MedicaidChain

The Second Channel.
Medicaid Eligibility on Chain.

A sibling to VitalChain Emergency Records, running on the same Hyperledger Fabric network in a separate channel. Real-time eligibility verification, employer directory, fraud detection, and an admin analytics suite.

Why a Second Channel

Two Regulated Domains, One Network

Emergency medical records and Medicaid eligibility verification are both HIPAA-regulated, but the access patterns are different. Emergency reads are urgent, short-lived, and role-scoped. Medicaid queries are longer-running, document-heavy, and governed by workforce compliance requirements. Fabric's channel abstraction lets us serve both from one permissioned network without letting workloads bleed into each other.

  • Dedicated medicaidchannel with its own chaincode and peer set
  • Shared orderers and CAs; shared TLS, audit, and monitoring stack
  • Independent deployment cadence; Medicaid upgrades do not require Emergency downtime
Eligibility Verification

Real-Time Eligibility, Answerable in Milliseconds

Medicaid eligibility is answered at the chaincode layer. A query from a provider or caseworker returns eligibility status, program codes, effective dates, and current restrictions as a single signed response. No screen-scraping state systems, no batch files, no overnight ETL. The recipient's on-chain record is the source of truth; edits are immutable and attributable.

  • Eligibility queries answered directly from state, no external service call required
  • Verification events logged on-chain with caller identity, timestamp, and requested scope
  • Effective date, program tier, and restriction flags surface in one response
Employer Directory

Employers, Work Hours, and Verification

Many Medicaid eligibility determinations depend on hours worked at a participating employer. MedicaidChain includes a first-class employer directory: employers register, certify their own payroll data flow, and submit work-hour reports on a regular cadence. Recipients and caseworkers can query the record directly. Disputes are recorded on-chain alongside resolutions.

  • Registered employer directory with status (active, suspended, under review)
  • Work-hour submissions signed by the submitting employer
  • Dispute trail with caseworker annotations and resolution timestamps
Fraud Detection

Anomalies Surfaced, Not Buried

Fraud detection on MedicaidChain is not a quarterly report; it is a dashboard that updates as transactions land. A rules engine and an anomaly detector flag suspicious submissions (duplicate hours across employers, impossible travel patterns, statistical outliers against peer cohorts). Each flagged event is routable to a caseworker with a one-click investigation drawer.

  • Severity-coded alerts with reason, affected recipient, and data points
  • Investigation drawer with status, notes, and assigned caseworker
  • Manual and automated scan triggers; Run Scan is one click
  • Filter by status, severity, alert type, or assignee
Analytics

A Dashboard Procurement Asks For

Every state Medicaid procurement asks the same analytics questions: eligibility distribution, work-hour trends, fraud patterns, and compliance posture. MedicaidChain answers them from an admin dashboard without requiring a custom report request. The data comes from the ledger, not a warehouse, so the numbers are current to the transaction.

  • Eligibility distribution across program tiers (pie chart, exportable)
  • Work-hour trends over rolling windows (area chart, filter by employer)
  • Fraud trend stacked by alert type (bar chart, time-series)
  • Compliance overview with open findings, remediated items, and trend direction
Recipient Portal

Recipients Can See Their Own Record

The recipient-facing portal mirrors the patient consent model of VitalChain Emergency Records: recipients see their eligibility status, work-hour submissions filed on their behalf, pending disputes, and the record of who has looked them up. Full access history, full transparency.

Evaluating Medicaid Platforms?

MedicaidChain runs alongside VitalChain Emergency Records or as a standalone channel. We will walk a state procurement team through the architecture and the admin console.

Schedule a Walkthrough Start a Pilot