Recognize the barrier
Identify where a member needs help completing the next step.
MANAGED MEDICAID
A care option is only useful if it is reachable.
Connect the recommendation to the realities of getting care: eligibility, available destinations, transport, and a completed handoff.
MCO operations · Medical directors · Member services
NeXtriage / IN MOTION01 / 06
Make care reachable.
A recommendation needs a workable handoff
A care journey starts with the presenting concern and relevant context.
ILLUSTRATED WORKFLOW
Illustrated access pathway. Transport availability depends on the implementation.
Read the complete process
- Begin with the member. A care journey starts with the presenting concern and relevant context.
- Resolve eligibility questions. Exceptions need a support path rather than an unsupported coverage conclusion.
- Find a usable destination. Availability, clinical fit, and location requirements belong in the decision.
- Connect the journey where supported. Transport depends on configured benefits, eligibility, and provider arrangements.
- Make the handoff explicit. A chosen option needs a clear next step and a receiving destination.
- Know what happened next. Capture completion or the reason a journey could not be completed.
PRE-HOSPITAL DECISION SUPPORT + IN-FACILITY WORKFLOWSClinical review. Member choice. Clear evidence.
THE ESSENTIAL QUESTION
What makes Medicaid care navigation useful?
A useful pathway goes beyond a referral. It checks whether an option is clinically appropriate, available, covered for that member, and realistically reachable. Teams should measure failures at every handoff and retain an explicit route for escalation.
A WORKFLOW TO EVALUATE
Connect the decision to what happens next.
Resolve the handoff
Confirm eligibility, destination requirements, and transport arrangements where supported.
Measure completion
Track the outcome and reason for an incomplete journey, not just the referral.
GO DEEPER
Useful before your first demo.
BUYER GUIDE
Design Medicaid navigation around access
Questions, implementation considerations, and a pilot readiness checklist for medicaid plans.
↗INTERACTIVE PLANNERFind the access drop-off
Model the share of offered journeys that become completed care. All values are illustrative and should be replaced with local observations.
↗Questions worth asking.
Is this a replacement for the plan’s transportation benefit?
No assumption should be made. Transport scope, eligibility, sponsorship, and provider arrangements must be confirmed for the particular implementation.
Does the site establish state-program compliance?
No. It is a planning resource. Your plan’s operational and compliance teams should evaluate the proposed configuration and applicable requirements.