you already have. Dates as of October 2026.
Path to live

From a sample of cases to statewide

  1. 01BriefWe walk your team and your integrator through the Tidegate engine on fictional case files, share the security packet and answer your RFI or capability questions. An evaluation on your own records follows once your agreements are in place.
  2. 02PilotOne region or caseload goes live. Caseworkers review the matches your agency routes to them, and no match reduces or ends coverage without a caseworker's decision.
  3. 03StatewideRollout through your systems integrator, with match quality within your data reported each release. From v1.1: quality broken out by patient group.
Funding and procurementChanges to Medicaid eligibility systems may qualify for enhanced federal matching funds. We work with your systems integrator on the planning documents your state submits to CMS, and can be delivered through your systems integrator, subject to your state's procurement rules.
What you get

What changes on Monday morning.

For state Medicaid agencies and their integrators

Caseworkers decide on complete evidence, on time.

TodayThe same person appears under different IDs across programs, and evidence already in claims or letters sits unmatched. Caseworkers search by hand, and determinations are delayed or made without it.
With TidegateExemption evidence found in existing claims and documents, one identity across the programs your agency holds, and evidence findings with citations and match explanations delivered to your case system. Caseworkers decide on complete evidence.
Caseworkers decide on complete evidenceExemption and renewal evidence reaches your case system, for a caseworker to review, before the determination is made.Track: closures for missing documentation
Data you hold, used firstExemption evidence in claims, encounters and documents is found before anyone is asked for paperwork.Track: requests for information sent to enrollees
One identity across your programsDuplicate and cross-program records within the programs your agency holds are found and explained. From v1.1: match quality broken out by patient group.Track: duplicate-enrollment findings confirmedTrack: duplicate-enrollment findings overturned on review
An audit-ready trailEvery match and every human decision is recorded for CMS and state oversight.Track: findings in eligibility quality control
Checks

Where it matters

One pattern for every check: data arrives, Tidegate finds what it shows and which case it matches, and a caseworker decides.

01Work requirement verification What arrivesProvider letter, from text your systems extract: “She has end-stage renal disease and receives dialysis three times weekly.” What Tidegate doesEvidence finding delivered to case ••-2081, cited on page 1, MATCH 0.96 Who decidesCaseworker confirms the exemption
02Duplicate enrollment What arrivesTwo program IDs for the same person, at different addresses What Tidegate doesLinked within your agency’s data, with the evidence and a match explanation Who decidesCaseworker confirms before any notice is sent. The agency's notice and fair hearing process applies.
03Claims and attachments What arrivesManaged care encounters and prior authorization attachments with no case or request ID What Tidegate doesLinked to the member’s eligibility record and the request they answer Who decidesPlan or agency reviewer confirms in the right queue

Illustrative. Fictional cases.

Principle

Evidence, never a decision

Tidegate finds evidence, delivers it to your case system with citations and explains every match. Caseworkers decide, and every step is recorded. No match ever ends anyone’s coverage on its own.

Resolution

The hard cases

THE HARD CASES03 CASES
01One date written three ways in a letter (03/04, March 4, 4 Mar)All three are found as DATE.DATE
02A Medicaid ID with one character wrongMatched below threshold at MATCH 0.71 and sent to a caseworker with the evidence. Illustrative threshold: 0.80, set by your team.MATCH 0.71
03The letter with a partial name and no IDWeak matches go to a caseworker with the evidence shown.NEEDS CASEWORKER REVIEW
How you get it

Delivered through your systems integrator

At application and renewal, Tidegate runs inside the eligibility and case management systems your integrator already supports. It stays under your agency's controls and arrives as a module your integrator adds to the eligibility build, so it is designed to fit your certification path.

Tidegate Forward Deployed Engineers work alongside your integrator to connect sources, set review thresholds with your caseworkers and hand over runbooks to your team.

Coverage

What this means for your data

Medicaid data carries identifiers most tools were never built for. The Tidegate engine recognizes Medicaid and CHIP member IDs, Medicare Beneficiary Identifiers, case and claim numbers, T-MSIS eligibility codes and claim adjustment codes alongside standard PHI, wherever they sit, so agencies can see exactly what a dataset holds before it is used or disclosed for purposes your program allows under Medicaid confidentiality rules (42 CFR Part 431, Subpart F).

What the engine recognizes
Designed to support review under HIPAA Medicaid confidentiality 42 CFR Part 2 holds · ROADMAP State health privacy laws SOC 2 Type I and HITRUST e1 in progress. The engine runs in a cloud account you control.
Sample output

Questions we hear first

Which agreements does this fit?
Designed to support your safeguards under 42 CFR 431 Subpart F and your data-sharing agreements. Your counsel confirms specific obligations, such as for federal tax information or SSA data.
Does it change coverage?
No. A caseworker decides.
How do we start?
A briefing on fictional case files, then an evaluation under your agreements.
Technical fitNext to your eligibility system, as documents arrive.
MODEAs documents and feeds arrive; batch before renewal cycles
INPUTSEligibility records, claims and encounters, attachments, letters, case notes
DEPLOYA cloud account your agency controls, deployed with Tidegate Forward Deployed Engineers
Engine details