Leveraging the Power of Generative AI for the Future of State Health Program Oversight

States can run their State Health programs within federal guidelines, but core pillars like eligibility, cost management, and quality of care create a significant administrative burden.

However, each state must, at minimum, be accountable for upholding several "core pillars" of State Health program administration, such as Eligibility and Enrollment, Program & Performance Monitoring, Cost Management, Quality of Care and Beneficiary Experience, and Access to Care. Unwinding continuous Enrollment due to COVID-19 and reduced federal matching funds further complicate matters.

Generative Artificial Intelligence (AI) offers a transformative approach. We propose dedicated, program-specific Large Language Models (LLMs) trained on state health program knowledge, including CMS guidelines, state directives, and specific standards. This in-house "Program expert" provides real-time assistance across core pillars:

• Faster Policy Research: Reduce research time from days to seconds.

• Personalized Enrollment: Create a smoother experience for beneficiaries.

• Managed Care Support: Facilitate hands-off Enrollment for managed care organizations.

• Real-Time Language Assistance: Offer language support for program monitors and recipients.

• Bridging Access Gaps: Understand provider coverage and help address access-to-care issues.

• Beyond the Benefits: Risks and Considerations

While generative AI offers tremendous potential, we acknowledge the importance of responsible implementation. This session will explore:

• Cost Considerations: Addressing the cost of implementing and maintaining AI solutions.

• Risk Mitigation: Identifying and mitigating potential risks associated with AI use.

• Ethical Considerations: Ensuring fair and unbiased application of AI in State Health programs.

• Contractual compliance: While working with the vendor, understand their compliance in an automated way.

By openly discussing these considerations, we can unlock the full potential of AI for a more efficient and effective State Health administration.

This session will showcase an example of the Policy Genie, a GenAI-powered solution designed to search through policy documents, evaluate contractual compliance, and address ethical considerations during the implementation of GenAI. Additionally, we will walk through the testing methodology used to mitigate risks associated with the deployment of Generative AI.