Healthcare Coverage · Medically Complex Children

The coverage engine for medically complex children.

Carob converts the hardest-to-enroll pediatric patients onto Medicaid — through disability pathways that self-service tools can't touch — and keeps their care covered through EPSDT. We work with the providers, pharmaceutical programs, and foundations who carry the cost when these children go uncovered.

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What We Do

Medicaid's most valuable patients are the ones it can't enroll.

Income-based Medicaid enrollment is now a five-minute self-service flow. The hard pathway — disability-based eligibility for medically complex children — remains manual, slow, and routinely skipped. A disabled child can qualify regardless of household income, but families can't self-assess "institutional level of care," so they never apply. Carob does the hands-on work of finding these children, assembling the evidence, and winning the case.

The Problem

Families don't know the child qualifies

Disability-based eligibility ignores parental income in many pathways — but the rules are opaque, state-specific, and impossible for a family to navigate alone. Eligible children simply never enter the system.

The Problem

Self-service tools solve the easy 80%

Modern enrollment tools handle income-based renewals in minutes. Complex conversions need evidence assembly, eligibility expertise, and appeals — work that a self-service flow cannot do.

The Problem

The cost lands on providers and pharma

Complex kids go uninsured or under-covered. Providers absorb uncompensated care, and six-figure therapies go unreimbursed — which is why institutions, not families, are our customers.

75%
of Medicaid disenrollments are procedural — not because someone became ineligible
~11M
people face new procedural hurdles under 2025 federal reform
$13B+
lost each year by providers to coverage churn and uncompensated care
Industry estimates, 2025.
Who We Serve · Beachhead

Providers

Hospitals, specialty centers, and FQHCs convert charity care into reimbursed Medicaid revenue — including the 90-day retroactive window.

Who We Serve · Expansion

Pharma patient-access programs

A converted patient is a reimbursed patient on a high-cost therapy. Compensation is fixed, fair-market-value, and drug-agnostic — never a share of drug revenue.

Who We Serve · Adjacent

Disease foundations

Disease-specific patient-services budgets fund coverage access for their own population of complex patients.

Product

Two engines: get complex kids covered, then keep their care covered.

Engine 1

Eligibility Conversion

We identify disabled and medically complex children in clinical and coverage data, and convert them onto Medicaid via income-disregarding disability pathways — TEFRA / Katie Beckett, 1915(c) HCBS waivers, and SSI-linked Medicaid.

Closes the coverage gap.
Engine 2

EPSDT Advocacy

Once a child is enrolled, we use the EPSDT mandate — which covers any medically necessary service for under-21s — to win coverage for therapies that plans deny. A recurring event for every child.

Turns the gap into a durable relationship.

How a conversion works, end to end

  1. 1

    Case-finding

    Surface eligible kids from clinical and coverage data (EHR / HIE).

  2. 2

    Pathway triage

    A rules engine maps each child to the right route by state and profile.

  3. 3

    Evidence assembly

    LLM-assisted documentation package with clinician and navigator sign-off.

  4. 4

    Submission

    File with the state, SSA, or waiver program; manage information requests.

  5. 5

    Appeals

    Contest denials through fair-hearing rights — often where the case is won.

  6. 6

    Activation + EPSDT

    Secure coverage for specific medically necessary therapies.

  7. 7

    Attribution

    A provable conversion record lets the provider bill recovered revenue.

Where we are today

Want a walkthrough of the conversion engine? Request a demo.

Team

Built for regulated-domain AI.

A

Alia

Founder & CEO

Cognitive science & HCI (Carnegie Mellon). MBA (Imperial College London). Engineering at Morgan Stanley — fixed-income derivatives and data pipelines.

D

Daniel Stambler

Technical Co-Founder

Engineer at Meta (NYC). NLP background from Johns Hopkins. Owns the data and model stack.

E

Elijah Genin

Finance & Operations

Wharton MBA. Private equity and finance/operations leadership. Owns the financial model, go-to-market motion, and capital.

Supported by part-time ML engineering, and clinical & academic advisors across pathology and critical-data research.

Incubator CMU Project Olympus
Community Partner MIT Critical Data
Accelerator NVIDIA Inception Program
Get in Touch

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