The Exemption Machine: the Medicaid work requirement business nobody has built, why it fits a $5M preseed and a $25M seed, and the contract by contract plan to get there before January 1, 2027

Starting Jan 1, 2027, ~18.5 million Medicaid expansion adults must prove 80 hours/month of community engagement or a medical exemption or lose coverage. Federal projections put disenrollment in the millions. Most of those losses are paperwork failures, not job gains.

States assumed they could automate exemptions with a diagnosis code sweep. A federal int…