Determined Care — Simplifying the Path to Coverage
Built by Medicaid Insiders

Simplifying the Path to Coverage — and the Care That Follows.

Determined Care automates redeterminations, SSI enrollment, and eligibility corrections — including helping members meet the criteria for dual-eligible and LTSS status.

Classification Status — Up to date
Medically-Frail Exception — Verified for renewal cycle
Acuity-Based Payment — Aligned to current care needs
Next Re-attestation — Automatically scheduled
Audience Split

For Individuals

Living with a serious health condition or disability? We help you get — and keep — the coverage you qualify for.

See how it works

For Health Plans & Providers

Caring for Medicaid or dually eligible members? We make sure you’re paid accurately for the care you deliver.

See how it works
For Individuals

Redetermination, Work Requirements, and SSI — Simplified.

Applying for disability or Medicaid coverage can feel like an uphill battle. That’s not a reflection of whether you qualify — it’s a broken process. We meet you where you are and simplify every step, so you don’t fall through the cracks.

Only 36% of disability claims are approved on the first try — most people only get there after appealing. That’s the gap we exist to close.

Path One

Already Approved for SSDI or SSI?

Your disability award already proves what Medicaid needs to know. We submit it directly on your behalf — no extra paperwork, no re-proving your condition.

Path Two

Need to Meet H.R. 1 Work Requirements?

If your health makes it hard to meet the new work-hour requirement, you may qualify as “medically frail” and be exempt. We build the proof your state requires, so redetermination doesn’t cost you your coverage.

One Connected System, Not Another Navigator Program.

A simple, human path to the coverage you’ve earned. No paper forms, no long hold times, no lost notices — just a clear path from application to approval, and someone to call if you ever want one.

Human First, Tech at Scale

We meet people where they already are — grocery stores, libraries, community clinics, food pantries, and shelters — and let AI-driven tools handle the process end to end, in your language, with a community health worker on standby whenever you want one.

Screened in Minutes

A short, guided check tells you which path applies to you — no complicated forms to start.

Never Miss a Deadline

Automatic reminders and re-attestation keep your coverage current — you don’t have to track the calendar yourself.

Whole Person

Coverage, care, and community resources, all in one path.

Built by Insiders

Healthcare professionals with lived experience — caring for the IDD population, medically frail seniors, and family who navigated SSI and Medicaid firsthand.

No one falls through the cracks.

For Health Plans & Providers

Compensation Based on the Most Accurate Level of Need.

Medicaid payments are often tied to how a member was classified at enrollment — and reimbursement doesn’t always keep pace as care needs evolve. We help states and health plans capture the clinical and consumer data needed to keep members connected to coverage, and keep payment matched to the care they need.

A June 2026 federal rule raised the bar for proving medically-frail status — self-attestation no longer qualifies, and every classification must be documented and re-verified on a fixed cycle.

1

Identify

Match claims & SSA data

2

Document

Build the file (frail path)

3

Submit & Reconcile

File and align payment

4

Re-attest

Every 3–6 months, by state

Health Plans

Payment that reflects your members’ real acuity, stronger compliance, and better member retention.

Providers

Fair reimbursement for the higher-acuity care you’re already delivering — without adding work to your team’s plate.

Common Questions

Common Questions.

Does this create risk-score or audit exposure?

The opposite. Every determination is backed by a documentation file built to the state’s own criteria — we’d rather stand behind fewer, well-supported members than a number that doesn’t hold up later.

Isn’t this what our payment-integrity vendor already does?

No. Payment-integrity review happens after a claim is paid. We work earlier in the cycle, changing the classification before the rate cell is set — different point, different data, no overlap.

How do you handle every state defining this differently?

That variation is the product, not a complication. We maintain a state-by-state library of criteria, forms, and timelines, and keep it current as rules change rather than reading them once.

Who handles member outreach and consent?

We do, directly, in the member’s own channel. Your team gets status updates, not a task list — and consent language is reviewed with your compliance team before any member is contacted.

What if Determined Care isn’t around in a few years?

A fair question for any early-stage partner. We’re only paid when payment is actually aligned, the documentation stays yours either way, and transition terms are written into every agreement up front.

Why not build this in-house?

Some plans should. The honest test is whether you’ll still be maintaining a state-by-state criteria library and a recurring re-attestation calendar for every member a few years from now — that’s usually where internal builds stop scaling.

Our Purpose

Vision, Mission, and Values.

Vision

We see our purpose as the power to change lives by ensuring no one loses coverage or care to a broken system, and every provider is paid fairly for delivering it.

Mission

To be the best and most innovative company at removing barriers to coverage and care.

Values

  • Integrity
  • Caring
  • Creativity
  • Joy
  • Determination
  • Trust
Our Leaders

Built by Medicaid Insiders.

Decades of combined healthcare leadership, earned across the nation’s largest payers, providers, and health systems — plus lived Medicaid experience. Four different paths into healthcare. One shared focus: making sure the most vulnerable get the coverage and care they’ve earned.

Denise Kajanoff

Chief Executive Officer

Denise is driven by one goal: making sure people get the coverage they’ve earned, the care they deserve, and real access to the resources that help them navigate a complicated healthcare system. She believes in surrounding people with the right resources and being part of the effort to help the most vulnerable gain access to high-quality, affordable care.

She spent over a decade at Optum and UnitedHealthcare, helping build the nation’s largest payment integrity organization and leading growth across Optum and UHC’s Employer and Individual, Military and Veterans, Medicaid, and Medicare businesses — work that led to her selection for UHC’s Executive Development Program at Stanford, and, more recently, recognition from the University of Phoenix as one of 76 leaders selected from a pool of more than one million for healthcare industry leadership.

She’s also a longtime community advocate, giving her time to organizations like PROVAIL — dedicated to ensuring people living with disabilities can live life on their own terms. She spent more than a decade on PROVAIL’s board, including as its first woman board chair, and has chaired the American Heart Association’s Circle of Red. After UHG, she built Cityblock Health’s Partner Success function, led behavioral health products at Evernorth (Cigna), and advised other healthcare startups working toward the same kind of change. Today she’s also the Washington Market President of Together Health, a primary care organization that serves communities and employers directly.

Tonya Copeland

Chief Operating Officer

Tonya has spent her career inside the exact populations and programs Determined Care serves: 14 years with Evergreen Life Services across home health, home care, and long-term services and supports, then senior leadership at UnitedHealthcare Tennessee as Vice President of Clinical Services for Complex Populations and Executive Director.

She went on to Managing Principal at Health Management Associates and Chief Growth Officer at Liberty Healthcare Corporation, where her work in IDD and LTSS assessment mirrors the functional-impairment documentation Determined Care builds today. A published author on the needs of individuals with intellectual and developmental disabilities and co-occurring mental health conditions, she also advises healthcare startups and growth-stage companies on Medicaid strategy — helping translate mission-driven ideas into sustainable businesses.

Melissa Reilly

Chief Strategy Officer

Melissa brings more than two decades of experience driving growth, innovation, and transformation across behavioral health, payer strategy, and healthcare delivery. Her career spans senior leadership roles at UnitedHealth Group, Aetna, and Evernorth Behavioral Health, where she served as Chief Growth Officer, leading enterprise strategy and business development to expand access to high-quality mental health care.

Melissa also founded STLTH CNSLTNG, an advisory practice focused on elevating healthcare startups, which she continues to lead alongside her role as Chief Strategy Officer at Determined Care. She holds a JD/MBA from Quinnipiac University.

Anna Hardeman

Chief Growth Officer

Anna’s growth career runs through the exact motion Determined Care’s go-to-market depends on: selling into health plans and state programs. She spent her early healthcare years at Optum advancing from Senior Analyst to Senior Consultant, then led product at Level2 before moving into Medicaid business development leadership as Director of Strategy & Solutions at UnitedHealthcare Community & State, then Managing Consultant at Bullard Advisory Group.

She went on to Director of National Payer Sales at Kinetik and, most recently, growth leadership at Thrive Mobile. Anna holds a BA in Political Science and International Relations from St. Catherine University, sits on the board of the Non-Emergency Medical Transportation Accreditation Commission (NEMTAC), and is a member of Women Business Leaders of the U.S. Health Care Industry.

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