Derin™ Medicaid Case Study

Understanding How Medicaid Shapes Decision-Making

Product: Derin™ 

Summary

Surgo Health leveraged its AI behavioral intelligence platform Derin to collect firsthand accounts from Medicaid beneficiaries on their experiences with the program. Medicaid surveys are  limited to high-level trends about patient satisfaction, concerns, and usage. Derin’s adaptive AI conversations revealed why people are satisfied, people’s frustrations with the program, and  a heterogeneity in how current beneficiaries respond to coverage gaps. Medicaid plays a wide-reaching role that extends beyond healthcare alone, and these findings reframe what Medicaid is and does today.

What Traditional Analyses Miss, and Why It Matters for Health Organizations

Traditional analyses can quantify the impact of policy changes, but they often miss how people experience and respond to them. By uncovering how beneficiaries make decisions, navigate barriers, and adapt to changing circumstances, Derin helps organizations:

• Design more effective policies and programs
• Anticipate unintended consequences of coverage changes
• Improve outreach and beneficiary engagement
• Identify emerging barriers before they appear in traditional metrics
• Make more informed resource allocation decisions

This behavioral intelligence helps organizations move beyond measuring outcomes to understanding the drivers behind them.

Challenge 

7.5 million Americans are projected to lose Medicaid coverage by 2034 due to recent funding cuts and new eligibility requirements, the largest reduction in the program’s history. Policy and healthcare leaders need more than enrollment statistics to navigate Medicaid cuts. They need to understand how coverage shapes beneficiary behavior across their lives. Anticipating the impact of these policy changes requires understanding the role the program plays in people’s day-to-day lives.

Approach

Derin was used to capture the lived experiences of Medicaid beneficiaries at a depth traditional surveys cannot reach. The AI-powered conversational interface is grounded in behavioral science and adapts to responses in real time, probing for detail, following emotional threads, and surfacing the behavioral logic behind respondents' choices. Conversations are then analyzed by Derin for themes, drivers, and segments.

Results 

1. A Foundation for Thriving

Medicaid provides a foundation for economic and personal wellbeing. Derin unpacks high Medicaid satisfaction rates by exploring what the program enables for beneficiaries. Medicaid is more than just a safety net: respondents describe their coverage as a foundation for career development, financial planning, and strong family relationships. 

90% are satisfied with the program

93% cited financial stability as a key benefit

85% reported peace of mind as a primary benefit

58% expressed an improved quality of life

I have less stress now. I don’t have to worry about medical bills. It lets me focus on my career goals and spend more time with my kids.

I'm able to address my long-term family planning as a result of Medicaid, which was something I didn't think I would be considering until I was in my 30s. I'm more secure in the ability to work and go to school.

2. The Eligibility Trap 

Medicaid’s current income and asset thresholds disincentivize behaviors that could lead to financial independence. Beneficiaries have to stay below specific income and asset thresholds to stay eligible for Medicaid, and low-wage and part-time jobs that don’t offer similar benefits are deprioritized by those who need good healthcare coverage.

70% worry about losing coverage

26% mentioned frustration with Medicaid’s eligibility criteria, the most commonly mentioned negative topic. 

I cannot apply for jobs that would cause me to lose Medicaid unless they are also offering equal coverage, which almost none are. I am trapped in a system I cannot improve my way out of, because any step up is going to cost more than the job would cover.

Turning down full-time jobs or promotions to stay under income limits feels like being punished for ambition. I skipped a coding bootcamp because losing coverage would've risked my mom’s insulin.

3. Managing Health Without Coverage 

Medicaid beneficiaries already know how they manage care when expenses aren’t covered. Some skip care, seek information online, try alternative treatments, or ration medications. Others say they would have to give up food or educational goals to pay for medications.

23% experienced delay when receiving care and describe a range of downstream adaptations as they balance their healthcare needs against competing financial priorities.

I was using expired or nearly expired inhalers before obtaining Medicaid. It felt awful and the effectiveness of the inhalers went down. At the end it was a question if they were helping at all.

Without [Medicaid], we'd sacrifice groceries for my heart pills.

See How Derin Turns Conversations Into Action

Move beyond what happened to understand why it happened. See how Derin uncovers the behaviors, motivations, and barriers that traditional analyses miss.

Talk to an expert and see Derin in action.