Current state
Business as usual
Doors 8
Retellings 10
Forms 10
days 61
Needs met 3/9
6 indignities experienced Detailed by stage in the journey below.
DCHS Insights CX Human-Centered Design @ DCHS PROTOTYPE no real data DCHS Insights CX Aboul & Hossina (post-HR1)
Separate HR1 household assumption. This exercise assumes no dependent child under 14. The workshop persona has three children, including a newborn in April 2025. These are independent scenarios, not the same household followed forward in time.
Future state
With service integration
Doors 3
Retellings 2
Forms 4
days 30
Needs met 7/9
3 indignities remain Structural constraints are still visible.
Profile
Aboul & Hossina (post-HR1)
One lawful-permanent-resident household must make earnings, renewals, and language access line up across records that still see two partial pictures.
Persona type Household
Engagement path Prospective HR1 impact: expansion Medicaid verification
Persona narrative
Who they are
Aboul and Hossina remain one household in their mid-thirties, facing a second eviction notice and $3,400 in arrears. This profile adds that both are lawful permanent residents enrolled in Virginia Medicaid Expansion, neither is pregnant, and they have no dependent child under 14. Aboul remains employed. The central uncertainty is whether household or spousal income can be matched and verified through an accessible process and whether twice-yearly renewals preserve the household view.
Voice
In their words
We were denied based on our old income, but we're earning less now.
Hossina can go at 2. Aboul has the English and is at work.
We need someone to see the household, not half of it.
What they are good at
- They act quickly when the notice arrives
- They divide labor to keep work and appointments moving
- They keep track of what they owe and how much help they still need
- They are persistent across multiple partial answers
What they are carrying
- Second eviction notice and $3,400 in arrears
- Prior-income rules that miss the present crisis
- Language access needs at every meaningful step
- A split between who has English and who has daytime availability
- Lawful-permanent-resident status and expansion Medicaid eligibility documentation
- Six-month Medicaid renewals beginning in 2027
- Aboul's earnings held in records that may not match the Medicaid household cleanly
What they hope for
- A real path to close the rent gap
- A household plan, not separate adult fragments
- Interpretation without having to prove they need it
- A renewal process that recognizes household income without shifting the burden to Hossina
What they would never volunteer
- That sleeping in the car has already happened
- How much the appointment time forces Hossina to carry alone
- How little the denial explanation makes sense in English, let alone Amharic
Open as a poster, without the site chrome →
HR1 impact map · prospective · policy checked September 17, 2026
What HR1 asks of Aboul & Hossina — and why it has to see the whole household.
Both adults are lawful permanent residents enrolled in Virginia Medicaid Expansion. Neither is pregnant, there is no child under 14, and Aboul is employed. Virginia's guidance lets household or spousal income satisfy the new requirement for both — if the records that hold that income can be matched to the household that holds the coverage. Whether they can is the research question this profile exists to ask.
- The rule
- Why it reaches Aboul & Hossina
- What it does
- Determination pending
-
CMS issues the community-engagement rule, with its verification and exclusion tests
0102 -
Eligibility changes for non-U.S.-citizen adults take effect; lawful permanent residents remain eligible
04 -
Six-month Medicaid renewals begin
03 -
Community-engagement requirement applies
01 -
The second renewal of the year — and the same match, again
03
01 Jan 2027
Medicaid expansion adults must show 80 hours a month — or about $580 in earnings. Household or spousal income can count under current Virginia guidance.
42 CFR 435.554 · Virginia applies it January 2027 Income match undetermined
Both are expansion adults with no exemption in this profile: no pregnancy, no child under 14. Aboul's earnings should cover the household — if his employer's records, his name, and the Medicaid household identifier line up.
The household must prove that its own records belong together. If the match fails, the risk is not only a lapse: Hossina could be asked for a separate 80-hour showing she was never meant to owe.
- Coverage for both adults
- One household
02 Sept 2026
Affected households are notified of the new requirement by the end of September 2026.
DMAS · September 2026The notice arrives in English while Aboul is at work. Hossina can act during the day but cannot confidently read what action is required.
The household clock starts before interpretation is arranged — and every later step divides the same way: the English is at work, the daytime is at home, and the portal, the call queue, and the counter each want both.
- Language and time
- One household
03 Jan 2027 →
Expansion Medicaid eligibility is redetermined every six months instead of every twelve.
Federal floor Dec 31, 2026 · Virginia renewals from Jan 1, 2027Two renewals a year, each restarting the same income match and the same interpretation request.
Twice the mail they cannot parse, twice the divided labor, and twice the chance a mismatch becomes a request, a delay, or a lapse — while the next renewal is already approaching and the eviction notice has not gone away.
- Coverage for both adults
- Language and time
- The reason they came
04 Oct 2026
Medicaid eligibility ends for several humanitarian immigration categories. Lawful permanent residents remain eligible.
Effective October 1, 2026 Verification path undetermined
They remain eligible — but their LPR documentation now has to be verified, and their household record has to show it.
One more category to prove, in a process where citizenship category, coverage group, and activity rules already blur together across separate notices.
- Coverage for both adults
Coverage for both adults
Expansion Medicaid that a mismatch can lapse
One household
Being seen whole instead of as two partial records
Language and time
Amharic access, and the split between who has the English and who has the daytime
The reason they came
A second eviction notice and $3,400 in arrears that do not wait for a renewal cycle
We need someone to see the household, not half of it.
Where DCHS can change the experience
DCHS makes these determinations under federal and state rules it did not write and cannot change. These levers make the process one accessible household task; they do not change what the rule asks.
- Book the interpreter with the notice
Accessible outreach in the household's preferred channel, with the renewal date visible to both adults and an interpreter booked before the clock matters.
Acts on 010203 - Match before asking
Attempt authorized income matching first, explain what household or spousal income can count, and request only the evidence that remains unresolved — no invented requirement for Hossina.
Acts on 0104 - One household task
One interpreted appointment records consent, connects wage evidence to the household record, and confirms what the receiving system accepted.
Acts on 0102 - Status, not silence
A shared renewal view distinguishes submitted, matched, accepted, and still pending, with accessible outreach before any adverse action.
Acts on 0304 - Start the next one further along
The next renewal reuses what remains valid, so the household is not asked to prove the same thing twice a year.
Acts on 03
Business as usual
Business as usual
The current experience across six stages, including its human cost and the indignities created along the way.
Stage
1. Notice Received
a household receives an English notice
a household receives an English notice
2. Applicability Understood
LPR and expansion status made explicit
LPR and expansion status made explicit
3. Proof Gathered
income should count if it can be matched
income should count if it can be matched
4. Proof Submitted
one accessible household task
one accessible household task
5. Renewal Decision
match success is the research question
match success is the research question
6. Coverage or Navigation
repeatable, not one-time
repeatable, not one-time
What happens
An English renewal notice arrives while Aboul is at work. Hossina can attend during the day but cannot confidently interpret the action required.
The household must distinguish continued LPR eligibility from the new work-requirement and renewal questions that apply to expansion adults.
Aboul's work may satisfy the household-income route, but pay records, names, and household identifiers may not match automatically. Hossina should not be assumed to owe a separate 80-hour showing.
Portal prompts and office appointments divide the task: Hossina has daytime availability; Aboul has the English and wage documents.
A mismatch can create a request, delay, or lapse even when qualifying household earnings exist. The same risk returns at the next six-month renewal.
If coverage lapses, the household must find appeal, restoration, or medical-navigation help while the next renewal is already approaching.
Where
Home mail and portal
Separate notices and assistance calls
Employer records, portal, and home files
Portal, call queue, and counter
Eligibility system
Appeal and navigation channels
Feeling
Concerned
Uncertain which rule is decisive
Split between two records
Forced to work in halves
Fragile
Tired of restarting
Cost
The household clock starts before interpretation is arranged
Citizenship category, coverage group, and activity rules blur together
The household must prove that its own records belong together
Duplicate uploads and interpretation delays
Administrative churn repeats twice a year
Another cycle of divided labor
Indignities
Experience
Business as usual vs Integrated
Business as usual Integrated
How coordinated service delivery changes the same six-stage experience while keeping unresolved constraints visible.
Stage
1. Notice Received
a household receives an English notice
a household receives an English notice
2. Applicability Understood
LPR and expansion status made explicit
LPR and expansion status made explicit
3. Proof Gathered
income should count if it can be matched
income should count if it can be matched
4. Proof Submitted
one accessible household task
one accessible household task
5. Renewal Decision
match success is the research question
match success is the research question
6. Coverage or Navigation
repeatable, not one-time
repeatable, not one-time
Business as usual
Concerned
An English renewal notice arrives while Aboul is at work. Hossina can attend during the day but cannot confidently interpret the action required.
Uncertain which rule is decisive
The household must distinguish continued LPR eligibility from the new work-requirement and renewal questions that apply to expansion adults.
Split between two records
Aboul's work may satisfy the household-income route, but pay records, names, and household identifiers may not match automatically. Hossina should not be assumed to owe a separate 80-hour showing.
Forced to work in halves
Portal prompts and office appointments divide the task: Hossina has daytime availability; Aboul has the English and wage documents.
Fragile
A mismatch can create a request, delay, or lapse even when qualifying household earnings exist. The same risk returns at the next six-month renewal.
Tired of restarting
If coverage lapses, the household must find appeal, restoration, or medical-navigation help while the next renewal is already approaching.
Integrated
Prepared
The household receives accessible outreach and a booked interpreter, with the renewal date visible to both adults.
Oriented
A household screen records LPR status, coverage group, known exemptions, income sources, and which items still need determination.
Recognized
Staff attempt authorized data matching first, explain what household or spousal income can count, and request only the evidence that remains unresolved.
Workable
One interpreted appointment records consent, connects wage evidence to the household, and confirms what the receiving system accepted.
Able to respond
A shared status view distinguishes submitted, matched, accepted, and still pending, with accessible outreach before adverse action.
Held as one household
The household receives accessible renewal support and any alternative medical-navigation referral is tracked through contact, enrollment, and service received.
Indignities
Removed 0
noneRemaining 2
Removed 1
Remaining 1
Removed 2
Remaining 1
Removed 1
Remaining 1
Removed 0
noneRemaining 2
Removed 0
noneRemaining 2
Change
Shift
The household clock starts before interpretation is arranged -> One household deadline
Shift
Citizenship category, coverage group, and activity rules blur together -> The unknowns are named instead of inferred
Shift
The household must prove that its own records belong together -> No invented requirement for Hossina
Shift
Duplicate uploads and interpretation delays -> One household proof packet
Shift
Administrative churn repeats twice a year -> Mismatch has an owner and a deadline
Shift
Another cycle of divided labor -> The next renewal begins with reusable evidence
Experience
Current system
Fragmented touchpoints
Each service can do its own work while the person is left to carry the thread between them.
Touchpoint sequence
01 English renewal notice
02 Aboul's employer records
03 Hossina's daytime appointment
04 Medicaid household record
05 Portal
06 Interpretation request
Continuity breaks
Where the thread drops
01
Work evidence and household record may not match
02
Language access arrives after the task starts
03
Six-month renewal repeats the mismatch risk
04
Two adults are seen as partial records
Integrated system
Coordinated service path
Shared context and explicit handoffs reduce the work required of the person without hiding constraints the system cannot remove.
Touchpoint sequence
01 Accessible household notice
02 Booked interpreter
03 Authorized income match
04 Household proof packet
05 Shared renewal status
06 Closed-loop navigation
Continuity improves
What changes
01
Household or spousal income is assessed without inventing a separate work duty
02
Only unresolved evidence is requested
03
Submission, match, and acceptance stay distinct
04
The next renewal reuses what remains valid