Highmark Wholecare and Fortuna Health introduce state's first AI-enabled Medicaid renewal support

— New conversational phone-based support is designed to help eligible members navigate renewals, reduce administrative barriers, and maintain access to coverage.

PITTSBURGH (October 7, 2026) — Highmark Wholecare and Fortuna Health today announced plans to expand Fortuna’s Medicaid renewal support program in Pennsylvania to include AI-powered voice capabilities designed to help Wholecare members complete time-sensitive renewal steps and stay connected to Medicaid coverage.

The expanded collaboration builds upon Highmark Wholecare’s work with Fortuna to provide members with added support throughout the Medicaid renewal process. Fortuna’s platform helps identify members with upcoming renewal actions, reaches them through targeted reminders, and provides step-by-step guidance in plain language. When members need additional help, Fortuna connects them with live navigators.

The new AI-enabled phone support is intended to add another access point for members who may miss mailed notices, face long wait times on phone calls, have limited internet access or need help understanding what action is required. The conversational phone agent can remind members that their Medicaid renewal is due, explain deadlines and next steps, answer common renewal questions and route complex plan member cases to a live person.

The expansion comes as health plans, states and community partners prepare for federal Medicaid changes on Jan. 1, 2027. These changes will include more frequent eligibility checks as well as new work or community engagement requirements for beneficiaries enrolled in the Medicaid expansion program, raising the risk that eligible members lose coverage for administrative reasons. The federal government estimates that roughly 15% of all adults in the Medicaid expansion population may lose health coverage once the new rule is in effect, the majority of whom are people who can’t prove they meet the new eligibility requirements, or don’t return their Medicaid renewal forms in time.

“With Medicaid renewals, our focus is on access and making it easier for our members to understand what they need to do, when they need to do it and where to get help,” said Victor Fields, president, Highmark Wholecare. “By expanding our work with Fortuna and introducing responsible AI-enabled outreach, we can support members earlier and in ways that are more accessible to their daily lives.”

In Pennsylvania, Medicaid renewals are administered by the commonwealth’s Department of Human Services. Members receive renewal packets when it’s time to renew and may lose coverage if they do not complete and return required information by the due date. The Highmark Wholecare-Fortuna program complements these state processes by helping members recognize, understand, and act on their respective renewal requirements.

Fortuna’s AI-powered phone agent is not a robocall or automated voicemail. It’s designed to hold a responsive conversation, provide bilingual support, and hand off to human navigators when needed. The tool does not make eligibility decisions; it provides education, reminders, and navigation support under human oversight and with secure privacy safeguards for personal health information.

Measuring the results of thousands of renewals with AI-enabled contact support versus human contact support, Fortuna saw members who received AI-enabled support renew at a 9 percentage-point higher rate than those who only received human contact support.

“The members most likely to lose coverage are often those with the greatest burdens on their time. A father who works evening shifts, the caregiver of a disabled child," said Nikita Singareddy, co-founder and CEO of Fortuna Health. “We’re proud to expand our digital support with Voice AI and meet members, at more hours, in the language of their choice. Our aim is to provide guided support through the renewal process and decrease member burden, and we're proud to bring this work to more Pennsylvanians with Highmark Wholecare.”