Open Arsenal

Transforming Medicaid to Medicare with Intelligence

MedIQ is an open-source AI platform designed to seamlessly transition verified U.S. citizens from Medicaid to Medicare through fully automated, secure, and intelligent workflows. Built with a federated, state-by-state architecture, MedIQ connects to government systems, identity verification services, and healthcare data sources to ensure that every transition is accurate, compliant, and efficient. Its core mission—Transforming Medicaid to Medicare with Intelligence—is realized through a combination of automation, advanced analytics, and rigorous security standards.

At the heart of MedIQ is a powerful AI-driven eligibility and decision engine that evaluates each citizen’s history, current status, and eligibility across all Medicare programs (Part A, B, C, D, and Medicare Savings Programs). The system integrates KYC protocols, Real ID verification, SSN validation, and EVVE (Electronic Verification of Vital Events) to confirm identity and citizenship with high confidence. Once verified, MedIQ automates the transition process end-to-end, minimizing delays, eliminating manual errors, and ensuring that eligible individuals are enrolled in the correct programs without gaps in coverage.

A defining feature of MedIQ is its fraud, waste, and abuse detection system, which uses machine learning and anomaly detection to identify irregular patterns in Medicaid service history or enrollment behavior. When anomalies are detected, the platform generates full investigative audit reports, complete with historical service data and explainable AI insights for both citizens and auditors. These reports are tamper-evident and designed to meet federal and state compliance requirements, providing transparency and accountability at every stage.

Security and privacy are foundational to MedIQ’s design. The platform implements end-to-end encryption, Zero Trust architecture, FIPS-140-3 compliant cryptography, and role-based access controls to protect sensitive data. Its federated data model ensures that states retain control over their data while still enabling coordinated intelligence across systems. Additionally, MedIQ includes simulation and predictive analytics tools, allowing agencies to model budget impacts, forecast enrollment trends, and evaluate fraud prevention strategies without exposing real citizen data.

Through its combination of automation, verification, intelligence, and transparency, MedIQ is more than a transition tool—it is a next-generation public infrastructure platform that empowers governments to deliver healthcare benefits more effectively while safeguarding taxpayer resources and ensuring every eligible citizen receives the coverage they deserve.